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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 81. This is the beginning of the thread.
Posted by Sobriquet Style on March 30, 2006, at 7:28:25
I want to, would very much like to see : ) medical evidence - medical studies conducted which can pose serious doubt as to what is stated here:
"Tolerance to the anxiolytic effects develops more slowly but there is little evidence that benzodiazepines retain their effectiveness after a few months. In fact long-term benzodiazepine use may even aggravate anxiety disorders. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use, and panic attacks and agoraphobia may appear for the first time after years of chronic use. Such worsening of symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects, so that "withdrawal" symptoms emerge even in the continued presence of the drugs. However, tolerance may not be complete and chronic users sometimes report continued efficacy, which may be partly due to suppression of withdrawal effects."
http://www.benzo.org.uk/manual/bzcha01.htm
Theres studies I've come across which only appear to validate this information. Some studies were slightly better, but conducted in the early 1980's, when less was known. I fully know that Prof. Ashton's view on this matter is very one-sided to say the least and doesn't put this group of drugs in its best light. The only positive thing I read on her site was that her qualifications and experience was impressive.
I know theres many on this board who have been taking Benzo's for long periods of time and can safely say that they have not lost the anxiety effects to these drugs. However, in order to get my doctor to prescribe one of these drugs (i'm going to ask for low dose Diazepam) I have a strong feeling he's answer will be "No" (I mentioned the drugs a long time ago and this was the response, but back then I knew little of what I do now) This said, I also know through experience with my doctor that if I can show him hard medical data - new studies - he will more than likely give a "Yes" answer.
I think the withdrawal and abuse potential is something that is a fact with the drugs, for some. However I am not one to abuse drugs, which will be clearly stated to him, and because I wish to use this drug longterm until something better comes along, withdrawal is not something i'll be going through anytime soon. Any evidence that puts these two factors in a better light too is good though, but the anxiety tolerance I feel is the main information I need.
If anyone can provide positive, new, evidence which shows that Diazepam can work for anxiety long term, hopefully I won't have to change doctor, which will not be easy.
Many thanks in advance to anyone who can provide as many high quality studies as possible!
~
Ps reminder Ace ;-)
Posted by krybrahaha78 on March 30, 2006, at 8:38:55
In reply to Tolerance to Benzo Anxiety Effects, posted by Sobriquet Style on March 30, 2006, at 7:28:25
dont know about diazepam--but i have been taking klonopin for my anxiety for about 6 months now and have not had any tolerance issues at all. It still works like the first day i tried it. For some reason though, i keep hearing that tolerance is NOT an issue with klonopin as with the other benzodiazepines.
Posted by Phillipa on March 30, 2006, at 21:41:22
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by krybrahaha78 on March 30, 2006, at 8:38:55
I don't know what to say. Since the 1970's when I started on valium for panic attacks they really worked well. So well in fact that I went on to go to nursing school divorce, raise three kids and run an Aerobics Dance business at the same time. Deans list graduated magna cum laude. Then ativan came out and I took that for years then xaxax which worked the best low dose down to .125mg at bed at one time. Then there was klonopin which depressed me. So back to the xaxax and it still worked. Then I went on Diability after my thryroid quit working and at the same time so did the benzos. Enter SSRI's and for two years l0mg of paxil with xanax worked well. I forgot to mention all this time I was drinking either beer or wine 5-6 cornaoas at night. When I stopped the drinking I became depressed and havent't worked since and the benzos don't work the same at all. Anyone have any possible reason for this. As right now I'm seriously thinking of getting off the luvox, valium(NOW) and starting to drink again as I felt well then. Love Phillipa
Posted by yxibow on March 31, 2006, at 0:38:59
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by Phillipa on March 30, 2006, at 21:41:22
Well, I have been on high dosage Klonopin, which I tapered over to Diazepam. It works enough to a degree to control part of my complex anxiety disorder. It has quite a half life, at least 24 hours, and metabolites, so despite the bad press about Valium experiences, I would say its less likely to generate tolerance due to its long half life. It does have some immediacy effects, much more than Klonopin, but not nearly as "gratifying" as Xanax, which really should be a PRN medication for the most part.
