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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1124 to 1148 of 8406. Go back in thread:
Posted by dr. dave on November 5, 2002, at 5:04:21
In reply to Re: Citalopram pharmacology » JLM, posted by Alan on November 4, 2002, at 9:34:43
> > I too get a bit tired of the ad nauseum claims of Lex's lower incidence of SE 's and efficiacy over Celexa.
> >
> > We hear a lot about how 'the published studies' demonstrate both things clearly, even thou the data is contradictory at best.
> >
> > Know what I would like to see? The UNPUBLISHED studies that would have had to have been submitted to the FDA for the approval of Lexapro. They can be obtained thru the Freedom of Information Act for those brave enough to do so. I would NOT be surprised to see several studies that show NO greater effect than either placebo or Celexa for that matter.
> >
> > All we have so far are the studies done by paid Forrest consulants, which may not be all that objective.
> >
> > Perhaps I will take the time to learn how to submit a FOIA request for the unpublished studies submitted to FDA. I bet there are some real gems in there.
> >
> > Like Dr. Dave, I have yet to hear a remotely plausible explaination for the claims of less SE's with Lexapro.
> >
> >
> >
> ============================================
> Until the FDA has better oversight of the test results, the pharm. co.'s are allowed to cherry pick test results and throw out the undesired test results after having changed the test criteria until they get the result that they want - which the FDA never sees before adjudicating the drug's acceptance. Fox guarding the chicken coop.
>
> Alan
>==================================================
Maybe Pharmrep could help us out with this.
To my knowledge, there have been four efficacy studies on escitalopram, two in the US and two in Europe and Canada.
Both US studies compared Lexapro with Celexa. Study MD-02 has not been presented, but we know it was a 'failed' study in the sense that it showed no statistically significant difference between Lexapro, Celexa and placebo (see Cipralex product monograph at www.cipralex.com, page 22.)
The other study (MD-01, published by Burke et al) showed no statistically significant difference between Celexa and Lexapro on the measure they had previously defined as the primary outcome measure.
One of the European studies compared Lexapro with Celexa (study 99003, described in papers by Lepola et al, Montgomery et al and Reines et al. Note that these are not seperate trials but the same trial reported several times.) Again this showed no statistically significant difference between Lexapro and Celexa on the previously defined main outcome measure.
If there have been other trials comparing the efficacy of Celexa and Lexapro I'm sure we'd all like to know about them.
Posted by Anyuser on November 5, 2002, at 9:40:28
In reply to Re: Lexapro 'failed' trial, posted by dr. dave on November 5, 2002, at 5:04:21
I wonder why someone switching from Celexa to Lexapro would experience any new side effects or ramp-up time at all. Lexapro is supposed to be only the efficacious half of Celexa. One would think the switch would be entirely transparent, with a reduction of s/e at best, or no change whatsoever at worst. Any theories?
Posted by Brandymac26 on November 5, 2002, at 9:52:09
In reply to Re: for people taking Lex for anxiety » Brandymac26, posted by Ritch on November 4, 2002, at 21:01:03
Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
Posted by Brandymac26 on November 5, 2002, at 9:58:00
In reply to Why the new side effects?, posted by Anyuser on November 5, 2002, at 9:40:28
> I wonder why someone switching from Celexa to Lexapro would experience any new side effects or ramp-up time at all. Lexapro is supposed to be only the efficacious half of Celexa. One would think the switch would be entirely transparent, with a reduction of s/e at best, or no change whatsoever at worst. Any theories?
I took celexa for over a year, and have just started taking lexapro 5 days ago, and so far my side effects arent quite as bad as they were on the celexa, but I havent experienced any different side effects on lexapro than I did on celexa. Also, if it helps, I was off of my med's for 6 months before i started taking celexa, so I figured that the side effects would as bad if not worse than they were on celexa, but thank God there not.
