Category Archives: Mental Health

Guns and drugs: Psychoactive drugs may impact mass shootings

drugs

washingtontimes.com | Jan 15, 2013

byDr. Lind by Peter Lind

OREGON, January 16, 2013 – A few weeks before the Newtown school shooting there was a mall shooting in Oregon. That shooting ended when a civilian pulled out his own gun and drew it on the killer. When the killer saw him, he turned his gun on himself and the ordeal was over. Two dead, seven injured, and over 69 shots fired. Chances are you didn’t hear about this. Chances are you didn’t hear about many shootings that take place across the country.

You may also not have heard that many of the shooters in these cases have a history of taking psychoactive drugs, used to treat a variety of mental illnesses from depression to Schizophrenia.

As American politicians look at gun laws, they cannot ignore the growing observable evidence of prescription medications in the majority of the mass shootings.

The Newtown School shooter reportedly took the pharmaceutical drug Fanapt, made by Novartis Pharmaceuticals Corporation. Fanapt is prescribed to treat schizophrenia in adults, according to the drug company’s literature. Fanapt was approved by the FDA after two short-term research trials: a four week and a six week trial.

Side effects listed in the literature that accompanies Fanapt notes the following: Fanapt can cause “arrhythmia and sudden death – consider using other antipsychotics first.”

Other side effects of Fanapt include suicide, along with hostility, aggression, mania, a confused state, along with problems with impulse control. Fanapt can also cause seizures, erectile dysfunction, high blood pressure, and low blood sugar.

Frequent side effects of Fanapt include restlessness, aggression, and delusion. Fanapt can also cause hostility, paranoia, anorgasmia, confusional state, mania, catatonia, mood swings, panic attack, obsessive-compulsive disorder, bulimia nervosa, delirium, polydipsia psychogenic, impulse-control disorder, and major depression.

Novartis and the FDA state that this drug has not been safely tested on young people. According to Novartis, “Safety and effectiveness in pediatric and adolescent patients have not been established.”

There is evidence that suggests prescription medication may play a role in mass shootings.

Documents show that 109 people have been wounded and 58 killed in recent shootings where the shooters were taking psychotropic drugs. The FDA has reports of 11,000 incidents of violence resulting from these drugs between 2004 -2011, including 300 homicides, representing less than 10% of actual incidents.

Psychology Today, January 5, 2011 describes this problem in detail. Of the 1937 total case reports of violence toward others by individuals taking psychotropic drugs, there were 387 cases of homicide, 404 physical assaults, 27 cases of physical abuse, 896 reports of homicidal ideation, and 223 cases of “violence related symptoms.”

The adverse events reported to the FDA are known to represent but a tiny fraction of all such adverse events. This study simply identified 31 drugs responsible for most of the FDA case reports of violence toward others, with antidepressants near the top of that list.

The many past shootings at school campuses and other public venues should be investigated by government officials concerning whether psychotropic drug use may have been involved in the case.

Moore and his collaborators concluded: “These data provide new evidence that acts of violence towards others are a genuine and serious adverse drug event that is associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine and serotonin reuptake inhibitors were the most strongly and consistently implicated drugs.”

Selective Serotonin Reuptake Inhibitor (SSRI’s) appear particularly dangerous. SSRI’s raise not only serotonin levels but also potentate the activity of epinephrine, norepinepherine, and in some cases dopamine. These are neuro-active substances that are part of the catecholamine family.

People who use Prozac and other SSRI drugs are five times as likely to commit suicide than if they took no medication at all.

These drugs can cause helplessness, apathy, aggression, and sedation.

Serotonin elevating drugs are prescribed for stress related emotional conditions, yet the evidence is that serotonin is already too high in people suffering from emotional stress. This is because stress liberates free fatty acids from storage, which, in turn, increases the uptake of tryptophan into the brain, increasing the formation of serotonin.

A record of violence has clearly been associated with above average blood serotonin levels.

Politicians, it is time to look at the psychoactive medications use and abuse in America.

Dr Peter Lind practices metabolic and neurologic chiropractic in his wellness clinic in Salem, Oregon. USA. He is the author of 3 books on health, one novel, and hundreds of wellness articles. His clinical specialty is in physical, nutritional, and emotional stress.

