The Permanent Mental Health Regime

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Xan
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Re: The Permanent Mental Health Regime

Post by Xan » Wed Jul 17, 2019 9:46 am

So WiseOne, would you mind clarifying your point of view specifically with regard to the battery of tests that GPs recommend as patients cross particular ages? (In my case, 40?) I'm not sure exactly what they are: colonoscopy, heart CT, etc?
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Re: The Permanent Mental Health Regime

Post by Kriegsspiel » Wed Jul 17, 2019 11:19 am

Doing a shit ton of exercise is good for your mental health.

Not feeling persistently stressed is big too. If you're stressed all the time, you need to fix it.

Resolve to have personal agency instead of acting like a victim.
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Re: The Permanent Mental Health Regime

Post by Maddy » Wed Jul 17, 2019 1:20 pm

Xan wrote:
Wed Jul 17, 2019 9:46 am
So WiseOne, would you mind clarifying your point of view specifically with regard to the battery of tests that GPs recommend as patients cross particular ages? (In my case, 40?) I'm not sure exactly what they are: colonoscopy, heart CT, etc?
I'd be interested in knowing this, too.

Machine Ghost is an example of someone who, by most normal standards, went hog wild on the preventive front. However, he seems to have put good use to the information he got from all the testing, modifying his diet and engaging in a regimen of supplements that he used to bring about objectively-verifiable metabolic changes, especially in terms of gut microbiome. He inspired me to begin doing blood sugar testing, which was a real eye-opener for me and which vastly improved a situation of debilitating fatigue. So I'm inclined to believe that while the majority of preventive tests that keep doctors' offices humming may not be warranted, there's a small segment of the population with sufficient motivation to make very good use of some of the stuff that's out there. . .

BTW, where is he?
Last edited by Maddy on Wed Jul 17, 2019 1:23 pm, edited 1 time in total.
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Re: The Permanent Mental Health Regime

Post by Kriegsspiel » Wed Jul 17, 2019 1:23 pm

Maddy wrote:
Wed Jul 17, 2019 1:20 pm
BTW, where is he?
He left California and subsequently froze to death ;D
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Re: The Permanent Mental Health Regime

Post by jacksonM » Wed Jul 17, 2019 3:53 pm

dualstow wrote:
Wed Jul 17, 2019 5:47 am
WiseOne wrote:
Tue Jul 16, 2019 6:04 pm
jacksonM wrote:
Sun Jul 14, 2019 6:07 pm
I agree with most of these points but I would add to stay as far away from the medical establishment as long as you can if you don't really think you are sick
Just had to comment on this - not only do I heartily agree with this, but you might be surprised to know that most specialists would say the same. There are way too many "worried well" seeking unneeded care and self-diagnosing with all kinds of crazy stuff like chronic Lyme, it's practically a national pastime.

...
I wonder if I’m Worried Well/hypochondria lite. I had not been to the doctor in a couple years, but I went recently, because of some discomfort that hasn’t gone away in three months and counting. Could be nothing, but...nip it in the bud?
I hope it's working out well for you but in my experience one of four things usually happens when you go to the doctor because of "some discomfort" that isn't going away as fast as you want it to.

1.) They will actually find something wrong with you that may even be life-threatening and you'll be glad you went. This was the case with my first wife but it took two different doctors treating her for allergies and three trips to the emergency room before someone finally ordered a chest xray for a 53-year-old lifelong smoker and ultimately discovered she had lung cancer. Unfortunately, it was too late by then.

2.) They will find that despite the symptoms you are complaining about there is really nothing wrong with you so it must be all in your head. I'd share my personal experience with what eventually turned out to be a tooth abscess by my own diagnosis using google but it would be too long of a story.

3.) You will be misdiagnosed because the doctor figures he/she has to tell you something and prescribe some kind of medicine for you because that is basically what you are paying for and expect, isn't it? Ditto #2, I have a couple of personal stories I can tell. None of them did me any lasting harm but they did keep me from finding out what was really wrong for long periods of time because I accepted what they said with actually NO evidence to back it up.