Posted by TwoFeathers on November 5, 2002, at 10:29:29
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I am on Lexapro, and i do have more energy. i had taken Zoloft and Prozac and felt like a zombie. so far i'm not sure about the sexual side-effects on account that i recently broke up with my boyfriend. but i like lexapro a lot better than any of the other antidepressants i've taken.
Posted by tiredofthis on November 5, 2002, at 11:21:16
In reply to Re: Luxapro and Wellbutrin, posted by ANXIETY ANN on November 4, 2002, at 16:36:18
> > My Dr said he would add Wellbutrin to the Luxapro as a way of enhancing it and hopefully heping w/the sexual side effects. What does everyone think about that.? Anyone have any experience w/Wellbutrin. Actually, I hve been pleased w/what I've heard.
>
> Hi Bridgette
> My doc also told me that he might add the wellbutrin with my Lexapro too. I am hesitate to add more drugs to what I already take (lexapro, adivan ) but if it helps the anxiety I guess its worth a try. I go see him tomorrow. Do you take Lexapro fro anxiety? If you do, do you notice that sometimes you get very anxious? I do especially in the mornings and evenings. It seems as though we all have some sort of s/e from these damned drugs!
> AnnHello!
I have been taking Wellbutrin for few months now. At first it seem to work but I start having really bad headeches. My doc increase my dose, and I got very anxious and irritable. The sex is great but that was about the only thing (when I was in the mood for it). So now my doc told me to stop Wellbutrin and I just star taking Lexapro. I don't know any of the side effects, that's why I got in the website. Let me know how it works taking both of them.
Posted by ROO on November 5, 2002, at 11:28:50
In reply to Re: Luxapro and Wellbutrin, posted by tiredofthis on November 5, 2002, at 11:21:16
If the standard dose of Celexa was 20 mg's...why
is the standard dose of lexapro 10 mg's (since that
is equivalent to 40 mg's of celexa) seems like the standard
dose should be 5 mg's.....
Posted by Katarina on November 5, 2002, at 12:13:06
In reply to Re: for people taking Lex for anxiety » Ritch, posted by Brandymac26 on November 5, 2002, at 9:52:09
> Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
-----------------------
I started on Prozac, having told my doctor of my depression. I failed to say that anxiety was part of it. Prozac worked like a charm for the depression but I was bouncing off the walls and it did nothing for the anxiety. After discussing more in depth my symptoms, I was given Effexor, which didn't work. Now I'm on Lexapro...it's been 3 weeks now and no great relief. I called the doc to give a report, told of my continued anxiety so he added Serax (today). I really don't know about this...I'm with you in that there must be another way. I feel as if my anxiety level is climbing, too. Perhaps we feel like guinea pigs?
Those of you who have tried a better approach, feel free to opine.
Thanks,
Kat
Posted by Ritch on November 5, 2002, at 12:50:15
In reply to Re: for people taking Lex for anxiety » Ritch, posted by Brandymac26 on November 5, 2002, at 9:52:09
> Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
Hi, there are other antidepressants besides the SSRI's that have also been used with success for anxiety. Trazodone, Serzone, and tricyclics such as amitripytline, nortriptyline, and doxepin, and the MAOI's. The level of success will be highly individual. If *all* SSRI's tend to cause more agitation for someone, then it would be logical to try an antidpressant from another class. There could be an unwarranted bias by pdocs for SSRI's that goes beyond their safety profile.
Posted by bluedog on November 5, 2002, at 13:03:43
In reply to Re: Lexapro 'failed' trial, posted by dr. dave on November 5, 2002, at 5:04:21
Dr Dave
I have been following this thread with much interest. ( I have taken citalopram and my mother and sister-in-law are both currently taking citalopram. I currently take fluoxetine as citalopram was just too sedating for me).
I greatly respect your opinions and based on your line of reasoning I can see no reason for either myself or my relatives to switch to escitalopram.
I would love to ask you a question. I noticed that SLS recently asked you about your background. Going through the posts it seems you have answered similar questions since at least August last year. On 20 August 2001 you also mentioned that you work in a little village in the mountains of Wales.