Some doctors are simply benzophobes, they are in my opinion, in a proper dosing scheme, one of the safest psychiatric medications as we have more than 40 years of experience with them, especially Valium. Now tapering up and down is important -- but of course, if you haven't noticed, the benzo.org.uk site is largely directed to getting EVERYBODY off of benzodiazepines which is not proper practice. The site is run by someone independent to the doctor he professes as far as I can tell.
Tidings
- J
Posted by Sobriquet Style on March 31, 2006, at 11:11:26
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by krybrahaha78 on March 30, 2006, at 8:38:55
>but i have been taking klonopin for my anxiety for about 6 months now and have not had any tolerance issues at all.
:-)
>i keep hearing that tolerance is NOT an issue with klonopin as with the other benzodiazepines.
Thats very interesting, hope diazepam is the same.
~
Posted by Sobriquet Style on March 31, 2006, at 11:18:10
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by Phillipa on March 30, 2006, at 21:41:22
>When I stopped the drinking I became depressed and havent't worked since and the benzos don't work the same at all.
Do you still gain benefits from the diazepam? Perhaps the beer was potentiating the benzo's..
>starting to drink again as I felt well then.
I've noticed that people I know without 'psychiatric' problems eg. don't see a psychiatrist and never have been on the medication, all get along fine with drinking as their medication if you like. some don't drink at all obviously, but to the ones that do it seems to be the thing that gives them stability using a strange meaning for the word. I don't know, you can run into problems longterm, but some people are able to drink moderatey for years with no worries.
~
Posted by Sobriquet Style on March 31, 2006, at 11:27:56
In reply to Re: Tolerance to Benzo Anxiety Effects » Phillipa, posted by yxibow on March 31, 2006, at 0:38:59
>Some doctors are simply benzophobes, they are in my opinion, in a proper dosing scheme, one of the safest psychiatric medications as we have more than 40 years of experience with them, especially Valium.
I agree wholeheartly. Do you think out of all the benzo's, valium is the safest, short and long term?
>the benzo.org.uk site is largely directed to getting EVERYBODY off of benzodiazepines which is not proper practice.
Yes exactly, theres not hardly a postive word spoke about any of the benefits of the drugs. Its all focused on withdrawals completely. I think thats something to be aware of for sure, but in moderation would be better and not solely overemphasizing on the dangers. I mean you could equally have a site dedicated to effexor withdrawal, even topamax withdrawal.
Espeically when you bear in mind her type of work with the drugs was "Her main clinical work was in running a benzodiazepine withdrawal clinic for 12 years from 1982-1994." The site could use some improvements bringing a middle ground to the subject.
>The site is run by someone independent to the doctor he professes as far as I can tell.
I think you're right :-)
~
Posted by yxibow on March 31, 2006, at 14:11:40
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by Sobriquet Style on March 31, 2006, at 11:27:56
> >Some doctors are simply benzophobes, they are in my opinion, in a proper dosing scheme, one of the safest psychiatric medications as we have more than 40 years of experience with them, especially Valium.
>
> I agree wholeheartly. Do you think out of all the benzo's, valium is the safest, short and long term?There's always a definiton of safe. I take a high amount of Valium for a noxious anxiety commplex disorder, but my level of metabolism may not be your level at all.
Safe is, of coure monitoring for signs of habituation (escalation of dose) (I don't ascribe to the "addictive" view, unless one already has an addictive genetics or tendency), and only gradually going up or down on dosage.
Benzodiazepines are much safer than the barbiturates they replaced, but can still cause respiratory depression mostly usually if someone combines them with a fair amount of alcohol.
Doesn't say you can't have a drink now and then but they're all CNS depressants (alcohol, and OTC things, benadryl, etc..)
Most people would probably take in the 10-40mg range, maybe topping at most at a high range of 80mg/dy (equivalent to 4mg Klonopin.)