4.) You'll just get better on your own because your body has amazing healing powers. You may or may not attribute this to the treatment, like when you go to the doctor for a sinus infection and they prescribe antibiotics. When you read later on that antibiotics are ineffective at treating sinus infections and should not be prescribed you may start to question it but at least, in your mind, it worked.

For the record, I really do have a lot of respect medical professionals and don't mean to be completely negative. Someone like WiseOne who works in research has my greatest respect. Hard to think of a higher calling than dedicating your life to curing/preventing diseases. And when they are able to identify something with an accurate diagnosis I've found that most of them are very compassionate and professional. When my wife was finally diagnosed with lung cancer the oncologist we first went to even offered to treat her for free because he wasn't on our insurance plan.
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Re: The Permanent Mental Health Regime

Post by WiseOne » Thu Jul 18, 2019 7:48 am

Xan wrote:
Wed Jul 17, 2019 9:46 am
So WiseOne, would you mind clarifying your point of view specifically with regard to the battery of tests that GPs recommend as patients cross particular ages? (In my case, 40?) I'm not sure exactly what they are: colonoscopy, heart CT, etc?
There is not a straightforward answer for everyone, because there are costs and benefits to each test and you have to decide for yourself whether the net is worthwhile to you. The problem I have is not necessarily with the preventive tests, it's that they are presented as an unqualified benefit that you have no choice but to participate in.

Here's a few examples that I feel like I can intelligently say something about:

1. Mammograms. The problem with breast cancer is that about 90% of detected cancers are ones that would never become clinically evident. The ones that kill you arise very quickly, within a few months, so that to guarantee catching one on a mammo before you can detect it yourself you'd have to get a test about every 3 months. Further, there is NO evidence that the slight time advantage you might get from a mammogram will improve your chances of surviving one of these killers (there's been at least one study I know of showing zero difference in survival time based on cancer size at detection.) So, breast cancer is simply not amenable to screening, from scratch. Meanwhile, every time you hear of someone being diagnosed with breast cancer via mammogram, you can be sure that they are going through biopsy, resection, chemo and radiation for something that in all likelihood is harmless. These are not harmless interventions, and may have lifelong consequences.

You can make a reasoned case that mammograms have more political than scientific value, and that women are truly being done a major disservice. In any case, don't get one more often than every 2 years, and stop by age 75 - that's the current recommendations. If you're at high risk due to carrying a BRCA1 or 2 gene, this is a different story...if I had that situation I'd probably go for bilateral mastectomy.

2. Colonoscopy. This is a more useful cancer screening test, since colon cancer behaves in a way that makes it possible to screen for it: it starts slowly and can be easily nipped in the bud by removing polyps. The problem is that colonoscopy carries a risk of bowel perforation that increases with age. Currently, the risk is considered to be greater than the benefit after age 70. If you've had one clean colonoscopy and have no family history of colon cancer, it might be reasonable to call it quits at that point.

3. Hypertension and dyslipidemia: The extent to which these are predictive of cardiovascular events is probably way overblown. The studies were mainly funded by drug companies, which of course stand to gain enormously. It is pretty clear that there is a statistical association between these and disease, but that does not prove that modulating them will reduce disease risk - in fact it could even be harmful. It's sort of like trying to cure a cold by giving you aspirin for your sore throat; the aspirin will take care of the symptom, but you still have the cold. In fact, C-reactive protein is a better predictor of heart disease than lipid profile, and half of people with first time heart attacks have normal lipids. The few studies out there not industry-funded, coincidentally, show very little if any benefit of treatment. The statistics in the studies that do show benefit have been severely manipulated, and selective in their reporting.