My question is this........ are you the same Dr Dave as descibed by the Guardian as "director of the North Wales department of psychological medicine and the UK's foremost expert in antidepressants"? ( see http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html ) or is it just a coincidence that their are two psychiatrists in North Wales called Dr Dave who happen to be very knowledgeable about antidepressant medications?
just curious
regards
Posted by THOV on November 5, 2002, at 14:50:45
In reply to Re: that Phil, he's a manly hi-T kind of guy ;-) (nm) » Phil, posted by .tabitha. on August 17, 2002, at 15:35:49
Question for any of you experts...
Just started lexapro...10mg
can i drink alcoholic beverages while taking this medication? How will effect me?
this is my 2nd day..First day I was very nauseated...I am very concerned about the sexual s/e's
Posted by bridgette on November 5, 2002, at 15:15:51
In reply to Question for Dr Dave, posted by bluedog on November 5, 2002, at 13:03:43
This is my 1st day on the two of them together and I feel great---but, how can that be---is it just a placebo effect, or the fact that I was on Lexapro for 5 weeks made the Wellbutrin work instantly. See, I'm not used to feeling good, so I question WHY? I have to say the things I have read on line about Wellbutrin were all pretty positive!
Posted by Brandymac26 on November 5, 2002, at 15:55:19
In reply to Re: for people taking Lex for anxiety, posted by Katarina on November 5, 2002, at 12:13:06
> > Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
>
> -----------------------
> I started on Prozac, having told my doctor of my depression. I failed to say that anxiety was part of it. Prozac worked like a charm for the depression but I was bouncing off the walls and it did nothing for the anxiety. After discussing more in depth my symptoms, I was given Effexor, which didn't work. Now I'm on Lexapro...it's been 3 weeks now and no great relief. I called the doc to give a report, told of my continued anxiety so he added Serax (today). I really don't know about this...I'm with you in that there must be another way. I feel as if my anxiety level is climbing, too. Perhaps we feel like guinea pigs?
> Those of you who have tried a better approach, feel free to opine.
> Thanks,
> KatWhat exactly is serax? I've never heard of it.
Posted by Kara Lynne on November 5, 2002, at 15:57:28
In reply to Lexapro and Wellbutrin, posted by bridgette on November 5, 2002, at 15:15:51
May I ask how much of each you take--and when in the day? And were you doing well with the Lexapro prior to the Wellbutrin? Thank you.
Posted by Brandymac26 on November 5, 2002, at 15:59:09
In reply to Re: for people taking Lex for anxiety » Brandymac26, posted by Ritch on November 5, 2002, at 12:50:15
> > Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
>
> Hi, there are other antidepressants besides the SSRI's that have also been used with success for anxiety. Trazodone, Serzone, and tricyclics such as amitripytline, nortriptyline, and doxepin, and the MAOI's. The level of success will be highly individual. If *all* SSRI's tend to cause more agitation for someone, then it would be logical to try an antidpressant from another class. There could be an unwarranted bias by pdocs for SSRI's that goes beyond their safety profile.Right now I am seeing a general practitioner. She's the one that keeps prescribing the ssri's, but If the lexapro doesn't work SOON, I'm gonna ask for something in a different class b/c all I've ever been on were ssri's, and they don't seem to work for me.
Posted by JLM on November 5, 2002, at 16:19:03
In reply to Re: Lexapro 'failed' trial, posted by dr. dave on November 5, 2002, at 5:04:21
> > > I too get a bit tired of the ad nauseum claims of Lex's lower incidence of SE 's and efficiacy over Celexa.
> > >
> > > We hear a lot about how 'the published studies' demonstrate both things clearly, even thou the data is contradictory at best.
> > >
> > > Know what I would like to see? The UNPUBLISHED studies that would have had to have been submitted to the FDA for the approval of Lexapro. They can be obtained thru the Freedom of Information Act for those brave enough to do so. I would NOT be surprised to see several studies that show NO greater effect than either placebo or Celexa for that matter.
