Re: Special Snowflakes

1

This probably says everything there is to say about me as a person, but should I know what brand name-brand rubbing alcohol is? Also, how many doctors stock their own first aid kits versus having spouses or employees do the shopping? Also also, I'm pretty sure most doctors have more disposable income than I do, though perhaps that means they should be less likely to squander it on more expensive medicines.


Posted by: Thorn | Link to this comment | 07-26-14 8:37 PM
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I'm very cheap and only buy OTC generics. Growing up my parents were cheap and did the same. On the few occasions I've used non-generics, I've noticed a difference. Not in every occasion, but there are at least two distinct occasions where I got noticeably better results with the non-generics.* And in every case, the non-generic is easier to use--easier to swallow, tastes better, less fiddly, etc. I still can't bring myself to pay more and can live with buying bitter horsepills to save money, but it is true that at least with OTC medicines generics really are the factory outlet version. (Which isn't to say they don't work or aren't as overall effective or if you're looking to save money you shouldn't buy them. However if I were really wealthy, I would buy brand name version.)

*E.g. one was a pain medication. The same dose of generics gives me a mild upset stomach and takes about 45 minutes to work. The brand name went goes down like a breeze with no stomach problems and worked in about 20 minutes.


Posted by: Buttercup | Link to this comment | 07-26-14 9:39 PM
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People in the pharmaceutics biz no longer buy me lunch every Friday so now I'm less likely to believe what they say.


Posted by: Moby Hick | Link to this comment | 07-26-14 10:11 PM
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Sounds like they dumped you in favor of ogged.


Posted by: teofilo | Link to this comment | 07-26-14 10:27 PM
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Tempted to make a cheap point about intellectual property that I don't really believe just to rile up anger and provoke conversation, but I'm past "trolling" and into "Tourette's style insulting," so fuck you all, shitmunchers. Have a good night.


Posted by: Robert Halford | Link to this comment | 07-26-14 10:59 PM
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Non-confidential to LB:

I have to flake on chapter 11 of Piketty. I'm sitting in an airport at 5 AM (been up since 3:30) and I'm just going to be too worn out to write up a summary after I get home at whatever time it will be when I get there. I have been catching up and can take an even later chapter.


Posted by: fake accent | Link to this comment | 07-27-14 2:14 AM
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On topic, am I wrong that some brand-name versions of drugs include things that can counter common side-effects of the drug? That is, if a pain medication is known to cause an upset stomach and there's a way to counter that which doesn't affect the effectiveness of the drug, it may be added to the combination that goes into the brand-name pill?

I may have made this up in the last few minutes. Needless to say, I have not read the link in the post.


Posted by: fake accent | Link to this comment | 07-27-14 2:19 AM
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The parenthetical at the end of the OP seems to be in significant tension with the OP's overall thesis, unless you assume that doctors value their own health more than that of their patients.


Posted by: teofilo | Link to this comment | 07-27-14 2:39 AM
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I had this problem with an anriconvulsant. Mylan was ok, but Dr. Reddy sucked. My insurance uppped the co-pay on the brand name so much that I went back to the generic, but I always make sure to go to Walgreens, because they carry Teva which works fine.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 4:05 AM
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anti-convulsant


Posted by: Bostoniangirl | Link to this comment | 07-27-14 4:07 AM
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The bupropion case is special, because it had to do with the mechanism of sustained release. I think that the Teva version wasn't exactly sustained gradually, more like taking an immediate-release version 2-3 times per day.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 4:14 AM
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I think I heard someplace that there is a tendency for pharmaceutical companies to wait until a compound is about to go off-patent, then make a slight improvement to the formula so the patent can be reset again. So, the name-brand moves on to a formula that doesn't make you have an upset stomach, while the generic form is stuck with the version that does.


Posted by: Spike | Link to this comment | 07-27-14 5:15 AM
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seems to be in significant tension

That's because the whole post is pretty squirrelly. Note that I don't actually offer an opinion on Drum's question of why doctors buy name brand drugs for themselves, and I don't even say that most doctors know that the generic and branded drugs can differ significantly. (My natural tendency to elide nuance for the sake of keeping things punchy is exacerbated by the fact that I usually have about five minutes to put up a post.) As for the final parenthetical, even in the case of doctors who do know that the generic can differ, there's no systemic data to guide them, so simple expedience will have them try another drug or class of drugs if something doesn't work.