If you've had a heart attack or stroke, there is useful data that a statin and/or beta blocker can increase your time to the next event. (However we don't know why they work...it is clear that statins don't exert their benefit by reducing cholesterol; it's now thought to be an anti-inflammatory effect.) If you haven't, there is simply no convincing data out there that you can benefit from taking one of these drugs. Side effects of statins (muscle damage that can be irreversible) and beta blockers (depression, loss of exercise tolerance) are well known. This is not exactly an orthodox position though, so you should do your own research on the topic.

4. Hopefully everyone already knows that prostate cancer screening has been declared useless.
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Re: The Permanent Mental Health Regime

Post by Maddy » Thu Jul 18, 2019 7:58 am

WiseOne wrote:
Thu Jul 18, 2019 7:48 am
Meanwhile, every time you hear of someone being diagnosed with breast cancer via mammogram, you can be sure that they are going through biopsy, resection, chemo and radiation for something that in all likelihood is harmless.
Whoa.
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Re: The Permanent Mental Health Regime

Post by Mountaineer » Thu Jul 18, 2019 10:42 am

WiseOne wrote:
Thu Jul 18, 2019 7:48 am
Xan wrote:
Wed Jul 17, 2019 9:46 am
So WiseOne, would you mind clarifying your point of view specifically with regard to the battery of tests that GPs recommend as patients cross particular ages? (In my case, 40?) I'm not sure exactly what they are: colonoscopy, heart CT, etc?
There is not a straightforward answer for everyone, because there are costs and benefits to each test and you have to decide for yourself whether the net is worthwhile to you. The problem I have is not necessarily with the preventive tests, it's that they are presented as an unqualified benefit that you have no choice but to participate in.

Here's a few examples that I feel like I can intelligently say something about:

1. Mammograms. The problem with breast cancer is that about 90% of detected cancers are ones that would never become clinically evident. The ones that kill you arise very quickly, within a few months, so that to guarantee catching one on a mammo before you can detect it yourself you'd have to get a test about every 3 months. Further, there is NO evidence that the slight time advantage you might get from a mammogram will improve your chances of surviving one of these killers (there's been at least one study I know of showing zero difference in survival time based on cancer size at detection.) So, breast cancer is simply not amenable to screening, from scratch. Meanwhile, every time you hear of someone being diagnosed with breast cancer via mammogram, you can be sure that they are going through biopsy, resection, chemo and radiation for something that in all likelihood is harmless. These are not harmless interventions, and may have lifelong consequences.

You can make a reasoned case that mammograms have more political than scientific value, and that women are truly being done a major disservice. In any case, don't get one more often than every 2 years, and stop by age 75 - that's the current recommendations. If you're at high risk due to carrying a BRCA1 or 2 gene, this is a different story...if I had that situation I'd probably go for bilateral mastectomy.

2. Colonoscopy. This is a more useful cancer screening test, since colon cancer behaves in a way that makes it possible to screen for it: it starts slowly and can be easily nipped in the bud by removing polyps. The problem is that colonoscopy carries a risk of bowel perforation that increases with age. Currently, the risk is considered to be greater than the benefit after age 70. If you've had one clean colonoscopy and have no family history of colon cancer, it might be reasonable to call it quits at that point.

3. Hypertension and dyslipidemia: The extent to which these are predictive of cardiovascular events is probably way overblown. The studies were mainly funded by drug companies, which of course stand to gain enormously. It is pretty clear that there is a statistical association between these and disease, but that does not prove that modulating them will reduce disease risk - in fact it could even be harmful. It's sort of like trying to cure a cold by giving you aspirin for your sore throat; the aspirin will take care of the symptom, but you still have the cold. In fact, C-reactive protein is a better predictor of heart disease than lipid profile, and half of people with first time heart attacks have normal lipids. The few studies out there not industry-funded, coincidentally, show very little if any benefit of treatment. The statistics in the studies that do show benefit have been severely manipulated, and selective in their reporting.