But to get back to your question, yes, I do think so, with the caveat that since everything goes through P450 in the liver, Valium is metabolized at 3A4 so drugs that use 3A4 may cause a lower level of Valium in your blood and they may have to be adjusted. But these are common issues, 1A2, etc. I'm getting a bit over the top probably, but that's the gist. In summary, its 24+ hour half life makes removal from the system easier and yes I do think it is one of the safer ones long term. There are people still taking it since it came out in 1962. (It was the 2nd benzo, Librium came out in 1960.)
Cheers-- J
Posted by Sobriquet Style on April 2, 2006, at 7:51:23
In reply to Re: Tolerance to Benzo Anxiety Effects, posted by yxibow on March 31, 2006, at 14:11:40
Posted by Sobriquet Style on April 2, 2006, at 7:54:40
In reply to Tolerance to Benzo Anxiety Effects, posted by Sobriquet Style on March 30, 2006, at 7:28:25
Re: "If anyone can provide positive, new, evidence which shows that Diazepam can work for anxiety long term, hopefully I won't have to change doctor, which will not be easy."
I've read over 200 studies - really need your help guys, if you know of some studies please link them!
~
Posted by ed_uk on April 2, 2006, at 13:30:36
In reply to Someone Prove Ashton Wrong!!!!!!!!!!....Please!, posted by Sobriquet Style on April 2, 2006, at 7:54:40
Hi!
Here is a list of studies posted by Elizabeth in 2001. Most studies relate to the use of alprazolam in panic disorder. There is more long term efficacy data for benzos in panic disorder than in other anxiety disorders.....
J Clin Psychopharmacol 1998 Dec;18(6 Suppl 2):12S-18S. Panic disorder: long-term pharmacotherapy and discontinuation. Rickels K, Schweizer E.
Neuropsychopharmacology 1995 Apr;12(2):147-57. Benzodiazepine sensitivity in panic disorder: effects of chronic alprazolam treatment. Cowley DS, Roy-Byrne PP, Radant A, Ritchie JC, Greenblatt DJ, Nemeroff CB, Hommer DW.
Arch Gen Psychiatry 1993 Jan;50(1):51-60. Maintenance drug treatment of panic disorder. I. Results of a prospective, placebo-controlled comparison of alprazolam and imipramine. Schweizer E, Rickels K, Weiss S, Zavodnick S.
Int Clin Psychopharmacol 1993 Summer;8(2):115-8. Three-year follow-up of patients with panic disorder after short-term treatment with alprazolam and imipramine. Lepola UM, Rimon RH, Riekkinen PJ.
J Psychiatr Res 1993;27 Suppl 1:127-42. Maintenance drug therapy of panic disorder. Curtis GC, Massana J, Udina C, Ayuso JL, Cassano GB, Perugi G.
J Clin Psychopharmacol 1992 Oct;12(5):352-4. Discontinuation of alprazolam after long-term treatment of panic-related disorders. DuPont RL, Swinson RP, Ballenger JC, Burrows GD, Noyes R, Rubin RT, Rifkin A, Pecknold JC.
Arch Gen Psychiatry 1989 Nov;46(11):993-9. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Nagy LM, Krystal JH, Woods SW, Charney DS.
Acta Psychiatr Scand Suppl 1987;335:39-46. Pharmacology of the benzodiazepines; with special emphasis on alprazolam. Soderpalm B.
Hope this helps.......
Ed
Posted by Sobriquet Style on April 2, 2006, at 18:08:44
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » Sobriquet Style, posted by ed_uk on April 2, 2006, at 13:30:36
>Here is a list of studies posted by Elizabeth in 2001.
:-) Elizabeth wrote some interesting posts all those years ago..
>There is more long term efficacy data for benzos in panic disorder than in other anxiety disorders.....
I think basically my condition is somewhat comorbid, bipolar/anxiety/panic. I've been mainly treated for bipolar, so the relief I hope to get from the benzo's, well, time will tell I guess.
>Hope this helps.......
