Re: Guest Post: This Appalachian Life

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Didn't read the first link yet, but is it generally agreed that for congestion pseudo works and that replacement crap phenyl ephedrine is shit? I've found that to be the case, ironically the purchase restrictions make me buy when I don't need it so we always have some because I'm convinced some time I'll have a cold and the pharmacy will be closed or something.


Posted by: SP | Link to this comment | 08-17-13 11:29 AM
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Big Pharma is on the side of the angels on this one. If you prefer to think of it as a blind squirrel finding a nut, that's okay. Just keep the Sudafed available.


Posted by: Trumwill | Link to this comment | 08-17-13 11:44 AM
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Banning drug precursors has never seemed like a very solid law enforcement strategy to me, but I can't claim to have thought about it enormously hard.


Posted by: Sifu Tweety | Link to this comment | 08-17-13 11:46 AM
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Real pseudoephedrine works well for me and the replacement does not; I have some of the same hoarding behavior as SP.

I'm not done with the article yet, but it feels like I've been here before - panic about a drug epidemic! - and I am far from sure that the problem is as described or that the proposed reversion to prescription status would help. How's that other epidemic of prescription-opiate abuse going?


Posted by: Nathan Williams | Link to this comment | 08-17-13 11:48 AM
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And while I have no problem believing that an amateur meth lab is a bad place to be, the article is conflating problems with labs and problems with addiction, and I don't see any reason (in the article or elsewhere) to think that shutting down labs helps the addiction problem much. (I thought I had read that the behind-the-counter rules in 2005 had shifted a lot of production to more-organized labs already).


Posted by: Nathan Williams | Link to this comment | 08-17-13 11:52 AM
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If I have to get a prescription every time I need pseudoephedrine, I'm going to be very cranky. Now the common cold costs me a doctor's visit?


Posted by: Cala | Link to this comment | 08-17-13 12:14 PM
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Methland, mentioned in the article, is a very good book.


Posted by: Cala | Link to this comment | 08-17-13 12:20 PM
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Here is more about the electrosensitive:

http://www.slate.com/articles/technology/future_tense/2013/04/green_bank_w_v_where_the_electrosensitive_can_escape_the_modern_world.html


Posted by: lemmycaution | Link to this comment | 08-17-13 12:27 PM
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Green Bank and other areas in the National Radio Quiet Zone were genuinely isolated for decades before the arrival of cable TV and the internet, but now it is only cell phones that are really missing from daily life -- and the article is just wrong about dial-up modems being the only way to access the internet in Green Bank....


Posted by: Astronomer | Link to this comment | 08-17-13 1:20 PM
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I steal my cold medicine from stalled trains.


Posted by: Bave | Link to this comment | 08-17-13 1:21 PM
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3

Did you not find the evidence of reduced meth labs in the article plausible?

5

This was addressed explicitly in the article.

It's a problem Lieutenant Eddie Hawkins, methamphetamine coordinator for the Mississippi Bureau of Narcotics, was all too familiar with before his state passed its prescription bill in 2010. Since then the number of meth labs found in the state has fallen 74 percent. "We still have a meth problem," Hawkins says, "but it has given us more time to concentrate on the traffickers that are bringing meth into the state instead of working meth labs every night." Now, he says, they go after international criminal networks rather than locking up small-time cooks.


Posted by: F | Link to this comment | 08-17-13 1:50 PM
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Though admittedly they don't say whether going after international criminal networks is actually doing anything to reduce the availability of meth.


Posted by: F | Link to this comment | 08-17-13 1:52 PM
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Using this as a thread to post links to interesting but slightly depressing journalism, this story is very good (and talks in passing about meth production/usage as one of the problems facing small rural communities).

The only constant in her life was Carroll Academy, a school run by the Carroll County Juvenile Court. Hannah has spent parts of the last three school years there, and played the past two seasons on the girls basketball team, the Lady Jaguars, who have now lost 213 games in a row.

For nearly two decades, Carroll Academy, a one-hallway school set in the one-story wing of a former hospital, has been a catch basin for teenagers slipping through society's cracks. Through the course of a typical school year, 100 or more students from a five-county area are sent there to try to regain their footing.

Most students come for a few months. Hannah may be there a few years.

"She's one of the top 10 percent of cases here," Randy Hatch, a probation officer who has been the director of Carroll Academy since it opened, said this spring. "It's clearly from lack of parenting, not behavior problems on her behalf. We know there are two active warrants for their arrest. What if they get taken to jail? Where does she go? That's as bad as it gets."

