Child Psychiatry

[C Elegans]

I'm sorry, the studies done in psychiatric fields dealing with the success of drugs on patients are broken. Doctors who don't take the medication doing observations on patients too drugged to be coherant and voice their opinions isn't a study, it's a doctors opinion on a patient. Nothing more, nothing less.

I am not sure what way you mean that double blind, placebo controlled studies are "broken". I know you have suffered severely from mistreatment in psychiatry (I know thousands of other people who have in the US and some here in Sweden too) but again: mistreatment of some patients does not mean the tested and controlled psychopharmaca works for a majority of patients in certain groups, and it does not mean "alternative medicine"-remedies work better, or at all.

Many large independent studies show that about 2/3 of patients with psychosis, get a significant symptom reduction with D2-blockers and about 2/3 of patients with affective disorder, get significant symptom reduction with SRRI:s/TCA:s or other classes of drugs acting on the serotonin and/or norephinedrenine system. There is however no definite cure for any neuropsychiatic disorder.

Unless you've dealt with the effects of those chemicals yourself, you cannot possibly grasp the true extent of the effects they have on a person.

The patients own symptom reports as well as the doctor's reports, should always be included in a controlled drug trial (at least in Sweden).Let me give you an example: one of the first jobs I got as a psychologist, was to monitor healthy control subjects who were taking a drug. I didn't get to know what drug it was (due to risk for bias) not what it was for, but later I learned that the drug was an antipsychotic. However, the university where I work were to test (for the FDA, not for the company) the safety and side-effects of this drug by giving it in clincial doses (ie same dose intervall as patients should have got) to healthy people. The producer of the drug was not involved at all, and they did of course not in any way support the trial or the people working in it, finacially since that is illegal in Sweden. We even bought the medicine from the company, since you can't get it for free, then it counts as financial support.

In any case, I did a lot of cognitive testing on these subjects to assess whether they were negatively affected by the drug. I and a physician also wrote down and report everything regarding the subjects' state that the subjects said themselves, and quantify this on a scale. Everything I and the physician observed, we also quantified and we had to make independent assessments for the FDA to compare.

The reason why I tell you this is just to give an example of how drug trials look in Sweden. The things you have told me that happened to you, would simply not have happened here - especially not considering your young age. I just wish the US would do something to contoll and regulate the use of pharmaceutics better, but it's seems that there is a political level where this question has no importance.

Do you really think doctors who force their patients to take them and are being paid to do so will admit to this? The studies handed to the public are whack, and so are the doctors performing them.

As I have stated before, there is a huge difference between the US and Sweden. I know you allow people who are affiliated to the drug industry to perform clinical trials, and even sit in the FDA and participate in decisions of whether a new medicine should get licensed or not. I know overmedication, bribing of physicians etc, is a major problem. It is however not in Sweden. Firstly, a drug cannot be licenced based only on research done by the producer, or in affiliation with the producer. The Swedish FDA makes their own independent clincial trials of all new drugs, and that must be done without any involvement of the producer. Doctors and nurses who participate in such clinical trials, are controlled for affiliation with drug companies. Even having held a lecture for a drug company will mean you may be excluded. Also, you cannot have an affliation to the drug companies if you work in the FDA. That's illegal, and it is checked. This procedures are the reason why it always takes at least an extra 2-3 years before a new medicine reach the Swedish market, and also why many medicines you have in the US are never released here.

[Lestat]

CE, I must say I agree for the most part with you for what you posted here on drug research and testing.

But, and this is important, that is only a component, and not even the most important one, in the delivery of health care.

You can have all the perfect drugs you want (but admit it, no drug is really perfect), but if your initial diagnosis is incorrect, there's bound to be some effect. To make a correct diagnosis is as much 'art' as science, and something that requires interpersonal skills, not only knowledge, even more so where mental health & children are concerned (which is the subject of this thread BTW). And I think that is where most of the problems with medical "mistreatment" originate.
And where the prescribing of the wrong treatment can already have adverse effects, if only by not treating the disease, in 'standard' or 'physical' health, I personnally think that the risks are even higher when wrongly diagnosing mental health cases.

And even if the diagnosis is correct, you have to hope that your MD is keeping up to date on his knowledge of drugs and not unduly influenced by the pharma-industry.