It certainly does, thank you :-)
~
Posted by ed_uk on April 3, 2006, at 13:53:18
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » ed_uk, posted by Sobriquet Style on April 2, 2006, at 18:08:44
Hi
Have you ever tried chlordiazepoxide (Librium)? Chlordiazepoxide is easier to taper than most benzos (similar to diazepam). The advantage of chlordiazepoxide is that it apparantly has a lower 'street value' than the other benzos......and so your doc may be more comfortable prescribing it.
Chlordiazepoxide is not a good PRN benzo, it doesn't 'kick in' as quickly as Xanax or Valium. It is, however, a logical choice if a benzo is to be taken daily for several weeks or more.
As with all anxiolytic benzos, it's efficacy beyond 4 months is unclear.
Regards
Ed
PS. How do you like clonazepam (Klonopin, Rivotril)?
Posted by yxibow on April 3, 2006, at 14:58:55
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » Sobriquet Style, posted by ed_uk on April 3, 2006, at 13:53:18
> Hi
>
> Have you ever tried chlordiazepoxide (Librium)? Chlordiazepoxide is easier to taper than most benzos (similar to diazepam). The advantage of chlordiazepoxide is that it apparantly has a lower 'street value' than the other benzos......and so your doc may be more comfortable prescribing it.
>
> Chlordiazepoxide is not a good PRN benzo, it doesn't 'kick in' as quickly as Xanax or Valium. It is, however, a logical choice if a benzo is to be taken daily for several weeks or more.
>
> As with all anxiolytic benzos, it's efficacy beyond 4 months is unclear.
>
> Regards
>
> Ed
>
> PS. How do you like clonazepam (Klonopin, Rivotril)?
>
Librium is like about 1/10 of the resulting potency of Valium, which is why Valium became the default when Librium was released around 1959-1960 and Valium became the seller in 1962. Librium is still used for alcohol detox, I guess primarily because its so weak that abuse by patients would be inhibited. Valium doesnt have, at least in the US anyway, nearly the street value of Xanax, and Klonopin I doubt has much at all.
Posted by ed_uk on April 3, 2006, at 15:20:23
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » ed_uk, posted by yxibow on April 3, 2006, at 14:58:55
Hi Yxi
>Librium is like about 1/10 of the resulting potency of Valium
Diazepam is about 4 times more potent than chlordiazepoxide. In the treatment of anxiety, the usual maximum dose of chlordiazepoxide is 100mg per day ie. about 25mg diazepam - which is probably an adequate dose for most people. Chlordiazepoxide comes in 5mg, 10mg and 25mg capsules. Chlordiazepoxide is not a good choice for people who require high doses of benzodiazepines.
>its so weak
It's ideal for people who respond well to low doses of benzodiazepines. Also, the 5mg capsules are very convenient for tapering.
>abuse by patients would be inhibited
Chlordiazepoxide has a gradual onset, it doesn't suddenly 'kick in'. This may result in a lower recreational value. Doctors see this as a bonus.
>alcohol detox
It's used a lot for detox here in the UK. If it really was so 'weak' it wouldn't be useful for detox.
>Valium became the default when Librium was released around 1959-1960 and Valium became the seller in 1962
I think Librium was popular for a long time.
Regards
Ed
Posted by Phillipa on April 3, 2006, at 21:53:34
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » yxibow, posted by ed_uk on April 3, 2006, at 15:20:23
Well no wonder it didn't work when I originally started on valium in the 70's. The doc tried to switch me to librium but nothing. Back to valium. It does lose it's relaxing properties over the years but they last for a lot of years not months. I'll be the rat that is the test subject. Love PJ O
Posted by yxibow on April 4, 2006, at 1:15:17
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » yxibow, posted by ed_uk on April 3, 2006, at 15:20:23
> Diazepam is about 4 times more potent than chlordiazepoxide. In the treatment of anxiety,5, http://en.wikipedia.org/wiki/Diazepam, and http://www.dr-bob.org/tips/bzd.html, though we won't quibble :)
> I think Librium was popular for a long time.
http://www.guardian.co.uk/medicine/story/0,,1583671,00.html
And then it earned its bad reputation, but both have long half lives, Valium the longest, and thus less likely for abuse.