Posted by: NickS | Link to this comment | 08-17-13 1:57 PM
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I am not very sympathetic to concerns about opiate abuse. I like to have vicodin around for when my back flares up an I resent the hoops I have to jump through to get it. charge me double and spend the excess on treatment, education, and law enforcement going after trafficers. I think something similar for meth precursors would be a good idea too.


Posted by: togolosh | Link to this comment | 08-17-13 2:09 PM
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I agree with a lot of the other comments casting doubt on the effectiveness of the prescription strategy. It certainly seems to have reduced the number of meth labs in Oregon and Mississippi, but that's not the same as reducing the amount of meth. I expect doing it on a state-by-state basis just pushes a lot of the production into other states. If a national bill were passed, I expect the main result would be a huge increase in prescription fraud along with an increase in smuggling from Mexico (which, as the article acknowledges, is already the source of most meth in the US).

The taxation idea togolosh floats in 14 is interesting and might work better, but ultimately I'm not sure there's actually a solution here. Addiction is just a hard problem to fix. Public policy is usually based on the assumption that people are at least somewhat rational about their interests, but addicts aren't.


Posted by: teofilo | Link to this comment | 08-17-13 3:10 PM
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It seems to me that we should be able to on the margins push addicts from one drug to another one. I'd say the main downside of the place we've moved is that the homeless people here are much more of a safety problem than they were other places I've lived. I assume that's because more of them are meth addicts as opposed to other drugs or alcohol.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-17-13 3:17 PM
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the largest steerable radio telescope in the world

Does "telescope" here imply "single dish", or something like that? I'm wondering why something like the VLA doesn't count. (I guess all the really long-wavelength stuff coming online like LOFAR and LWA aren't steerable?)


Posted by: essear | Link to this comment | 08-17-13 3:22 PM
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Sudafed is still the only decongestant that really works for me. It's annoying enough having them record a lot of information about me when I buy it; it would be really annoying if it becomes prescription-only. Not even just "the common cold", as Cala said, but seasonal allergies. I don't want to go to a doctor when I don't even have an infection.


Posted by: essear | Link to this comment | 08-17-13 3:24 PM
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Sudafed makes me feel like I'm literally (that's for you, nosflow) on meth -- heart jumping out of my chest, insane jumpiness, inability to sleep/focus, etc, etc. It seems to do absolutely nothing, meanwhile, for any illness. I've decided, based on my reaction, that I should definitely not start doing meth.


Posted by: Parenthetical | Link to this comment | 08-17-13 3:31 PM
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I don't understand why they need a prescription requirement when they already take all my information every time I buy Sudafed. Is that program not effective? What are they doing with all that data if not tracking down serial pseudoephedrine buyers? And if it doesn't work, why are still doing it?


Posted by: Spike | Link to this comment | 08-17-13 3:52 PM
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20: According to the article it doesn't seem to be working very well in practice, partly because people have figured out how to game it. It's not clear to me that a prescription system would work any better, though, because it could be gamed in pretty much the same ways.


Posted by: teofilo | Link to this comment | 08-17-13 3:55 PM
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I think the Mother Jones author let his knowledge of the unscrupulousness of drug companies override his knowledge that attempting to control drugs from the supply side doesn't work. Industrial superlabs do">http://m.washingtonpost.com/blogs/wonkblog/wp/2013/08/15/heres-what-breaking-bad-gets-right-and-wrong-about-the-meth-business/">do exist, and the government thinks they account for most meth consumption in the country. Tight control of sudafed just brings them closer to 100%. It would also stop the harms from home production, but those are minor compared to the costs of consumption: the Rand study linked by MJ estimates total social costs at $23 billion, but costs relating to production (explosions, poisoning, etc.) just $60 million. Even if that increased tenfold since the 2005 study data due to the single-pot method, that's less than 3%. It's telling that the author finds great reductions in meth labs based on Oregon passing such a law, and decreases in violent crime (wasn't that happening nationwide in the same years?) but says nothing about abuse rates.


Posted by: Minivet | Link to this comment | 08-17-13 3:56 PM
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Also, I've found that ephedrine is basically the only thing you and get over the counter that's effective at stopping an asthma attack. If they take that away, there will be no nonprescription options left.