> > >
> > > All we have so far are the studies done by paid Forrest consulants, which may not be all that objective.
> > >
> > > Perhaps I will take the time to learn how to submit a FOIA request for the unpublished studies submitted to FDA. I bet there are some real gems in there.
> > >
> > > Like Dr. Dave, I have yet to hear a remotely plausible explaination for the claims of less SE's with Lexapro.
> > >
> > >
> > >
> > ============================================
> > Until the FDA has better oversight of the test results, the pharm. co.'s are allowed to cherry pick test results and throw out the undesired test results after having changed the test criteria until they get the result that they want - which the FDA never sees before adjudicating the drug's acceptance. Fox guarding the chicken coop.
> >
> > Alan
> >
>
> ==================================================
>
> Maybe Pharmrep could help us out with this.
>
> To my knowledge, there have been four efficacy studies on escitalopram, two in the US and two in Europe and Canada.
>
> Both US studies compared Lexapro with Celexa. Study MD-02 has not been presented, but we know it was a 'failed' study in the sense that it showed no statistically significant difference between Lexapro, Celexa and placebo (see Cipralex product monograph at www.cipralex.com, page 22.)
>
> The other study (MD-01, published by Burke et al) showed no statistically significant difference between Celexa and Lexapro on the measure they had previously defined as the primary outcome measure.
>
> One of the European studies compared Lexapro with Celexa (study 99003, described in papers by Lepola et al, Montgomery et al and Reines et al. Note that these are not seperate trials but the same trial reported several times.) Again this showed no statistically significant difference between Lexapro and Celexa on the previously defined main outcome measure.
>
> If there have been other trials comparing the efficacy of Celexa and Lexapro I'm sure we'd all like to know about them.Dr. Dave,
Its my understanding that companies must submit all trials for a given indication to the FDA as a part of the approval process, including failed trials. These typically would NOT be published anywhere in the public domain, but ARE available thru the Freedom of Information Act.
Thus, there may be quite a few trials that were conducted that we are not aware about. I'd be curious to see these unpublished results, but the only way to get them is to submit a FOIA request to the FDA. This is what was done in the Kirsch metaanalysis of AD's that was published in the Journal of Prevention and Treatment this July. They got ALL the trial resuls available thru FOIA.
Also, its my understanidng that there is NO requirement to list the negative trials, if there are any, in the PDR product labeling. In fact, you almost never see any mention of studies that do not demonstrate drug benefits in the PDR. That doesn't mean they aren't out there lurking.
Posted by mudbunny on November 5, 2002, at 17:15:41
In reply to Re: Luxapro and Wellbutrin, posted by tiredofthis on November 5, 2002, at 11:21:16
Hi, I have been taking lex10 mg with wellbutrin
200mg. No complaints at all the combo works great for me good luck.
Posted by Anyuser on November 5, 2002, at 18:35:55
In reply to Re: Lexapro 'failed' trial, posted by JLM on November 5, 2002, at 16:19:03
No offense, but how interesting would one old study be at this point? I would be much more interested in knowing whether it is efficacious and tolerable for the thousands and thousands of people taking it in a clinical setting.
Posted by JLM on November 5, 2002, at 19:25:04
In reply to Re: Lexapro 'failed' trial, posted by Anyuser on November 5, 2002, at 18:35:55
Well, the point is, we don't know how many studies they submitted for the NDA approval process. There could very well be 10 studies that show no positive effect from the drug. We don't
know because there is no requirement to publish the negative studies, and certainly Forrest wouldn't want anyone to see them. The fact that you have to submit a FOIA request to get them says a lot.Generally, it doesn't matter how many negative studies are sent to FDA for the NDA process. Prozac was approved on the basis of two positive studies. The other studies showed marginal benefits or NO benefits over placebo or impipramine. And yet the drug was still approved. As astounding as it sounds, all it takes generally is TWO POSITIVE studies to get approval, regardless of the number of negative studies submitted. Politics at FDA has a lot to do with it.