 

For more health tips go to http://www.wellnessreport.net

Advertisements

Vaccine Court Awards Millions to Two Children With Autism

“The hatred from the medical community towards families like ours is intense.”

huffingtonpost.com | Jan 14, 2013

by David Kirby

About 1 million children in the United States and about 30 million worldwide have gotten Rotarix vaccine, the FDA says.

The federal Vaccine Injury Compensation Program, better known as “vaccine court,” has just awarded millions of dollars to two children with autism for “pain and suffering” and lifelong care of their injuries, which together could cost tens of millions of dollars.

The government did not admit that vaccines caused autism, at least in one of the children. Both cases were “unpublished,” meaning information is limited, and access to medical records and other exhibits is blocked. Much of the information presented here comes from documents found at the vaccine court website.

Some observers will say the vaccine-induced encephalopathy (brain disease) documented in both children is unrelated to their autism spectrum disorder (ASD). Others will say there is plenty of evidence to suggest otherwise.

What’s more, these cases fit the pattern of other petitions, (i.e., Poling and Banks) in which the court ruled (or the government conceded) that vaccines had caused encephalopathy, which in turn produced permanent injury, including symptoms of autism and ultimately an ASD diagnosis.

And most of these children now have taxpayer dollars earmarked for applied behavioral analysis (ABA), an effective therapy specifically designed to treat ASD.

Meanwhile, parents, grandparents, friends and neighbors of both children testified they were developmentally normal, if not advanced for their age when they developed seizures, spiking fevers and other adverse reactions to their vaccines. According to these eyewitnesses, the children never fully recovered, and instead began losing vocabulary, eye contact and interest in others around them, all classic symptoms of regressive autism.

In the first case, involving a 10-year-old boy from Northern California named Ryan Mojabi, the parents allege that “all the vaccinations” received from 2003-2005, and “more specifically, measles-mumps-rubella (MMR) vaccinations,” caused a “severe and debilitating injury to his brain, described as Autism Spectrum Disorder (‘ASD’).”

The parents, who did not want to be interviewed, specifically asserted that Ryan “suffered a Vaccine Table Injury, namely, an encephalopathy” as a result of his MMR vaccination on December 19, 2003.” (“Table injuries” are known, compensable adverse reactions to immunizations.)

Alternatively, they claim that “as a cumulative result of his receipt of each and every vaccination between March 25, 2003 and February 22, 2005, Ryan has suffered . . . neuroimmunologically mediated dysfunctions in the form of asthma and ASD.”

In vaccine court, the U.S. Department of Health and Human Services acts as the defendant and Justice Department attorneys act as counsel.

In 2009, Ryan’s case was transferred to vaccine court’s Autism Omnibus Proceedings, according to the docket. A year-and-a-half later, the government conceded that MMR vaccine had indeed caused Ryan’s encephalopathy.

HHS agreed that “Ryan suffered a Table injury under the Vaccine Act — namely, an encephalitis within five to fifteen days following receipt,” of MMR, records show. “This case is appropriate for compensation.”

Whether HHS agreed with Ryan’s parents that his vaccine-induced brain disease led to ASD is unknown. The concession document is under seal.

In December 2003, when Ryan was nearly two, he received his first MMR and hepatitis B vaccines before his family left for an extended trip overseas. That day, his mother testified, Ryan began shaking with uncontrollable tremors and “was really uncomfortable, he didn’t feel well at all.”

The nurse at Ryan’s pediatrician said the symptoms were “pretty normal after the vaccination,” and advised Tylenol. The next day, Ryan began crying, “but it’s not a normal crying,” his mother testified. “He didn’t go to sleep, he was without energy.”

The family considered postponing their holiday, but that wasn’t feasible. The doctor’s office said it was fine to travel. Prior to leaving, Ryan’s mother said, the boy had difficulty breathing and “was without energy and sleepy.” He could no longer hold his head up, something “he could do prior to the vaccinations.” At the airport, Ryan began “screaming,” she recalled. “He was just opening and closing his eyes so hard, he was pulling my hair.”

After his shots, she added, Ryan “stopped saying those words that he had, even mommy and daddy, that he had repeated a hundred times before.”

In early January, while still abroad, Ryan was rushed to the hospital with vomiting, high fever and red spots covering his body “from head to toe in a measles-like rash,” the attending physician said. Ryan was diagnosed with “febrile convulsion, probably related to MMR.”