Posted by ed_uk on April 4, 2006, at 15:57:59
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » ed_uk, posted by yxibow on April 4, 2006, at 1:15:17
Hi Yxi
>5
You said 10, I said 4. Some people say 3. I'm not sure what you're getting at here. 4 seems like a reasonable compromise between 3 and 5. It's only an approximation of course, and shouldn't be taken too seriously. It will vary from person to person anyway.
>both have long half lives, Valium the longest, and thus less likely for abuse
Diazepam and chlordiazepoxide are both metabolised to desmethyldiazepam. The likelihood of 'abuse' doesn't generally have much to do with half life, it's got more to do with whether or not a drug 'kicks in' suddenly and rapidly or not. Drugs with a rapid onset of action have greater recreational value eg. alcohol.
Ed
Posted by yxibow on April 5, 2006, at 0:57:21
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » yxibow, posted by ed_uk on April 4, 2006, at 15:57:59
> Hi Yxi
>
> >5
>
> You said 10, I said 4. Some people say 3. I'm not sure what you're getting at here. 4 seems like a reasonable compromise between 3 and 5. It's only an approximation of course, and shouldn't be taken too seriously. It will vary from person to person anyway.Exactly. Some sources have said up to 10, thats why I said 10. I corrected to 5 from the first table in the dr-bob benzo list which I see as mostly accurate from my experience with benzodiazepines.
>
> >both have long half lives, Valium the longest, and thus less likely for abuse
>
> Diazepam and chlordiazepoxide are both metabolised to desmethyldiazepam. The likelihood of 'abuse' doesn't generally have much to do with half life, it's got more to do with whether or not a drug 'kicks in' suddenly and rapidly or not. Drugs with a rapid onset of action have greater recreational value eg. alcohol.Exactly, which is why Librium is used for alcohol abuse situations because it does not have nearly the kick and strength of Valium, which is why Valium really became the drug of choice of the brain child of Leo Sternbach.
However, Valium these days has lost its street value for the most part, this isnt the 70s -- Xanax is much higher I would bet.
And you're right about the metabolism, Librium has 4 metabolites though, that is just one of them. Valium has 3, two in common with Librium.
But that doesn't stop my belief that Ashton, or rather, the website that the person created who quotes her, is dangerous.
And being a UK site, it perhaps reflects the position of doctors in your country towards a medication class that while in some people can be habituated towards, helps millions of people around the world.
I still (yes I disclose that I take high dose Valium and thats a concern, but a possible necessity at the moment) believe that under the care of the right doctor, benzodiazepines are among the safest psychoactive drugs purely due to their very long history, over barbiturates, reducing the chance of overdosage.
As we examine drug classes closer and closer to the present, we are in a state of flux. TCAs, probably about the same, 50 years, with imipramine.
SSRIs, about 20-25 years, old line antipsychotics, 50 years, atypical antipsychotics, 40 years or so with Clozaril, around 10 years with Risperdal, and its followers.
Who knows what will be the drug of tomorrow -- but we can only estimate patient years in studies, in vitro -- in vivo of course is post marketing
Cheers
-- Jay
Posted by naughtypuppy on April 5, 2006, at 10:01:56
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » Sobriquet Style, posted by ed_uk on April 3, 2006, at 13:53:18
Actually I've got a prn presription for chlordiazepoxide and can feel the effects fairly quickly (within a couple of hours). I didn't care for using it chronically though. It caused bruxism, anorgasmia and dental pain after a while. I discontinued entirely on my own accord. A good technique for tapering is to dissolve the capsule in 100ml of water and drink half of it every day. Next week, double the amount of water, but drink the same volume and so forth. This prevents you from having to buy different strengths just to wean yourself off the med (ever notice that different stregths are about the same price? defies logic doen't it?). No discontinuence symptoms whatsoever, so at least in my mind Ashton is just a fear monger who likes the attention. I can still use benzos prn with no problems.