Posted by: Spike | Link to this comment | 08-17-13 3:57 PM
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Also, as it turns out, the only thing you can get over the counter that's effective at stopping an attack of priapism.


Posted by: Ace K | Link to this comment | 08-17-13 4:48 PM
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I hate unnecessary doctor's visits. My PCP is never available so when I need to see someone relatively quickly I'm dumped with the doctor no one else wants to see. Last month I had a classic Lyme rash, called them to say I need a prescription of Doxycycline, they said, no, you have to come in to see someone, 10am in two days is the soonest we can do. I got there and said, "I have a Lyme rash, look," unpopular doctor said, yup, and gave me 21 days of Dox. What a waste of a $20 copay and however many hundreds they charged the insurance company and 2 hours of my work day.
Also, my mom was an author on a study that says 14 days is plenty and actually 10 days is probably sufficient so I stopped after 14 days (it was killing my stomach too.) I'm sure unpopular doctor would be horrified I didn't finish a course of antibiotics.


Posted by: SP | Link to this comment | 08-17-13 6:57 PM
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There is, in general, way too much doctor control over medicines. For example, I've had asthma for 30 years. I know what brings on attacks, I know what drugs can be used to control them, and I know which drugs can be used to substitute for other drugs which are way to damned expensive. I should be able to go down to the pharmacist and get what I need. Instead I have to kill part of a workday to schlep to a doctor and have him say "yup, you've got asthma" and make me go through a couple tests that he can charge the insurance company for. Then he gives me a prescription for a few months worth of meds, and tells me to come back when I need another. For the love of god, WHY?


Posted by: Spike | Link to this comment | 08-17-13 7:26 PM
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Yes, my wife had the same thing with her asthma. She's used the same inhaler (rarely, a couple times a year) for 20 years. But she needed a new one before going on a trip, and the doctor refused to prescribe one without an office visit. Fucking waste of time and money.
Also too birth control prescriptions requiring office visits.


Posted by: SP | Link to this comment | 08-17-13 7:29 PM
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Agreed. There's a disconnect between the clinical trial results, and individual responses to drugs. So this drug makes 10% of people better, and 10% of people worse. So it should be taken off the market? But there are many people who know it helps them. Just be careful.

I remember Theresa ?Nielsen Hayden issuing an impassioned plea of this nature about her narcolepsy(?) drug.

My employer is making everyone take physicals and fill out detailed online health forms or else face a humongous increase in our insurance premiums. People aren't happy about it. I respect the people who aren't happy about it on principle. Not so much my co-workers who say "This thing tells me that just because I'm divorced and I have 3 kids and I am highly stressed, I'm at risk for stress! Who do you think you are, online form! You don't know me!"


Posted by: Cryptic ned | Link to this comment | 08-17-13 7:39 PM
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25: In general, I don't think that handing out antibiotics on the basis of self-diagnosis is a good idea. It wouldn't take too long before most antibiotics were being used to treat rhinovirus. Which is probably the case now, but still.


Posted by: Moby Hick | Link to this comment | 08-17-13 7:59 PM
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I've been off my daily-control asthma meds for 3 months precisely because of the hassle involved of having doctors do gatekeeping. (Lately I've been using a 10-years-expired Albuterol instead, much much more often than is ideal.) It sucks, and my response isn't rational, but I just hate hate hate interacting with medical bureaucracies.


Posted by: x.trapnel | Link to this comment | 08-17-13 8:01 PM
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Also, I blame this thread for encouraging me to mainline 6 episodes of Breaking Bad instead of doing the programming homework I really need to be doing.


Posted by: x.trapnel | Link to this comment | 08-17-13 8:02 PM
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Breaking Bad meth lab Lego set. Only $250.


Posted by: JP Stormcrow | Link to this comment | 08-17-13 8:10 PM
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She used Seldane for decades, and then they banned it
Phenylpropanolamine after that, attbt
We seriously considered trips to Mexico

Now she takes some PE every day.

I need some bad enough like once a month. I hate PE. I usually use very light doses of OTC dox 6 mg, I think. And hallucinatory doses of dextromethorphan. Just kidding.


Posted by: bob mcmanus | Link to this comment | 08-17-13 8:34 PM
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Lately I've been using a 10-years-expired Albuterol instead, much much more often than is ideal.

Been there. Shady offshore pharmacies are your friend.


Posted by: | Link to this comment | 08-17-13 8:38 PM
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18: Oh, yeah, allergies, too.