The next day, another doctor diagnosed him with “high fever, skin rash, tremors, and lethargy,” which were “most likely due to an adverse reaction to multiple vaccines he received earlier.”

Two days later, Ryan returned to the hospital with a persistent fever of 104 or more.

Ryan’s parents testified that, upon returning home, they expressed worry to their pediatrician about behavioral problems, non-responsiveness and language loss, which later produced an ASD diagnosis.

At trial, however, the government argued powerfully that written medical records, and the recollections of Ryan’s doctor, were inconsistent with his parents’ testimony. If Ryan had truly suffered an MMR encephalopathy, for example, his family would never have taken him overseas. And his parents’ complaints of ASD symptoms were raised a full year after returning from abroad, they alleged. It looked like the family had a weak case.

But then something changed.

In October, 2010, Ryan’s attorney filed four new exhibits (under seal) and proposed amending the court’s “findings of fact.” In January and May of 2011, several more exhibits were filed, along with a motion to further supplement the findings of fact.

A month later HHS conceded the case, which moved into the damages phase.

Award details were announced a few days ago: A lump sum of $969,474.91, to cover “lost future earnings ($648,132.74), pain and suffering ($202,040.17), and life care expenses for Year One ($119,302.00),” plus $20,000 for past expenses.

Another undisclosed sum, several millions more, will be invested in annuities to cover yearly costs for life, which could total $10 million or more, not accounting for inflation. Nearly $80,000 was earmarked for ABA in the first two years.

The second case involves a girl named Emily, whose mother, Jillian Moller, filed back in 2003 and has been fighting in vaccine court since. The docket, crammed with 188 items, documents Moller’s extended but victorious struggle to win compensation for Emily, who has seizure disorder and PDD-NOS, a form of ASD.

Moller alleged that Emily was severely injured by a reaction to the DTaP vaccine at 15 months (when MMR, HiB and Prevnar were also given). “She had a vaccine reaction and she just spiraled out of control,” Moller said in an interview.

Emily’s fever spiked to 105.7 and she began screaming. She stared blankly and developed seizures. Before long she began “shaking episodes” at night and “repetitive behaviors, including arm flapping and spinning,” court documents show. Like Ryan, she developed a measles-type rash.

Things went from bad to worse. Emily’s medical record is filled with damage and suffering. One neurologist, for example, noted that Emily “had staring spells and an abnormal EEG.” Another diagnosed “encephalopathy characterized by speech delay and probable global developmental delay that occurred in the setting of temporal association with immunizations as an acute encephalopathy.”

Moller filed for an encephalopathy Table injury in 2003, unaware her daughter would be diagnosed with ASD.

Two hearings were held in 2005. “I was badgered and harassed for four hours on the stand,” she said. “They said Emily couldn’t have been that sick, or else I would’ve taken her to the ER. But I took her to my doctor and he said not to bring her to the hospital!”

Government lawyers insisted that Emily had suffered neither a vaccine injury nor encephalopathy. But every alternative cause they suggested “made no sense, because she showed no signs of those things before that vaccination,” Moller said.

The case dragged on for years, with motions and counter-motions, status reports and expert medical reports. In 2007, Moller filed for summary judgment. That also took years, as more medical records were submitted to bolster Emily’s case.

After the ASD diagnosis, the judge reportedly became convinced that Emily would prevail. “My attorney said she was angry, she felt forced into a corner with no choice but to find for us,” Moller said. “She said, ‘Emily has autism, and I don’t want to give other families who filed autism claims any hope.'”

The government agreed to settle. Last spring the case went into mediation and, on December 3 HHS made its proffer, which was entered into the record on the 28th. Emily was awarded a lump sum of $1,030,314.22 “for lost future earnings ($739,989.57), pain and suffering ($170,499.77) and life care expenses for Year One ($119,874.88) plus $190,165.40 for past expenses.” Some of that money will go to ABA therapy.

Based on the first year payout, another estimated $9 million will buy annuities for annual expenses through life, which after inflation has the potential to pay over $50 million dollars.

HHS did not admit that vaccination caused encephalopathy or autism, but merely decided not to dedicate more resources to defending the case.

“I don’t understand why they fought so hard,” Moller said. “We had the evidence: the EEG, the MRI, everything was consistent with encephalopathy, post-vaccination. How can government attorneys claim what our doctors said happened, didn’t happen?”