If you've had a heart attack or stroke, there is useful data that a statin and/or beta blocker can increase your time to the next event. (However we don't know why they work...it is clear that statins don't exert their benefit by reducing cholesterol; it's now thought to be an anti-inflammatory effect.) If you haven't, there is simply no convincing data out there that you can benefit from taking one of these drugs. Side effects of statins (muscle damage that can be irreversible) and beta blockers (depression, loss of exercise tolerance) are well known. This is not exactly an orthodox position though, so you should do your own research on the topic.

4. Hopefully everyone already knows that prostate cancer screening has been declared useless.
Thank you WiseOne. This gives me some specific things to discuss with my physician at the next visit. I appreciate the time you took to answer Xan's question.

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Re: The Permanent Mental Health Regime

Post by dualstow » Thu Jul 18, 2019 11:06 am

WiseOne wrote:
Thu Jul 18, 2019 7:48 am
Xan wrote:
Wed Jul 17, 2019 9:46 am
So WiseOne, would you mind clarifying your point of view specifically with regard to the battery of tests that GPs recommend as patients cross particular ages? (In my case, 40?) I'm not sure exactly what they are: colonoscopy, heart CT, etc?
There is not a straightforward answer for everyone,
...
Here's a few examples that I feel like I can intelligently say something about:

1. Mammograms. ...
2. Colonoscopy. ...
3. Hypertension and dyslipidemia:
...
4. Hopefully everyone already knows that prostate cancer screening has been declared useless.
I only remember Ben Stiller urging men to get tested. I just reviewed that after reading your post. Hmm.
https://www.healthnewsreview.org/2016/1 ... te-cancer/
RIP Marcello Gandini
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Re: The Permanent Mental Health Regime

Post by WiseOne » Thu Jul 18, 2019 6:11 pm

Great article, thanks for posting it dualstow! You could take that article and substitute "mammogram" for "PSA test" and "breast" for "prostate", and the concepts would be the same.

Interestingly, this is potential fodder for the "left is eating itself" thread. The reason why you'll never see an article like that written about breast cancer screening is that the writer will instantly be stoned to death (figuratively of course) for being anti-women. It is ironic indeed that women are, in fact, victims of breast cancer screening politics.
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Re: The Permanent Mental Health Regime

Post by Kriegsspiel » Thu Jul 18, 2019 6:55 pm

dualstow wrote:
Thu Jul 18, 2019 11:06 am
WiseOne wrote:
Thu Jul 18, 2019 7:48 am
4. Hopefully everyone already knows that prostate cancer screening has been declared useless.
I only remember Ben Stiller urging men to get tested. I just reviewed that after reading your post. Hmm.
https://www.healthnewsreview.org/2016/1 ... te-cancer/
All I know about prostates is they're up in your butthole region. Of course, I didn't know you should not get it checked out, but it's welcome info.
WiseOne wrote:
Thu Jul 18, 2019 6:11 pm
he reason why you'll never see an article like that written about breast cancer screening is that the writer will instantly be stoned to death (figuratively of course) for being anti-women. It is ironic indeed that women are, in fact, victims of breast cancer screening politics.
:D :D :D :D
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Re: The Permanent Mental Health Regime

Post by dualstow » Thu Jul 18, 2019 7:51 pm

Kriegsspiel wrote:
Thu Jul 18, 2019 6:55 pm
All I know about prostates is they're up in your butthole region.
Hopefully just one.
RIP Marcello Gandini
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Re: The Permanent Mental Health Regime

Post by Xan » Thu Jul 18, 2019 8:48 pm

Kriegsspiel wrote:
Thu Jul 18, 2019 6:55 pm
dualstow wrote:
Thu Jul 18, 2019 11:06 am
WiseOne wrote:
Thu Jul 18, 2019 7:48 am
4. Hopefully everyone already knows that prostate cancer screening has been declared useless.
I only remember Ben Stiller urging men to get tested. I just reviewed that after reading your post. Hmm.
https://www.healthnewsreview.org/2016/1 ... te-cancer/
All I know about prostates is they're up in your butthole region. Of course, I didn't know you should not get it checked out, but it's welcome info.
Well, hang on... WiseOne is questioning the utility of PSA tests, but that isn't the same as the doctor sticking a finger up there to see how it's doing. Is that old-fashioned test better than a PSA, WiseOne?