Posted by: ogged | Link to this comment | 07-27-14 5:22 AM
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because they carry Teva which works fine

A dealbreaker for ogged, though.


Posted by: Jesus McQueen | Link to this comment | 07-27-14 5:28 AM
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No no, it was No Sandals for whom they were a dealbreaker. I actually own a pair of Tevas. They complement my hairy toes.


Posted by: ogged | Link to this comment | 07-27-14 5:45 AM
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I must have misremembered. I thought you didn't like them on women, but maybe that was just Russian women.


Posted by: Jesus McQueen | Link to this comment | 07-27-14 5:58 AM
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13: It's also really hard to try a different version. I used to use Cigna's mail-order, because I paid one co-pay for a 3 months supply. Every time I got a different generic. (At first it was Teva, because they were the first to market.) GSK's brand costs about $600/month, Teva's generic is $100, but there are others which are about $25. Guess who's get carried. They couldn't take a request for a specific generic. You could request brand-name only, but that's it.

They then went to 2 co-pays for 3 months instead of 1 co-pay and made the drug non-preferred brand. So, instead of $25 for 3 months it became $125. (Which is actually 2.5 co-pays for 3 months even though it's 2 co-pays per 3 months for everythign else). I found out that Walgreens carries Teva exclusively through a bunch of internet boards and am sticking with them for now, but doctors aren't really set up to prescribe a particular generic, and I don't know how I could request one anywhere else.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 6:08 AM
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Russian women have hairy toes.


Posted by: Moby Hick | Link to this comment | 07-27-14 6:44 AM
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7.1/12: This is an unsatisfying answer, but it depends on whether the extra bit is considered an "active ingredient." The FDA maintains a database of additives considered inactive. Package inserts and patents have a list of inactive ingredients used in a drug formulation, but not in what proportion. Sometimes the inactives are a significant fraction of the manufacturing cost, so the generic manufacturer will use cheaper. It's entirely possible that an inactive ingredient mitigates a side effect.

Spike in 12 has it right that different formulations can be patented as improvements (eg a once a day pill instead of 4X a day) to extend patent life. It is also true that it's possible to combine two drugs into one pill for a new patent (amoxicillin-clavulanic acid is an example of this).

17 is crappy. I'm a little nuts about where my generics come from, but maybe it's not just me. CVS seems pretty good about where they buy their generics but I'm usually getting basic antibiotics, nothing fancy. Teva is usually quite good, so I hope it spurs the FDA to look more closely at their standards for generics.

I'll admit to liking the brand name Advil because their coating lets me swallow them easily when I don't have a drink handy.


Posted by: ydnew | Link to this comment | 07-27-14 7:11 AM
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The other thing that's weird is that the U.S. FDA inspects production plants in the US but not abroad. That means that Indian and Chinese manufacturing facilities who are exporting pharmaceuticals to the US are not inspected by the FDA. (See ydnew's link above.) I don't know where Teva does its manufacturing, but it's an Israeli company, and I trust their capacity to regulate food and drugs more than China's.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 7:56 AM
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That article also confirms my personal experience that Dr. Reddy generics are absolute crap.

As an aside, drugs.com has a cool pill identifier that will help you figure out who manufactured your pill and tell you what it is.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 8:00 AM
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19: CVS was okay, but I switched to Walgreens, because they were always switching up this particular drug. I also really like the pharmacist at my local Walgreens who has given me useful advice and seems well-informed.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 8:02 AM
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I had to buy generic acetaminophen with caffeine without aspirin, and there is no brand-name version of that.

I used to buy generics for those OTC thing, but my BF is irrationally attached to brand-name drugs, because he works for PHRMA. (Not totally irrationally, since he's a chemist.) So I just let him buy the Advil brand at Costco.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 8:07 AM
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What ydnew said in 19. I haven't noticed any differences in effectiveness but there sure are differences in coatings and ease of swallowing. Some of Costco's generics seem to have Velcro hooks on the outside; for a while there I thought I'd embarked on the Parkinson's road to hell.


Posted by: biohazard | Link to this comment | 07-27-14 8:31 AM
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20: I think the FDA inspects manufacturing abroad, but they're badly understaffed (so inspection intervals are long) and generally don't show up unannounced. They also don't have the staff or facilities to independently verify data provided by manufacturers.