Perhaps the feds were loath to concede yet another vaccine case involving autism. Four cases in the Autism Omnibus Proceedings were recently compensated. Three of those cases are marked with asterisks, indicating the government did not conclude that autism can be caused by vaccines. But the fourth autism case that was paid out in 2013 (Ryan’s case? We don’t know) has no such caveat.

As for Emily, she is “not too good,” Moller said. “Her emotional state is fragile, at best. She has seizure problems and autoimmune issues… And it’s a constant fight when you have a vaccine-injured child. It’s not just the disability, it’s the ignorance. The hatred from the medical community towards families like ours is intense.”

Meanwhile, as HHS says it “has never concluded in any case that autism was caused by vaccination,” it is still underwriting autism treatments such as ABA for children in its vaccine-injury program.

Gaza children haunted by nightmare of Israeli bombardments bear psychological scars

MIDEAST HAMAS
Young boys pick through the ruins of a bombed building in the Gaza Strip in November during the latest round of violence between Israel and Hamas. (Washington Post file)

In Gaza Strip, children bear psychological scars of conlifct

Washington Post | Jan 5, 2013

By Abigail Hauslohner

GAZA CITY — Fatima still dreams about Ahmed. Sometimes, they’re playing with toys as they used to do. But in other dreams, she’s looking over the edge of the balcony at her brother’s smashed and bloodied body, her father screaming through his tears.

Ahmed was 7 when he was killed by an Israeli airstrike during the 2008 Israeli invasion of Gaza. Fatima was 8 years old at the time — but “old enough to remember,” said her father, Osama Mohamed Qurtan.

Four years later, Fatima has been through therapy. She has taken what her father calls “strong” medications to manage the flashbacks. The new apartment is darker and more cramped than the old one, but the Qurtans needed to get away from the scene of the trauma, the doctors said.

Fatima’s listlessness and aggression had started to improve, Qurtan said — until war struck again in November.

Gaza’s Children Haunted by Nightmare of War

Besides killing our children in Gaza, a great number of Palestinian children in Occupied Jerusalem and the West Bank get arrested by Israel each year

This time, the explosions felt just as personal as they did the last, the possibility of death just as likely. When Israeli airstrikes rattled the buildings for a week during the Jewish state’s latest confrontation with Hamas, the eight surviving Qurtan children hid in the stairwell, as Gaza schools have taught children to do.

Gazans often talk about the inescapability of war and the symptoms of their suffering. They cast Gaza as a prison — one physical and psychological, where Israeli bombardment comes every so often, and there is little to do but bear it.

There are few places in the Arab world where psychology and trauma are as openly discussed as they are in Gaza. But health professionals here argue that there are few places in the region that contain a population so traumatized, a youth so obsessed with conflict.

Every day on his return home from school, Ahmed Qurtan’s cousin and best friend Zohair sees a banner bearing a portrait of himself, bloodied and bandaged. Hanging next to it, on a wall in the entryway to the family’s building, is a similar portrait of Ahmed in his funeral shroud. Zohair used to be much smarter and more active before suffering a head injury in the same airstrike, said his father, Alaa Mohamed Qurtan.

“He’s not normal now,” the man said.

Psychologists say that few in Gaza would qualify as “normal.” The cramped territory has operated under an Israeli-enforced blockade that has limited the flow of goods and people since the militant group Hamas won an election in 2006. The enclave’s 1.7 million people, half of whom are under the age of 18, have endured two wars in the span of four years. Nearly everyone in Gaza knows someone who has died a violent death.

No one in Gaza wants a return to occupation. But the absence of interaction between Gazans and Israelis has left the younger generation with a different perspective.

Issam Younis, director of the Al-Mezan Center for Human Rights in Gaza City, says he and his peers still have some Israeli friends. “We still speak Hebrew,” he said.

“But those young guys, they’re a little bit different from their parents. And the Israelis created them that way,” Younis said. “Those guys — the people under 20 — their only engagement with the Israelis is through the Apache and the F-16.”

British government seeks a million ‘Dementia Friends’


Britain is seeking a million “dementia friends” who will be trained to understand the illness and help those living with it, Prime Minister David Cameron announced Thursday.