[Magrus]

[QUOTE=C Elegans]As I have stated before, there is a huge difference between the US and Sweden. I know you allow people who are affiliated to the drug industry to perform clinical trials, and even sit in the FDA and participate in decisions of whether a new medicine should get licensed or not. I know overmedication, bribing of physicians etc, is a major problem. It is however not in Sweden. Firstly, a drug cannot be licenced based only on research done by the producer, or in affiliation with the producer. The Swedish FDA makes their own independent clincial trials of all new drugs, and that must be done without any involvement of the producer. Doctors and nurses who participate in such clinical trials, are controlled for affiliation with drug companies. Even having held a lecture for a drug company will mean you may be excluded. Also, you cannot have an affliation to the drug companies if you work in the FDA. That's illegal, and it is checked. This procedures are the reason why it always takes at least an extra 2-3 years before a new medicine reach the Swedish market, and also why many medicines you have in the US are never released here.[/QUOTE]

Meh, so I wouldn't be disabled if I had been born in Sweden then. The antipsychotic's released on the market here are done so from pushes within the drug production companies themselves. They happen to be specifically producing medications that are highly addictive and more expensive since antipsychotics tend to be employed more and more often for a month or so when someone has a troubling period in their life. I cannot tell you how many people I know who've been prescribed Effexor for anything from random bouts of depression to schizophrenia and when attempting to get off the medication are wracked within a day with horrible pain and trauma that they would do anything for another pill.

This is the new age of psychotropic medicine, and at $200 a bottle of pills, the companies have started bribing everyone to be able to push more pills to the general public and get them addicted. IMHO the entire mental health community of the US should be jailed for allowing it to happen and continue.

It's nice to know some places do things better than we do here though. Non-biased, private studies would be great to help my friends out.

[C Elegans]

But, and this is important, that is only a component, and not even the most important one, in the delivery of health care.

Certainly, this I agree completely with. The actual delivery of health care is what makes a difference to the patient - what does it matter it we find the perfect medicine for a disease, if the patients cannot get it?

To make a correct diagnosis is as much 'art' as science, and something that requires interpersonal skills, not only knowledge, even more so where mental health & children are concerned (which is the subject of this thread BTW). And I think that is where most of the problems with medical "mistreatment" originate.

Since Thantor mentioned oestrogen replacement for menopausal women, anti-obesity medicine, Vioxx etc, I also discussed "alternative medicine" and conventional medicine in general. However, if we go back to child psychatry, or neuropsychiatry in general, I agree with you that especially in these cases, a correct diagnosis require more from the health care professionals than diseases and disorders you can detect by tissue samples or quantivative examination methods. To be a good clinician, is in my opionion at least as difficult as to be a good scientist. And in health care systems where you have 15-minute consultations and much diagnosis is done by non experts, misdiagnosis and consequent mistreatment will be much more common.

With the risk of annoying Thantor even more, my personal opinion is that one of the major reasons why people seek "alternative medicine" is simply because their needs have not been satisfied by conventional medicine.
this study on breast cancer patients found that patients who were more depressed and more worried about recurrency of cancer, were more likely to seek "alternative medicine" after breast cancer treatment than women who did not seek any "alternative medicine" treatment. At baseline, all women had equal scores for "psychic health". There are some more studies of the same type, showing a similar result: that patients who seek "alternative medicine" report more symptoms and worse psychological health, than those who do not (when controlled for severity of disease and medical treatment outcome). This may mean this group of patients have larger psychosocial needs, or that they have less benefit from conventional medicine because their illness trigger other problems that cannot be treated with the same methods as the primary disease. Whatever this increased "vulnerability factor" may be, it is however demonstrated that in some way, this group is more vulnerable and less psychologically well than the group who have never used "alternative" methods. In my opinion, this makes it even more important to make sure this group are not in any way exploited or led into believing "alternative medicine" can offer something it cannot. It would be highly unethical to let this group who worries more about recurrency, buy expensive treatment that actually does nothing to prevent recurrency. Thus, the failure of conventional medicine to adhere to these patients needs, is no reason not to demand that all "alternative medicine" should undergo controlled investigation for effect and safety. On the contrary, it may be an extra vulnerable group who seeks this kind of treatment.