And thanks very much for sharing your wisdom here!
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Re: The Permanent Mental Health Regime

Post by Maddy » Fri Jul 19, 2019 8:11 am

Here's a question (albeit a little tangential) that I've just been dying to ask:

Are there any studies that compare the outcome of cancer patients who go through the standard treatment protocols and those who do nothing? I'm guessing that the data is limited due to the fact that you can't very well create a "control" group of non-treated cancer patients. But I'm also guessing that there's a growing number of self-styled controls out there. WiseOne?
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Re: The Permanent Mental Health Regime

Post by WiseOne » Fri Jul 19, 2019 9:30 am

Gee, I guess I need to answer these questions...

Rectal exams used to be mostly about checking for occult blood in the stool, which is (or rather was) a very useful and inexpensive colon cancer screening test. Plus you get an instant answer. JCAHO however has effectively banned the practice, I guess because the test was maddeningly simple and didn't make money from an administrator's point of view (sarcasm). Honestly I have zero idea why that was done.

It is also a way of doing prostate cancer screening, which is not useful no matter how you do it, or to check for an enlarged prostate or altered rectal tone to investigate causes of urinary issues. Thus, there's no longer any reason for screening rectal exams. You guys can now rejoice.

Maddy, I'm not sure what you're intending with your question exactly? What you said is definitely true for a cancer that manifests due to clinical symptoms, and I doubt that would ever get IRB approval as it would violate equipoise. Cancers caught on screening tests, though, are a different issue. A randomized trial might just get past an IRB board, but I suspect it might be hard to recruit for it plus you'll likely get pilloried by the press, patient advocate organizations etc.

So you have to try alternative approaches. One is to study the correlation of survival with lesion size at detection. This is a useful assessment of the value of screening because lesions do tend to be caught when they are smaller, but you have to be careful to limit to specific pathologies to avoid biasing the results by comparing fundamentally different types of cancers (which is a problem with nearly all studies of breast cancer screening outcomes). I'm aware of one study limited to aggressive breast cancers that did this well, and that's the one that found that lesion size (and thus screening) had no effect on survival. Another approach is to compare all-cause mortality in a sufficiently large study of patients randomized to receive screening vs. not. There have been 3 such studies of breast cancer screening. Two of them (in Canada and Finland) found no difference between groups. One of them did (New York) but the study was flawed because the two groups showed the difference BEFORE they started screening. Naturally, the screening recommendations were put in place using the New York study as the justification, ignoring the other two.

Anyway...it's so much fun when you start REALLY looking at the data that support preventive medicine recommendations. At best, primary prevention provides tiny benefits or exchanges one set of problems for another. At worst, it's downright damaging. A decision to screw the whole scene and just live your life is perfectly justifiable, and probably good for your mental health as well!
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Re: The Permanent Mental Health Regime

Post by amdda01 » Sat Jul 20, 2019 12:20 pm

WiseOne,

Curious about your opinion of "heart scans":

https://www.amitahealth.org/heartscan/? ... gJK4PD_BwE

Thanks!
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Re: The Permanent Mental Health Regime

Post by WiseOne » Sun Jul 21, 2019 6:46 am

No idea what the heart scan is...doesn't even say if it's an MRI or CT or plain X ray. Unlikely to be one of the first two given the price.

If it's just an Xray, it's mainly able to detect an enlarged heart, which I guess is not bad to know about. Just be aware that enlarged hearts can be normal for some people especially athletes. Also for men, active heart disease is not something you'd miss...women on the other hand can have heart attack symptoms that get overlooked (including by doctors). So I'm not really sure why a man would need one of these. Also, for either sex an EKG is going to be at least as informative, and doesn't involve any radiation.