Posted by: Cala | Link to this comment | 08-17-13 8:53 PM
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So this drug makes 10% of people better, and 10% of people worse. So it should be taken off the market? But there are many people who know it helps them. Just be careful.

I realize the force of this goal, but we need more accurate means of drug testing before we can feasibly make it a regulatory principle. In clinical trials, some percentage of the group is always going to respond well by random chance. Drug companies would love to use this as a camel's nose to make clearance a formality.


Posted by: Minivet | Link to this comment | 08-17-13 8:57 PM
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Maybe I shouldn't cop to these intellectual incuriosities but, as the saying almost goes, the largest telescope in the world couldn't begin to detect my interest in how the stars and galaxies formed.


Posted by: Mister Smearcase | Link to this comment | 08-17-13 10:07 PM
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Careful, Smearcase. If you keep talking that way Phil Plait will beat you up.


Posted by: teofilo | Link to this comment | 08-17-13 10:59 PM
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37: Really? I love that shit. Whenever my politics addiction drives me to despair, I try looking at some science blogs to cheer me up. (Years of overuse have made me build up a tolerance to cute animal pictures.) Though half the time the science blogs are talking about politics too.


Posted by: Walt Someguy | Link to this comment | 08-17-13 11:26 PM
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Though half the time the science blogs are talking about politics too.

Again, Phil Plait is a classic example of this.


Posted by: teofilo | Link to this comment | 08-17-13 11:27 PM
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I usually never read his blog for that very reason, but I just looked and only 1 out of his last 10 posts are about politics.


Posted by: Walt Someguy | Link to this comment | 08-18-13 12:19 AM
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Yeah, he's actually not as bad that way as some others. When he does do his political stuff, though, it gets old really fast.


Posted by: teofilo | Link to this comment | 08-18-13 12:24 AM
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26, 27 - C is asthmatic, and he can phone or email his GP surgery to request a repeat prescription. Then he (or I) has to physically pick up the piece of paper and go to the pharmacist, but most of our nearby pharmacists have arrangements with some of the local surgeries whereby they'll collect the repeat prescriptions for you, and so you just go and collect your medicine. I guess there's not so much money to be made at each step here.

We also have a walk in clinic very close that you can use if you want to see someone straightaway(ish) but can't get to a GP and it's not serious enough for A&E. Open 8-8 every day.


Posted by: asilon | Link to this comment | 08-18-13 2:32 AM
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Paper prescriptions? Boy, you've sure got a backward health care system!
29- Oh, I agree in general, but there's no reason they can't handle some things over the phone that are 100% obvious, or even by email/secure website/whatever- I'll happily email them a picture of my ass to make a diagnosis instead of having to go into the office.


Posted by: SP | Link to this comment | 08-18-13 4:42 AM
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I live so close to our doctor's surgery that I walk past it every day on my way to work, and stopping in to pick up a prescription takes about 2 minutes. We've even had our doctor drop it off to us during a snowstorm.

(I forgot where I was last time I went to the doctor and tried to go up and pay afterwards.)


Posted by: Parenthetical | Link to this comment | 08-18-13 4:49 AM
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I'm happy that we have nicer ticks. I don't think a Lyme rash would be obvious here.


Posted by: Moby Hick | Link to this comment | 08-18-13 5:12 AM
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40-42: Had never heard of the guy. Then switched over to Twitter and there at the top of my feed was this interview with him by The Register.


Posted by: JP Stormcrow | Link to this comment | 08-18-13 6:41 AM
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For example, I've had asthma for 30 years. I know what brings on attacks, I know what drugs can be used to control them, and I know which drugs can be used to substitute for other drugs which are way to damned expensive. I should be able to go down to the pharmacist and get what I need.

Similar here for extreme seasonal allergies. I also have the problem that doctors and NPs never believe me at first about how bad my allergies are, and insist that I should be able to use some lesser allergy regimen than the one I've used for decades now.

My first year of grad school, a NP from the student health services accused me of drug-seeking when I wanted an Rx for more than one month's worth of allergy eye drops. This is the same woman who, when I told her about the testing and care I'd previously received, suggested that my allergist in Missouri was a midwestern know-nothing who wasn't up on the latest in treatments.


Posted by: Blume | Link to this comment | 08-18-13 6:47 AM
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26, 48. You mean like this?