A quarter of hospital beds are already occupied by someone with dementia. Number of people with dementia is expected to double in the next three decades.

latimesblogs.latimes.com | Nov 8, 2012

Britain is seeking a million “dementia friends” who will be trained to understand the illness and help those living with it, Prime Minister David Cameron announced Thursday.

The plan is one of a host of measures aimed at dealing with dementia as the country braces for the side effects of longer lifespans. British government officials say a quarter of hospital beds are already occupied by someone with dementia; the number of people with dementia is expected to double in the next three decades.

Related

Shaken Troops Face New Foe: Early Dementia

Electronic tags to track dementia patients

Alzheimer’s cases may quadruple by 2050

Dementia drugs killing off many of the elderly

Psychiatrist hails GPS tracking for dementia patients as ‘major breakthrough’

Dementia sufferers should be “put down” as they have “a duty to die” claims British aristocrat

“There are already nearly 700,000 sufferers in England alone but less than half are diagnosed and general awareness about the condition is shockingly low,” Cameron said.

The British numbers mirror global trends that are putting new pressures on health systems and families worldwide, as better healthcare leads to longer lives and more cases of ailments associated with aging.

Earlier diagnosis of dementia can help patients find ways to cope with the illness and reduce costs for care, health researchers have found, but stigma often steers people away from diagnosis.The World Health Organization estimates that even in wealthy countries, only 20% to 50% of cases are routinely recognized.
“Through the Dementia Friends project we will for the first time make sure a million people know how to spot those telltale signs and provide support,” Cameron said.

The program is modeled on a similar effort in Japan, which faces a dramatically aging population. By 2015, the British government aims to recruit 1 million Dementia Friends through free “awareness sessions.” Participants will get forget-me-not badges to show they are knowledgeable about dementia.

“We’ll equip you with an understanding of dementia and how you can help, and the rest is down to you,” the newly launched Dementia Friends website says.

The effort will cost roughly $3.8 million. Besides launching the Dementia Friends program, Britain will also spend nearly $80 million to design better facilities and devote more than $15 million to expanding a biobank with thousands more brain scans to research why people develop dementia.

One death-a-day: Military suicides reach terrifying rate


US soldiers (Mark Wilson/Getty Images/AFP)

RT | Jun 8, 2012

More US soldiers are losing their lives to suicide than from enemy forces, the Pentagon reports this week.

According to findings released on Thursday by the US Department of Defense, the suicide rate for active duty soldiers so far in 2012 is around one per day. In just the first 155 days of the year, 154 soldiers have committed suicide, a statistic only made more ghastly by comparing it to the number of American troops killed by insurgency this year — the website iCasualties.org reports that only 139 US soldiers died in battle this year.

“We are very concerned at this point that we are seeing a high number of suicides at a point in time where we were expecting to see a lower number of suicide,” Jackie Garrick, head of the Pentagon’s newly established Defense Suicide Prevention Office, tells the Associated Press.

In analyzing the report, the AP notes that the suicide rate among active-duty soldiers has plateaued in the preceding two years, creating confusion for researchers caught off guard by the alarming numbers released this week. Even with the Iraq War officially over and the Obama administration promising an expedited end to its military operations in Afghanistan, troops are taking their own lives in shocking numbers. Dr. Stephen N. Xenakis, a retired Army brigadier general and a practicing psychiatrist, explains to the AP that the latest figures aren’t all that surprising to him, though.

“It’s a sign in general of the stress the Army has been under over the 10 years of war,” says Dr. Xenakis. “We’ve seen before that these signs show up even more dramatically when the fighting seems to go down and the Army is returning to garrison.”

A separate study published in 2011 revealed that the rate of attempted suicide among all US soldiers — both active-duty personnel and veterans — is around 18-per-day. Many have suggested that dire economic times awaiting returning soldiers exiting the battlefield have driven many veterans over the edge even after war.

After losing a friend and fellow US war vet to suicide last year, vet Matthew Pelak told the AP, “We know we have a problem with vets’ suicide, but this was really a slap in the face.”

The Pentagon’s latest report takes into account suicide data from the first of the year through June 3, 2012. Compared with the same span of time one year earlier, there has been an 18 percent increase in suicides already; the January-May total, adds the AP, has gone up 25 percent from two years prior.

The tally of those that did take their own life between 2005 and 2009 — 1,100 — comes close to exceeding the number of military personnel killed in Afghanistan in nearly a decade.