A very sad example of why "alternative medicine" needs to undergo the same control as all other medical treatment, was a treatment a friend of mine used. My friend was diagnosed with ovarie cancer in a late staage, she already had metastasis in most of the internal organs. She was treated all the conventional ways - with surgery, cytostatics and radiation therapy. She knew her life would not be long, and in a desperate try to prolong her life, she decided to try a a variety of "alternative methods". One alternative practisioner (I don't what what type) she met, told her that there was this nursing home in another country, where she could go for this highly expensive treatment. She sold her car and took bank loans in order to get money for this treatment, which costed several thousands Euro. After her first visit, she was told she needed another visit within 6 months, even longer and of course more expensive, so she sold her house and went back. She died 4 years after her diagnosis, which was within the time range her doctors had given her and also exactly the average survival time after diagnosis for women her age in that stage of ovarie cancer.
About one year later, this specific method was investigated in a retrospective study with matched controls (prospective randomised samples could not be used since the people who marketed this specific method refused that, referring to their "secret of trade") and the result of the study was that the patients who had used this specific method died in shorter time that those who did not.

And even if the diagnosis is correct, you have to hope that your MD is keeping up to date on his knowledge of drugs and not unduly influenced by the pharma-industry.

In my personal experience, most clinicians spend far to little time updating their knowledge. This is especially crucial in fast-developing areas of medicine such as neuropsychiatry. The average stately employeed physician in Sweden has 2 days a year to spend on education. If they want more than that, they have to do it on their spare time. This includes everything from new scientific discoveries, new drugs, other treatment methods, organisational and financial stuff and technical development. Influence from the drug industry is relatively speaking, very weak here, due to the strict regulations. Since income and source of income are official documents registered by the tax department here, it can easily be checked if somebody has more money that s/he should. (Such checks are performed for instance on people working for the Swedish FDA or university hospital professors who lead the indedepend drug trials.)

Black money is of course a possibility, but the Swedish FDA has lists of "golden standards" medicines that should be used, and pharmacies are a state monopoly here, so that means, if the doctor has prescribed you a non-FDA-recommended medicine for your disease, the pharmacologists change it to the recommended ones so it's not so easy for doctors to overprescribe a certain medicine. If Eli-Lilly wants a Swedish doctor to prescribe a lot of Prozac it will be difficult, since Prozac is not on the FDA-list of recommended medicines for the indications Prozac have in Sweden. (It should also be mentioned that the various indications for a medicine, ie which diseases or symptoms a medicine is prescribed for, are different and much more restrictive in Sweden than in the US and the UK.)

So, in short - there are plenty of bad medical doctors and bad "alternative" practicitioners around, just as in any other profession, but where I live, it's not so easy to be a dangerously bad doctor, but it's completely free for everyone to be a dangerously bad "alternative" practicioner.

[C Elegans]

Meh, so I wouldn't be disabled if I had been born in Sweden then.

Sadly, probably not I remember when you first told me (probably that was just a small part of it all!) about what you have been through in terms of horror-house psychiatry, and my first thought was "Oh, I wish Magrus had been a patient at the clinic where I used to work, because this would never have happened there"...

They happen to be specifically producing medications that are highly addictive and more expensive since antipsychotics tend to be employed more and more often for a month or so when someone has a troubling period in their life.

This problem was discussed to great extent last year at the largest international neuropharmacological congress. The drug industry has such an immense power in the US, and they influence clinicians to use "polytherapies", ie to use a mix of many expensive new drugs and sometimes even add those to the older medicines. Completely mad and not supported by any evidence from clinical trials. At the congress, it was discussed how on earth this should be stopped, but...as I've said in many other threads, scientists don't have much power, especially not compared to the drug industry.

I cannot tell you how many people I know who've been prescribed Effexor for anything from random bouts of depression to schizophrenia and when attempting to get off the medication are wracked within a day with horrible pain and trauma that they would do anything for another pill.

In Sweden, the only indication for Effexor is Major Depression. Effexor is viewed as an efficent but "strong" drug, it's something you only give to severely depressed patients and not the first choice due to the side-effects. It's something you try if other medicines have not worked.

It's nice to know some places do things better than we do here though. Non-biased, private studies would be great to help my friends out.

Many things are bad about Sweden, and people get very fed up with all regulations, but the health care system IMO needs these regulations to protect patients from the drug industry influences and from quacks of various types.