This is sort of like going to a used car salesman. They're trying to sell you something, and it's not necessarily something you need. But then, almost any medical encounter now is not too different from that.
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Re: The Permanent Mental Health Regime

Post by WiseOne » Sun Jul 21, 2019 7:50 am

A CT scan for $50? Sounds fishy. That's less than 10% of a typical chest CT charge.

This has "stay away" written all over it.
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Re: The Permanent Mental Health Regime

Post by amdda01 » Mon Jul 22, 2019 8:14 am

Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/
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Re: The Permanent Mental Health Regime

Post by Xan » Mon Jul 22, 2019 10:09 am

It may be that these are "loss-leaders". Give the scan away for (basically) free, and some percentage of people scanned will need hospital services. It's very likely they'll get those services at the same hospital.

I don't know whether that's good or bad: they're delivering on their promise to give you peace of mind, if nothing turns up.
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Re: The Permanent Mental Health Regime

Post by Mountaineer » Mon Jul 22, 2019 11:32 am

amdda01 wrote:
Mon Jul 22, 2019 8:14 am
Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/
This is what caught my eye in the link:
The amount of calcium may not closely correlate with the degree of narrowing in the coronary arteries. The clinical implications of any CAS result should be determined by a physician in conjunction with risk factors for coronary artery disease, possible symptoms, medical history, physical findings and may be influenced by many factors, including age, gender, location and number of calcifications and arteries involved. This screeningtool is not for purposes of evaluation or diagnosis of any conditions of the chest and we will not bill insurance for this screening. Payment is expected at the time of service.

Why even bother to get the test? Would you really have peace of mind?
DNA has its own language (code), and language requires intelligence. There is no known mechanism by which matter can give birth to information, let alone language. It is unreasonable to believe the world could have happened by chance.
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Re: The Permanent Mental Health Regime

Post by jacksonM » Mon Jul 22, 2019 2:28 pm

I've been working on my medical degree lately by watching youtube videos by Peter Attia.

Here's an article of his discussing this very thing and others when it comes to what we actually know about heart disease (or maybe it's more accurate to say it's about what we know that isn't true).

It's written mostly for doctors but I think he's pretty good at making these things understandable for laymen.

https://peterattiamd.com/heart-disease- ... revention/
Mountaineer wrote:
Mon Jul 22, 2019 11:32 am
amdda01 wrote:
Mon Jul 22, 2019 8:14 am
Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/
This is what caught my eye in the link:
The amount of calcium may not closely correlate with the degree of narrowing in the coronary arteries. The clinical implications of any CAS result should be determined by a physician in conjunction with risk factors for coronary artery disease, possible symptoms, medical history, physical findings and may be influenced by many factors, including age, gender, location and number of calcifications and arteries involved. This screeningtool is not for purposes of evaluation or diagnosis of any conditions of the chest and we will not bill insurance for this screening. Payment is expected at the time of service.

Why even bother to get the test? Would you really have peace of mind?
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Re: The Permanent Mental Health Regime

Post by WiseOne » Tue Jul 23, 2019 8:27 am

They're looking for arterial calcification with that test?

Wow, that's hilarious. You can't see coronary arteries with that degree of precision on a CT scan. They're too small! Plus there's a lot of uncertainty about the basic technique even if you're looking for something sufficiently big (like an aortic aneurysm). That's why the standard of care is an angiogram (injecting dye directly into blood vessels). Which obviously is invasive so you only do that when you have good reason to.

I'd say the chances of finding any useful information from this test is close to zero. Other than how easy it is for someone to hawk $50 services to the unsuspecting public.
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Re: The Permanent Mental Health Regime

Post by dualstow » Tue Jul 23, 2019 9:47 am

Read or listen to the bill of the month and enjoy. :-\ This one's a doozy.
https://www.npr.org/tags/585747919/bill-of-the-month
RIP Marcello Gandini
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