Posted by Anyuser on November 5, 2002, at 19:57:03
In reply to Re: Lexapro 'failed' trial, posted by JLM on November 5, 2002, at 19:25:04
I get confused by all the dissatisfaction with the FDA. My impression is that it's harder than hell to get a drug approved. There are interest groups that are very unhappy that drugs aren't approved more readily. Think of AIDs patients, or cancer patients. Think of all the biotech companies that go bust because they can't afford recurrent phase IIIs. Think of the posters on this board who advocate approval of a drug. On the other hand, there are people that blame the FDA because an approved drug isn't efficacious. Many posters on this board seem to be mad at the FDA for two contradictory reasons at once: approving drugs they don't like and refusing to approve drugs they want. I think by and large being steamed at the FDA is beside the point. If a drug doesn't sicken people, and there's a chance it works as intended, it seems to me the default mode should be that the FDA approves it, regulates advertising, and lets practitioners and the market figure out if it works.
Posted by Micki on November 5, 2002, at 20:21:21
In reply to Re: Lexapro 'failed' trial: I get confused, posted by Anyuser on November 5, 2002, at 19:57:03
I've been on 10 mg Lexapro for 4 weeks now and can't believe how much better I feel. I am in a stressful situation in my love life, and while a month ago I was almost wishing I was dead so I wouldn't have to face all the indecision, distress and conflict I was feeling, now it is really tolerable, even though the situation is not resolved yet. Before Lexapro I would worry and obsess about the situation almost constantly, which is no longer the case, to my huge relief. Even if I mess things up with both people, somehow it doesn't seem like it would be the end of the world.
The worst side effect I've had is feeling extremely sleepy for the first three weeks--to the point co-workers were commenting on it. Suddenly after three weeks the tiredness lessened markedly. I hope it continues this way. I take the Lexapro in the morning and may try it at night to see if that makes any additional difference.
Posted by Katarina on November 5, 2002, at 22:10:30
In reply to Re: for people taking Lex for anxiety » Katarina, posted by Brandymac26 on November 5, 2002, at 15:55:19
> > > Do you think that there are other med's out there that do work more effectively for anxiety other than ssri's? It seems like everytime I start a new drug, my anxiety gets worse, and over time the side effects get a little better, but they never fully make my anxiety go away. I take lex and xanax, and honestly, my increased anxiety (side effect) is the same as it was while I was taking the celexa. So far I dont think this is as great as everyone made it out to be. Thanks for the reply!
> >
> > -----------------------
> > I started on Prozac, having told my doctor of my depression. I failed to say that anxiety was part of it. Prozac worked like a charm for the depression but I was bouncing off the walls and it did nothing for the anxiety. After discussing more in depth my symptoms, I was given Effexor, which didn't work. Now I'm on Lexapro...it's been 3 weeks now and no great relief. I called the doc to give a report, told of my continued anxiety so he added Serax (today). I really don't know about this...I'm with you in that there must be another way. I feel as if my anxiety level is climbing, too. Perhaps we feel like guinea pigs?
> > Those of you who have tried a better approach, feel free to opine.
> > Thanks,
> > Kat
>
> What exactly is serax? I've never heard of it.
>................................................
>Serax is Oxazepam a benzodiazepine derivative therefore it's the cousin to Valium. It just makes me sleepy.
Posted by JLM on November 6, 2002, at 3:23:31
In reply to Re: Lexapro 'failed' trial: I get confused, posted by Anyuser on November 5, 2002, at 19:57:03
> I get confused by all the dissatisfaction with the FDA. My impression is that it's harder than hell to get a drug approved. There are interest groups that are very unhappy that drugs aren't approved more readily. Think of AIDs patients, or cancer patients. Think of all the biotech companies that go bust because they can't afford recurrent phase IIIs. Think of the posters on this board who advocate approval of a drug. On the other hand, there are people that blame the FDA because an approved drug isn't efficacious. Many posters on this board seem to be mad at the FDA for two contradictory reasons at once: approving drugs they don't like and refusing to approve drugs they want. I think by and large being steamed at the FDA is beside the point. If a drug doesn't sicken people, and there's a chance it works as intended, it seems to me the default mode should be that the FDA approves it, regulates advertising, and lets practitioners and the market figure out if it works.