[Hill-Shatar]

Antibiotics for infectious disease, surgery for injuries or cancer, chemotherapy and radiation treatment for cancer and proton pump inhibitors for ulcer, do you view them as "crutches that only mask the problem"? Conventional medicine includes all of the above. Conventional medicine however, lack a cure for many diseases and disorders. That's why we do medical research.

You removed the part where I said that I would give them drugs if they were going to cause harm to themselves, or to others, ie pain and the like. This is about the addictiveness based for pyshiological diseases, I was not speaking for all drugs related to medicine. I was posting within the original topic of this thread.

There is no drug that cures autism-Asperger. There is no treatment at all that cures autism-Aspergers. Thus, it should not be medicated. (Here, it ususally isn't. None of my patients with Aspergers have been medicated.) There are many diseases and disorders that have no cure. But I fail understand how this related to the question what evidence there is for alternative medicine. I also see no reason why lack of cure in conventional medicine should lower the demans for controlled clinical trials of alternative treatment. Healing or homeopathics do not work better because there is no pharmaceutical cure for Aspergers, there are two disparate questions.

I sauid ntohing to the thought that it was treatable, if you were debating my statement, I mentioned that they wanted to give him drugs for anti-anxiety, something that my brother could have gotten addicted to. Not that they were treating him that they were going to attempt to treat the anxiety that comes from it, when naturally my brother came better off than some doctor's thought he would.

2. An editorial from NJEM is not the editors personal opinion, it's the stance of the journal, and NJEM together with the Lancet is the most reowned and highest-quality scientific journals for all clinical medicine. They are expert journals, not to be compared to popular newspapers. The editors of these journals are medical professionals and experts on medical science, they are not ordinary journalists.

How lovely. Taking a word that is used for a writer's opinion (not usually one well versed on the subject) and using it for people who are educated in that specific area to voice what they know. It confused me, and I apologize, CE.

Thantor argued that he viewed "medical science" as an oxymoron. I argue that it's his personal opinion and not a fact. Others may have different opinions and I am sure there are thousands of people who share his opinions and thousands who do not share it. Questions not based on fact but on opinion, are bound to vary a lot.

I agree, my point was more that using the entire community behind a statement in which they have no idea about is not a prudent debating tool, no matter how much truth is in it, in my opinion, as not everyone here can totally verify what is said.

Considering I am in the medical sciences, I was not exactly pleased to read it myself D), but it is his opinion, so I chose not to take any offence, but merely state that we have different points of view on this part.

Yes, but this is placebo-effect, and placebo-effect must be distinguished from effect of the actual substance. People pay large amounts of money for medicine. Should they not have the right to know if they pay for and put in their bodies, a substance that has no effect besides the placebo effect, or a substance that has both placebo effect and a clinical effect?

I was speaking along the lines metaphorically of 'Cottage Treament'.

As for the rest, many a time I will see people use quotation marks to post remarks about what another person said. For example, I see the 'truth' in your argument.

Although it is easy to see you meant no offence, moving quotations around jobs have gotten me some pretty nasty emails in the past. I've learned to be extra careful about using any quotations regarding what could be a person's job from experience.

Although 'alternative medicine' does not sound wrong, I actually got nailed by a person who practises alternate types of medical practices cursing me for quite a while when I posted like that, so I was more worried that Than would take offence to something than you.

[Athena]

*looks up at all those long posts* A few short words;
Child psychiatry
My idea is that things sall be credited to DNA and basic instincts + enviornment = emotion.
after all, since emotions come before speech, how hard could they actually be to establish?
Some of you may have already discused this, but I'm only wondering what will come of my thoughts here. Perhaps more later.

[Maharlika]

A friendly reminder to all.

As I see it, things are getting a bit heated up in this thread.

May I remind EVERYONE to please relax and re-read the other's posts before replying. If you feel that you just HAVE to let the other person know what you feel, take it to PM's. I suggest proper communication/clarification is needed since tempers flare due to misunderstanding and misconstrued statements.

I see where both sides are coming from and that the posts tend to degenerate into potential flames and name callings because of misinterpretation.

Let's be a little bit more tact and aware of the other's POV, shall we?

I also see and appreciate the attempts of some of the posters to keep the discussion at a reasonable level.

Thanks.