Posted by: chris y | Link to this comment | 08-18-13 6:54 AM
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Or even like this?

Bloody HTML.


Posted by: chris y | Link to this comment | 08-18-13 6:56 AM
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39 Whenever my politics addiction drives me to despair, I try looking at some science blogs to cheer me up.

Where do you find science blogs that talk about science rather than engaging in petty bickering?


Posted by: essear | Link to this comment | 08-18-13 6:57 AM
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It's my subjective impression that physicists bicker more than the life scientists, if you discount the rabid atheists.


Posted by: chris y | Link to this comment | 08-18-13 7:02 AM
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But at least when I've looked at life scientists' blogs on, say, Scientopia, they're all about obtaining grant money, not about science.


Posted by: essear | Link to this comment | 08-18-13 7:12 AM
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There's a difference?


Posted by: Moby Hick | Link to this comment | 08-18-13 7:19 AM
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In my world, people have started using "science" to mean biochemistry or bench science.


Posted by: Moby Hick | Link to this comment | 08-18-13 7:24 AM
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My mom left her carry-on on the plane when we went to Tulum in March, and all of her many meds were in it. We texted her doctor who said, "Just go to the pharmacy." And, lo, we had to hit 4 of them, but we replaced all the drugs, including crazy and dangerous things like Coumadin, at like 7pm on a Sunday night.


Posted by: oudemia | Link to this comment | 08-18-13 7:40 AM
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You could have just bought rat poison at the hardware store. Same ingredient, different dosing.


Posted by: SP | Link to this comment | 08-18-13 9:17 AM
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I used to read Not Even Wrong* pretty much solely for the petty bickering. It's not as entertaining these days as it used to be though.

*Disclaimer: I have a stat mech-ish understanding of QFT, but nothing beyond a lay person's understanding of the actual issues they bickered about, and no position re: strings vs whatever. I just thought it was fun to watch.


Posted by: AcademicLurker | Link to this comment | 08-18-13 9:18 AM
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26, 48. You mean like this?

Yup, exactly. Works the same in Germany. Though you also have to talk to the pharmacist to get basic things like aspirin, which used to be super stressful for me before I was comfortable with the vocab.


Posted by: Blume | Link to this comment | 08-18-13 11:17 AM
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Topically, I guess, I'm in West Virginia. But only for maybe another hour.


Posted by: Moby Hick | Link to this comment | 08-18-13 11:30 AM
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51: Petty bickering about science is fine. As long as it's not (real-world) politics.


Posted by: Walt Someguy | Link to this comment | 08-18-13 1:43 PM
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I remember Green Bank producing some kick-ass junior chess players. Having a town full of children of PhD's with no electronic distractions will do that, I reckon.


Posted by: knecht ruprecht | Link to this comment | 08-18-13 8:10 PM
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33: She used Seldane for decades, and then they banned it
Phenylpropanolamine after that, attbt
We seriously considered trips to Mexico
Now she takes some PE every day.

This is very close to being the first verse of a great song in the Zevon/McMurty vein (and I actually thought it was lyrics on first read). Ladies and gentlemen, it's bob mcmanus with "Precursor Blues".


Posted by: ajay | Link to this comment | 08-19-13 2:41 AM
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63: ajay, I thought the very same thing.
37: mr. smearcase, you're making 12-year-old al, who was obsessed with astronomy, very sad. present me, even. how can you not find it endlessly fascinating? this is like when people tell me they just don't particularly care about music...how? what?


Posted by: alameida | Link to this comment | 08-19-13 7:06 AM
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37, 64:

Two things fill my soul with fresh and growing admiration and reverence, no matter how often or at what length I ponder them: the starry sky above me and the moral law within me ... and I'm all out of moral law within me!


Posted by: x.trapnel | Link to this comment | 08-19-13 11:15 AM
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65: love to comment; DO HOMEWORK to commenter. (and yes I need to take my own advice.)

I'm impressed by the unanimity of the views on Sudafed, which I share.


Posted by: lurid keyaki | Link to this comment | 08-19-13 11:41 AM
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37: Maybe it would help if you realized that that's not the sort of thing you use a telescope for?


Posted by: Benquo | Link to this comment | 08-19-13 11:49 AM
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64.2: indeed. Fair enough being a child-hating monster, Smearcase, but not being interested in astronomy either? Good God, man.


Posted by: ajay | Link to this comment | 08-20-13 2:04 AM
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