Here's an interesting read for you:http://www.journals.apa.org/prevention/volume5/pre0050025c.html
a snippet:
"In spite of the research design flaws that may favor the drug condition, there is a huge advantage to the FDA database from a scientific perspective. The database includes all of the data from initial trials, published or not, and therefore it is not subject to the usual "file drawer" and publication biases. It would be interesting to know how many of these studies actually were published, to get an estimate of the publication bias in this literature. An indirect estimate of publication bias is possible by looking at the percentage of studies that resulted in significant differences. Antidepressants are significantly more effective than inert placebos in about two thirds of published studies (Thase, 1999). In the FDA database, Kirsch et al. (2002) found the study medication had a significant advantage over inert placebo less than half the time (in 20 of 46 trials), similar to findings from other independent analyses of the same database (Khan, Khan, & Brown, in press; Laughren, 2001). Such a pattern would be consistent with a failure to publish about 23% of antidepressant trials, presumably those showing no advantage to the antidepressant, slightly more than has been estimated in the fluoxetine literature (Gram, 1994). This is a serious problem, because clinical practice guidelines based on the published literature fail to take this distortion of the literature into account (Gilbody & Song, 2000)."
Posted by dr. dave on November 6, 2002, at 3:50:27
In reply to Question for Dr Dave, posted by bluedog on November 5, 2002, at 13:03:43
> Dr Dave
>
> I have been following this thread with much interest. ( I have taken citalopram and my mother and sister-in-law are both currently taking citalopram. I currently take fluoxetine as citalopram was just too sedating for me).
>
> I greatly respect your opinions and based on your line of reasoning I can see no reason for either myself or my relatives to switch to escitalopram.
>
> I would love to ask you a question. I noticed that SLS recently asked you about your background. Going through the posts it seems you have answered similar questions since at least August last year. On 20 August 2001 you also mentioned that you work in a little village in the mountains of Wales.
>
> My question is this........ are you the same Dr Dave as descibed by the Guardian as "director of the North Wales department of psychological medicine and the UK's foremost expert in antidepressants"? ( see http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html ) or is it just a coincidence that their are two psychiatrists in North Wales called Dr Dave who happen to be very knowledgeable about antidepressant medications?
>
> just curious
> regards
>
>
>
>
I'm very flattered but no, that's David Healy who's mentioned in the article. I actually live in South Wales. I don't think it's purely co-incidence - I think that Wales is the sort of place that attracts people who like to think independently and are generally a bit bloody-minded.Thanks for the compliment - I'm nowhere near as high flying as David Healy.
Posted by dr. dave on November 6, 2002, at 3:59:59
In reply to Re: Lexapro 'failed' trial: I get confused, posted by JLM on November 6, 2002, at 3:23:31
I have no doubts that Lexapro is an efficacious and very well-tolerated antidepressant. The point I am trying to make is that the information presented to the general public, and medical practitioners for that matter, is often very misleading. I think that in a population including lots of people with milder forms of depression, the advantages of antidepressants over placebo are a bit slim. However, if you look at people with more severe depression I think the advantage over placebo increases to something really significant.
The idea that Lexapro has the same side-effect profile as Celexa has been vigorously disputed on this board, but as the data has come out the claim has been dropped. It has also ben claimed that there have been nine 'positive' studies and no negative studies. When we look into it there is at least one 'failed' trial, and I'm not sure where all these nine trials are.
I have no doubt Lexapro works and is a good drug - it's just that we're all being misled about it.
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