[thantor3]

I just wanted to let you know that I am back and that my hospitalization and lobotomy went well. Since my computer was confiscated and my house burned to the ground, I am using the staff's computer to write this, but I assure you all is well. I am now participating in a 12 step program to rid myself of the evils of alternative medicine and have nothing but praise for the scientific treatment I received at the end of a cattle prod.. Ouch... I mean, from the caring staff at the psychiatric facility I visited.

To make ammends for my extremely poor form, I have edited the second part of my original post, which said some truly awful things. I am sorry for all the trouble that caused.

I cannot remember why I said such things, but am want to assure you that I am now on my medications, so everything should be grand.

[Dottie]

Wouldn't it be better to respond to the arguments rather than being sarcastic? No one forces you to think anything special, people have just participated in the discussion.

[thantor3]

[QUOTE=Dottie]Wouldn't it be better to respond to the arguments rather than being sarcastic? No one forces you to think anything special, people have just participated in the discussion. [/QUOTE]

Excuse me, but why would I?

In my clinical training, as well as in life, I have learned there are two main times when it makes sense to engage in debate or confrontation. The first is when one or more minds are joined in a sincere attempt to gain knowledge, insight, or a clearer view of a truth. The second is when a relationship has been formed where the two people wish to increase the intimacy in that relationship and are willing to work through some difficult things to achieve it. In terms of the person to whom my original comments were directly, obviously neither of these are possible.

There is another point to be made that is not often discussed, which is an argument or debate occurs in a certain context. For the exchange to take place at all, there needs to be a certain measure of respect on both sides. That respect creates a type of energetic vessel or forum that safely contains the conversation. On a larger scale, a sense of community provides this type of vessel for its members. The often inevitable heated emotional responses that can take place in such a debate do not destroy the conversation because both sides trust that there is a purpose or that something meaningful will be forthcoming from the exchange. However, if that covenant is broken, if there is no safe container for the exchange to take place, then the exchange quickly degenerates into a series of rigid attacks and defenses, with neither side willing to give quarter. In my mind, this is a useless waste of time and to continue only supports dysfunctional behavior.

The simple answer to your question, Dottie, as to why I do not respond to the arguments presented is that I haven’t read them. To explain why, let me use CE’s responses as an example. CE and I have “debated” previously as to whether GB is a community and she has been quite clear that it is not in her view. If, as is the case, I believe that CE has no respect for my ideas (and, I would point out, this is based on long experience, not just waking up one day and having a hissy fit) then there is no vessel in which this rather one-sided argument can progress. There is no sense of community to contain it, nor respect for the other person. Further, as CE has proclaimed in the past, this forum is not a place people should go to have their needs met, since it is only an electronic bulletin board and not a community. Therefore, it is perplexing that one would need a member of this board to show respect, to extend goodwill, or to answer their responses. Why would one bother? No one owes anyone anything within the view being espoused. Like “scientific medicine,” such a view supports a coolly rational, logical assessment of a mechanistic universe. Since I owe CE nothing in this case, and since she clearly extends nothing to me, why would I read anything she writes? While the language changes, the message would be (and is) always the same: “My view is intellectual superior to yours and I can prove it.” In other words, all that is left is the hollow shell of what, in a supportive context, would be a perfectly legitimate debating position. To continue to “argue” with such a person only supports the dysfunctional behavior and perspective. This also explains why I choose not to respond to the other posts in this thread as well. While I owe nothing to CE, in her view, and she owes me nothing, in my own personal code of behavior it is exceeding rude to engage in a mulit-part conversation and pointedly ignore one person. She may not respect me, but I feel I owe her at least that level of respect.

[thantor3]

In closing, I feel I need to publicly apologize for Fiona for hijacking her thread. It was thoughtless of me to post such an inflammatory message in someone else’s thread and I am sorry for doing this. To make amends, I have edited my previous post and will no longer post in this thread so that hopefully it can move back to the discussion Fiona originally envisioned.

To contribute something to that discussion, I would say that, in my view, what has occurred in this thread is also symptomatic of what needs to be addressed in child psychiatry.