Posted by: ydnew | Link to this comment | 07-27-14 9:04 AM
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I think the problem is yes, generics can work differently, but that's not something in the realm of what gets studied often, and also psychosomatic effects could plausibly account for a lot of it. Also brand-names can be contract-manufactured abroad - I'd guess they have better controls what with the reputation premium, but only on average.


Posted by: Minivet | Link to this comment | 07-27-14 9:14 AM
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26: I agree with that, and I never would have taken the claim seriously except that I didn't identify that it wasn't working as well. My BF noticed the difference.


Posted by: Bostoniangirl | Link to this comment | 07-27-14 9:59 AM
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Bostoniangirl is exactly right in 17: the only real problem with generics is that pharmacies don't let you request specific ones and won't always stock the same one. Of course if they did that it would probably just eliminate name brands entirely. This is especially true with drugs where one of the generic versions is manufactured by the same company that manufactures the name brand version (ie, all of them). They don't usually run two separate production lines, after all. So with generics it's hard to maintain consistency (if some pill is just weaker or whatever you could always raise the dose a bit, but if you're shuttling back and forth between one that is weaker and one that is stronger at the same nominal dose it can cause issues).

The problem with Bupropion, from what I know, is that the name brand (and also the generic brand released by Watson Pharmaceuticals, which was the name brand but without "Wellbutrin" printed on the pills) released the drug slowly because the pills were (generally lazy/not especially scientific understanding) coated with a fine mesh and the drug could only move out of the pill slowly. The Teva version was made with a binding agent that dissolved very slowly (and the drug was distributed evenly through it). The problem was that at 150mg the release rate was almost exactly equivalent and someone at the (underfunded, etc) FDA checked off the bioequivalence box on the approval form as a result, without considering that a difference could show up at the 300mg level. But a 300mg pill is larger than a 150mg pill, and one of the mechanisms is a lot more affected by surface area more than the other, so the 300mg pill ended up releasing the drug at a noticeably different rate.*


*(I actually experienced this first hand since I took one and then took the other and the Teva one felt like it kicked in noticeably stronger/faster and then dropped off a lot harder later on. I just checked in with the local pharmacies until I found one that was stocking the one I'd been using before. Then about a month later the FDA finally gave in on the issue and I went back to the pharmacy I liked more.)


Posted by: MHPH | Link to this comment | 07-27-14 10:05 AM
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The difference between how doctors act about generic painkillers, though, could just be a result of the fact that naproxen, ibuprofen, etc. are all names of the active ingredient whereas alka-seltzer is a combination of various ingredients. If you think "I should pick up some aspirin (or ibuprofen)" you're just going to go to the store and pick (probably) the cheapest pill containing aspirin or ibuprofen (without looking I can't actually remember the name brand for most NSAIDs). But if you think "I should go pick up some alka-seltzer" you're unlikely to look at the shelf and think "now which effervescent painkiller and antacid should I buy", which is exactly the sort of small psychological difference that ends up having significant effects on behavior and making people look strange as a result.


Posted by: MHPH | Link to this comment | 07-27-14 10:11 AM
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So if Alka-Seltzer makes water fizzy (in addition to its other ingredients), why can't we make plain soda-water, or something resembling it, with a tablet, instead of siphons and other hefty equipment?


Posted by: Minivet | Link to this comment | 07-27-14 10:27 AM
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Intellectual property laws.


Posted by: Moby Hick | Link to this comment | 07-27-14 10:51 AM
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30 - You can! Just add baking powder to water.

Very few people drink alka-seltzer for the taste, but you can absolutely make fizzy water the same way. It's just the difference between having something producing CO2 by a chemical reaction and having a lot of CO2 dissolved into the water already.


Posted by: MHPH | Link to this comment | 07-27-14 11:00 AM
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It is possible to get a cooperative doctor and pharmacy to prescribe a particular generic manufacturer's version. I was able to do this with one of my thyroid drugs (liothyronine) after one of the generics sent my blood levels way out of whack. I have to give Express Scripts a couple of extra days to order from the distributor, but otherwise it's no big deal.


Posted by: Briefest Delurk | Link to this comment | 07-27-14 11:05 AM
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30: Fizzies


Posted by: Nathan Williams | Link to this comment | 07-27-14 11:36 AM
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I just had to switch insurance coverage and one of my meds (still under patent, natch) is now going to cost $700/month. I am working on the insurance company but really at that rate I could fly to Canada each month to pick up a supply. It is going to be fun to figure out how to work around this.