Posted by ed_uk on April 5, 2006, at 13:44:17
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » ed_uk, posted by naughtypuppy on April 5, 2006, at 10:01:56
Hi
>Actually I've got a prn presription for chlordiazepoxide and can feel the effects fairly quickly (within a couple of hours).
A couple of hours is fairly slow compared with the rapid-acting benzos like Valium and Xanax. Most people feel them start to work in less than an hour.
Kind regards
Ed
Posted by ed_uk on April 5, 2006, at 13:48:10
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please! » ed_uk, posted by naughtypuppy on April 5, 2006, at 10:01:56
>ever notice that different stregths are about the same price? defies logic doen't it?)
This is particularly true of a lot of very expensive new meds eg. 30 caps 200mg £60, 30 caps 400mg £60.
When it come to drugs like Viagra and Cialis, people can safe a lot of money if they purchase a pill splitter!
Regards
Ed
Posted by ed_uk on April 5, 2006, at 13:59:41
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » ed_uk, posted by yxibow on April 5, 2006, at 0:57:21
Hi Yxi
>Some sources have said up to 10, thats why I said 10
I never read that before! Most sources say 3 or 5! ......which is why I tend to say 4.
>Exactly, which is why Librium is used for alcohol abuse situations because it does not have nearly the kick and strength of Valium, which is why Valium really became the drug of choice of the brain child of Leo Sternbach.
But if someone is taking a benzo on a daily basis they don't need to feel it 'kick in'. They need a drug which provides continuous 24hr relief of anxiety. Chlordiazepoxide can fulfill this role for patients who do not require a high dose of a benzodiazepine. It doesn't really matter whether they are taking 20mg diazepam or 80mg chlordiazepoxide.
Diazepam is, as we have already noted, a better PRN than chlordiazepoxide. I wasn't recommending chlordiazepoxide as a PRN, I was simply suggesting that it was an alternative to diazepam in the treatment of chronic anxiety.
Ed
Posted by yxibow on April 6, 2006, at 1:20:53
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » yxibow, posted by ed_uk on April 5, 2006, at 13:59:41
> But if someone is taking a benzo on a daily basis they don't need to feel it 'kick in'. They need a drug which provides continuous 24hr relief of anxiety.True, you are correct -- I didn't mean the kick of Xanax, a more subtle one. I can notice differences between Valium and the previous Klonopin in terms more of anxiety relief. Maybe its the placebo syndrome, but if so, so what. And it does provide continuous 24 hour relief, past 24 hours actually though I take it twice daily because I took Klonopin twice daily too and the extra curve of onset at different times of the day helps, in my opinion. But that's just my case. Others will obviously vary tremendously since I have a special syndrome :/.
Chlordiazepoxide can fulfill this role for patients who do not require a high dose of a benzodiazepine. It doesn't really matter whether they are taking 20mg diazepam or 80mg chlordiazepoxide.
Mostly.... metabolites of diazepam are a little stronger I think, since Restoril is among them, I think it is not among Librium -- but no need to quibble. :)>
> Diazepam is, as we have already noted, a better PRN than chlordiazepoxide. I wasn't recommending chlordiazepoxide as a PRN, I was simply suggesting that it was an alternative to diazepam in the treatment of chronic anxiety.mmph... I would say Xanax or Ativan provides better PRN relief for onset time. Librium really is a fading drug, certainly here in the US I think except for some esoteric alcohol abuse reduction.
Posted by ed_uk on April 6, 2006, at 14:42:00
In reply to Re: Someone Prove Ashton Wrong!!!!!!!!!!....Please » ed_uk, posted by yxibow on April 6, 2006, at 1:20:53
Hi Yxi
>I would say Xanax or Ativan provides better PRN relief for onset time.
I find that diazepam works more quickly than lorazepam.
>Librium really is a fading drug, certainly here in the US I think except for some esoteric alcohol abuse reduction.
Diazepam is a fading drug in the US too, but that does not mean that it's valueless!
Regards
Ed
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Dr. Bob is Robert Hsiung, MD,
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