Orthodox, reductionist, academic medicine wishes to view the human individual in a rational, mechanistic fashion. It has a long history of viewing many of the inherent dynamics of the body as a disease state and suppressing them. Fever is one example. Another example is bronchoconstriction. It was first noticed in the 1960's that the use of asthma inhalers (expand the tissues of the lungs so people can breath better, which is called bronchodilation) was associated with an increasing asthma death rate. When these products were removed from the market, death rates dropped. Why? As Graham Williamson points out, “It seems that the bronchoconstriction that occurs during an asthma attack may be a defensive measure, an attempt by the body to prevent the ingress of allergenic substances which may cause serious lung disease if permitted to reach the deeper tissues of the inflamed and hypersensitive airways of the asthmatic person. According to this theory, bronchodilators open up the airways and expose more of the respiratory tract to the damaging effects of allergens. It is for this reason that doctors have now learnt to be very cautious about reliance upon "reliever" inhalers without the simultaneous use of "preventers" to lower inflammation of the respiratory tract.”

My point is that academic medicine, due to its rigid and markedly non-scientific dogma, has a long history of interfering in the body before they really know what they are doing. It is the same in child psychiatry. It wishes to view and treat the individual child as discrete object, when in fact any child is a part of series of interlocking environments. When I was working in child psych, we had a case of a 4 year old girl who was diagnosed with schizophrenia. She was given psychotropic medications and did not improve. It was later discovered that this child was not schizophrenic but was suffering from severe dissociative disorder and perhaps PTSD because the parents where using her to make pornographic movies that included multiple instances of intercourse. Clearly no amount of medication was going to “cure” this child.

Traditional medical systems, while they may not have the technical sophistication of academic medicine, provides the larger view of person-in-context that, I believe, better addresses the root of the human illness. I see no reason why academic and traditional medical systems could not work together as long as some respect was shown and academic medicine could dispense with its frantic instance that it is superior. At that point, a supportive context could be created to focus on the primary issue: providing the highest level of health intervention possible for the patient. And no, I do not have a double-blinded, placebo controlled study from the Lancet to support this view. Sorry.

[Fiona]

I just wanted to say that I do not think that Thantor3 owes me any apology at all. I had already decided I would post no more on this thread, for reasons quite similar to the ones he gives for not engaging in further argument. Rightly or wrongly I agree with much of what he says about when it is pointless to continue a discussion.

[dragon wench]

[QUOTE=Fiona]I had already decided I would post no more on this thread, for reasons quite similar to the ones he gives for not engaging in further argument. Rightly or wrongly I agree with much of what he says about when it is pointless to continue a discussion.[/QUOTE]

I do not wish to become embroiled in this thread. However, I want to say that I second the above. There is little point in trying to have a discussion with somebody when there is a lack of basic mutual respect. It is rather like attempting to debate a Jehovah Witness or other religious zealot, why bother?
I believe that what we have witnessed here is emblematic of a situation that has been steadily growing in SYM. I have already stated elsewhere my views in this area, so suffice to say, I find the current situation highly unfortunate.

Note: Not that I have responded extensively to this thread, but this will also be my final post here.

[Lestat]

Well, Thantor, thanks for poisoning this thread. I would have liked to have chosen other terms. But I don't have the energy to try get this back on rails. If you can't refrain from making acidic comments, then don't comment at all.

Maybe Fiona feels that you don't owe her an apology, but an apology is the least you owe to the health professionals and NGO volunteers, some of them people I have learned to admire while working besides them, that with meagre means do battle disease here on this continent and other disadvantaged countries, often in opposition some of the most unproven, damaging beliefs originating in traditional medicine.

So these parting remarks:

There are maybe things to be learned by academic medicine from the approach of traditional medicine, especially the approach of the patient as a person rather than just isolating the symptoms. But OTOH is it not normal that traditional medicine is held up to some of the same standards as academic medicine? Some proof maybe. Strict control on practices. Analysis so you know what they say you get is indeed what you get. Trials for damaging side effects. Warning of side effects. Possible indication of success rate. Liability insurance. Professional code. Etc.

Yes you can name failures, medicine as a whole is not an exact science. And one can't name the same large scale failures for traditional medicine for the simple reason there is no rigorous testing: no testing - no failures. But name me where traditional medicine has brought broad and influential gains for human health without passing through academic medicine first.

[Maharlika]

I'm closing this thread... for now.

Seeing that the threadstarter isn't interested anymore, and seeing how the flow of the exchange of posts has become, I'm closing this thread.

I dont think it's a good idea to dilute the thread with other "side-stories."

If you think that the thread needs to be opened again, PM me. But please make sure that your posts and the succeeding ones would be on topic.

Thanks.