Posted by: togolosh | Link to this comment | 07-27-14 2:31 PM
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35: WTF?


Posted by: Bostoniangirl | Link to this comment | 07-27-14 2:33 PM
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Yeah, that was my response too. Still working on getting the it sorted out.


Posted by: togolosh | Link to this comment | 07-27-14 2:38 PM
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OT: The pro-Israel protest I rode by today was bigger than the pro-Palestinian protest I saw Friday.


Posted by: Moby Hick | Link to this comment | 07-27-14 2:42 PM
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35: Jesus christ.


Posted by: heebie-geebie | Link to this comment | 07-27-14 3:17 PM
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No one was protesting for him.


Posted by: SP | Link to this comment | 07-27-14 3:28 PM
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Re: running the same production line, this isn't limited to drugs so I'll just note for anyone interested it applies to bourjois and the high end brand with very similarly shaped eye shadow.

Was once enjoying a beautifully turned out South Asian wedding party on a glorious summer afternoon in a PNW city, when effect was a bit spoiled on noticing the men had gone native - they were wearing tevas to a man.


Posted by: dairy queen | Link to this comment | 07-27-14 5:29 PM
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How do you know what they wear on their feet at weddings in India?


Posted by: Moby Hick | Link to this comment | 07-27-14 5:38 PM
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Have never seen such footwear at comparably fancy schmancy south asian weddings, it stood out. And not in a good way.


Posted by: dairy queen | Link to this comment | 07-27-14 5:45 PM
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Although as a nod to assimilationist PNW crunchiness, fair enough. In all other respects an enjoyable do.


Posted by: dairy queen | Link to this comment | 07-27-14 5:46 PM
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Anyway, my neighborhood is becoming more and more Asian, but I rarely see Asian people in bars here. Not even the East Asian people that are supposed to be big drinkers at home. Somebody should do something about that. I'd hate to see bars close.


Posted by: Moby Hick | Link to this comment | 07-27-14 5:47 PM
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I mean, diversity is great until somebody closes a bar to put in a place serving "bubble tea." Then I'm going jingoist.


Posted by: Moby Hick | Link to this comment | 07-27-14 5:53 PM
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Bubble tea franchise shenanigans were behind not our latest but the one before that corruption scandal here in SF, so there could be that T look forward to, silver lining etc.


Posted by: dairy queen | Link to this comment | 07-27-14 6:01 PM
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It's just tapioca. I looked it up.


Posted by: Moby Hick | Link to this comment | 07-27-14 6:04 PM
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Agreed, bubble tea is an abomination.


Posted by: torrey pine | Link to this comment | 07-27-14 6:30 PM
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If it were a mixer, I wouldn't care.


Posted by: Moby Hick | Link to this comment | 07-27-14 6:38 PM
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Counterpoint: Bubble tea is great.


Posted by: nosflow | Link to this comment | 07-27-14 6:39 PM
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Someone should open a bar serving alcoholic bubble tea. That way everyone wins.


Posted by: teofilo | Link to this comment | 07-27-14 6:40 PM
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Large balls of tapioca, alcohol and immigrant-on-immigrant exploitation, what could go wrong?! News at eleven...


Posted by: dairy queen | Link to this comment | 07-27-14 6:43 PM
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51 gets it right. 52, I am not so much sure.


Posted by: Sifu Tweety | Link to this comment | 07-27-14 6:48 PM
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50, 52: And where does this end? What else do you want floating in your drink, Cheerios and Lucky Charms??


Posted by: torrey pine | Link to this comment | 07-27-14 6:51 PM
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I don't want anything floating in my drink. Apparently there are some people who like that sort of thing, though.


Posted by: teofilo | Link to this comment | 07-27-14 6:52 PM
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I don't drink anything except beer, whiskey, and rusty nails. And wine. And gin. And other stuff.


Posted by: Moby Hick | Link to this comment | 07-27-14 6:56 PM
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Holy crap, "alcoholic bubble tea" does exist. One of the google search results contains the phrase "green tea Heineken with boba." What is wrong with people?!


Posted by: torrey pine | Link to this comment | 07-27-14 7:07 PM
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56: come on now, ice? A lemon wedge? An olive? A little umbrella? A cherry? A phone number?