 

DARPA creates “virtual humans, programmed to appear empathetic” for soldiers with PTSD

telepresenceoptions.com | Apr 26, 2012

by Katie Drummond

The Pentagon hasn’t made much progress in solving the PTSD crisis plaguing this generation of soldiers. Now it’s adding new staff members to the therapy teams tasked with spotting the signs of emotional pain and providing therapy to the beleaguered. Only this isn’t a typical hiring boost. The new therapists, Danger Room has learned, will be computer-generated “virtual humans,” used to offer diagnostics, and programmed to appear empathetic.

It’s the latest in a long series of efforts to assuage soaring rates of depression, anxiety and PTSD that afflict today’s troops. Military brass have become increasingly willing to try just about anything, from yoga and reiki to memory-adjustment pills, that holds an iota of promise. They’ve even funded computerized therapy before: In 2010, for example, the military launched an effort to create an online health portal that’d include video chats with therapists.

But this project, funded by Darpa, the Pentagon’s far-out research arm, is way more ambitious. Darpa’s research teams are hoping to combine 3-D rendered simulated therapists — think Sims characters mixed with ELIZA — with sensitive analysis software that can actually detect psychological symptoms “by analyzing facial expressions, body gestures and speech,” Dr. Albert Rizzo, who is leading the project alongside Dr. Louis-Philippe Morency, tells Danger Room. The therapists won’t treat patients, but they will help flesh-and-blood counselors by offering a general diagnosis of what ails soldiers, and how serious the problem is.

Antidepressants Do More Harm Than Good, Study Says


The antidepressant drug Prozac, also known as fluoxetine, is seen on a table. The side effects of antidepressants far outweigh their minimal benefits, according to a new study. (Photo: Reuters)

ibtimes.com | Apr 25, 2012

By Amir Khan

Antidepressants do more harm than good since patients presume the drugs are safe though numerous side effects are well known, according to a new study.

Harmful side effects of commonly prescribed antidepressants can include stroke and premature death and far outweigh the minimal benefits, according to the study authors.

“We need to be much more cautious about the widespread use of these drugs,” Paul Andrews, study author and evolutionary biologist at McMaster University, said in a statement. “It’s important because millions of people are prescribed anti-depressants each year, and the conventional wisdom about these drugs is that they’re safe and effective.”

One class of antidepressants relieves depressive symptoms by increasing the level of serotonin hormone, a mood regulator that contributes to feelings of well-being and happiness. The body produces serotonin for other non-neurological purposes such as blood clots, digestion and reproduction, researchers said.

“Serotonin is an ancient chemical,” Andrews said in a statement. “It’s intimately regulating many different processes, and when you interfere with these things you can expect, from an evolutionary perspective, that it’s going to cause some harm.”

Researchers found that antidepressants hinder serotonin regulation and can cause digestive problems, atypical sperm development, abnormal bleeding, stroke and premature death. Antidepressant manufacturers warn of side effects on drug labels though patients do not always consider how the side effects will affect their lives, according to the study authors.

“It is widely believed that antidepressant medications are both safe and effective; however, this belief was formed in the absence of adequate scientific verification,” the researchers wrote. “The weight of current evidence suggests that, in general, antidepressants are neither safe nor effective; they appear to do more harm than good.”

One in 20 Americans over the age of 12 reported feeling symptoms of depression between 2005 and 2006, according to the Centers for Disease Control and Prevention. Symptoms include hopelessness, feeling like a failure, poor appetite, lack of interest in activities and suicidal thuogts.

People with depression miss almost five workdays every three months, according to the CDC. Depression causes 200 million lost workdays every year and costs employers between $17 billion and $44 billion annually, according to U.S. health authorities.

Antidepressants were the most frequently used prescription drug by people aged 18 to 44 between 2005 and 2008, according to the CDC. From 1988 to 2008, antidepressant use increased by almost 400 percent.

Doctors need to re-evaluate the prudence of dispensing antidepressant prescriptions on such a large scale, according to the study authors. The study’s findings will hopefully get clinicians to take a critical look at the drugs’ continuing use.

“It could change the way we think about such major pharmaceutical drugs,” he says. “You’ve got a minimal benefit, a laundry list of negative effects – some small, some rare and some not so rare. The issue is: Does the list of negative effects outweigh the minimal benefit?”