Posted by: Sifu Tweety | Link to this comment | 07-27-14 7:07 PM
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59: Not particularly fond of any of those, no.


Posted by: teofilo | Link to this comment | 07-27-14 7:09 PM
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Not that I would necessarily refuse a drink with any of them if it were offered to me. Especially the phone number.


Posted by: teofilo | Link to this comment | 07-27-14 7:10 PM
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41: Which cosmetics company?


Posted by: Bostoniangirl | Link to this comment | 07-27-14 7:11 PM
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Yes, bubble tea is super gross.


Posted by: heebie-geebie | Link to this comment | 07-27-14 7:18 PM
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Love boba. Also love the little liquid filled bubbles. And the lychee jellies. I was sad when the lychees jellies in the choking hazard plastic cups went away. I could eat a thousand of those in one sitting.


Posted by: Megan | Link to this comment | 07-27-14 7:34 PM
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I will speak out as an appreciator of bubble tea. I don't seek it out, particularly, but I like it just fine.


Posted by: redfoxtailshrub | Link to this comment | 07-27-14 7:34 PM
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Fuck bubbles. Scotch please.


Posted by: Moby Hick | Link to this comment | 07-27-14 7:54 PM
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Poor Bubbles.


Posted by: Eggplant | Link to this comment | 07-27-14 8:17 PM
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6: LB: I think I could write up a summary of Piketty's chapter 11 for tomorrow, though it's dependent on how fast I can write tonight.


Posted by: Dave W. | Link to this comment | 07-27-14 8:23 PM
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Appreciated, but I have it covered. We have some later chapters still going begging, though.


Posted by: LizardBreath | Link to this comment | 07-27-14 8:35 PM
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62: chanel. Not exactly the same colorways, but close. Blush, eye shadow and foundation best bets in M experience.

64: Lychees are fabulous.

A propos of nothing much, watching Clueless with a 13 year old who is reading Jane Austen for the first time is an amazing experience of vicarious visceral cringe.


Posted by: dairy queen | Link to this comment | 07-27-14 8:49 PM
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For added cringe, next you should watch this with him.


Posted by: teofilo | Link to this comment | 07-27-14 8:59 PM
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70.last: why? The movie is fun.


Posted by: heebie-geebie | Link to this comment | 07-27-14 9:11 PM
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I thought the joke was about blowing Bubbles.


Posted by: SP | Link to this comment | 07-27-14 9:19 PM
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Who drinks tapioca?


Posted by: Moby Hick | Link to this comment | 07-27-14 9:22 PM
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Speaking of age-related lack of reading comprehension, 7 year old was trying to tease his older brother and call him names and seemingly out of nowhere came up with judenschwein.
(They had recently read an illustrated kids book explaining the Holocaust and that was thrown in there.)


Posted by: SP | Link to this comment | 07-27-14 9:34 PM
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72: he thought it was great, but it is extremely cringey when you are actually a teenager. Intentionally and deliciously so! Different from the completely helpless laughter that consumed him age 10 watching A Night At The Opera, but same all consuming nature of physical reaction.


Posted by: dairy queen | Link to this comment | 07-27-14 9:44 PM
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75 is wonderful.


Posted by: k-sky | Link to this comment | 07-27-14 10:43 PM
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As a true PNW native, I thought Tevas were the coolest shoes ever, and suitable for all occasions. It wasn't until college on the East Coast that I learned that they didn't count as dress sandals.

MH where are the Asians from? In China drinking is traditionally done with eating, and bars are seen as dens of iniquity, full of gangsters and prostitutes. This is changing in big cities but still a common view with older people and people outside of major cities.


Posted by: Buttercup | Link to this comment | 07-27-14 11:08 PM
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75
Yikes! That's not something you'd want the kid randomly shouting in public places.


Posted by: Buttercup | Link to this comment | 07-27-14 11:51 PM
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70: What's the cheaper alternative to Chanel?


Posted by: Bostoniangirl | Link to this comment | 07-28-14 5:37 AM
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78.2: It seems rude to ask.


Posted by: Moby Hick | Link to this comment | 07-28-14 5:53 AM
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bourjois, not distributed in USA but you can get it via asos.


Posted by: dairy queen | Link to this comment | 07-28-14 9:09 AM
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