Altimexis

The U.S. definitely has an over-treatment problem. There are two things driving this – direct marketing of pharmaceuticals to the public, and the lack of a national health program. Patients often present at their physicians' offices demanding to be tried on a drug they saw advertised on TV. It's far easier to accede to the patient's wishes than to take the time to explain why that particular drug, or any drug, might not be in their best interest. However, Zoloft has long been out of patent and I think the prescription of antidepressants in general is one of the desire to do something. Health insurance rarely pays for the intensity of counseling needed to deal with childhood depression. Even when counseling is available, its effectiveness is highly dependent on the therapist doing the counseling. Getting through adolescence is difficult as it is, and a counselor who might be perfect for one kid might be worse than nothing for another. How many parents have the time to deal with a depressed child? Nick's mother certainly didn't. I think the overprescription of stimulant medications is much more of a problem in the U.S. Hyperactivity is over-diagnosed and parents don't know how to deal with a mildly hyperactive child. The advent of smartphones and social media has made things infinitely worse. Although I think socialized medicine does a much better job when it comes to prevention, I've not been impressed by how it handles anything out of the routine. When I was in my first job at the NIH, I saw research fellows from all over the world with highly-treatable disorders that hadn't been addressed in their native countries. I recently read of a young man in Switzerland with Hodgkin's lymphoma that went untreated for several months while he received treatment for a pneumonia he clearly didn't have. I myself nearly died in a teaching hospital in Paris from a torn esophagus. They didn't even start an IV, even as they acknowledged I had internal bleeding. All of this discussion may be moot soon when AI makes its way into the practice of medicine. AI has the potential to be much more effective than the nurses often hired to provide triage, but I don't expect the transition to be a smooth one.

I don't like the sound of that. SSRIs in general have a relatively high preponderance of teen and young adult suicides. Depression-related suicide is all too common in this population, but there is a small increase in suicidal ideation with these meds. The FDA requires a black-box warning on the circular included with each bottle, but the need for it is controversial. The general consensus is that in kids diagnosed with depression, the benefits outweigh the risks. The issue is with the diagnosis. Few would doubt the need for medications with major depression. The need is much murkier with situational or reactive depression. My field was rehabilitation – not psychiatry nor pediatrics – but I worked with a lot of teens and young adults with spinal cord injuries and we used these medications short-term when the depression was sufficient to interfere with their participation in therapies. However, in no way do they substitute for counseling. Sertraline (Zoloft) is considered to be one of the mildest SSRIs and the easiest of wean, but some people can never be weaned without experiencing relapse. The older antidepressants were much worse in terms of side effects and much less effective. I have very mixed feelings about the use of clonazepam, which is a close relative of Valium. It's a long-acting benzodiazepine, which makes it less addictive than something like Ativan, but it does more than just take the edge off the feeling of anxiety. It could interfere with his schoolwork and that could make his depression much worse. For an anxious depression, escitalopram in place of sertraline might be a better choice, but I'm not convinced Nick's problem is with anxiety at all. In Nick's case, I felt from near the beginning that his father's death was behind much of his maladaptive behaviors. He has unresolved grief, but I sense there's something more behind his depression – perhaps a feeling of guilt over how his father died. I leave that aspect of the story to LB. I don't disagree with the use of an antidepressant, but weekly counseling sessions with a psychologist may be woefully inadequate.

Friday, June 16, 1972 The SSTP was scheduled to run from Monday, June 26 through Friday, August 4, a total of six weeks. Participants could check into their dorm rooms any time between the hours of 9:00 AM and 6:00 PM on either the Saturday or Sunday immediately before; however, meal service wouldn’t begin until the morning of June 26. Dorm rooms needed to be thoroughly cleaned and vacated by 6:00 PM on Sunday, August 6. The program was scheduled so as to avoid conflicts with schools th

We got a taste of Noah's mentality early on, when he told Nicky about the gay scene in New York, seemingly from personal experience. I'm sure Noah's intent in seeking Nicky out is to explain just what others have suggested — that sex with another boy meant nothing to him, which is probably accurate. Although I'm sure that being a spoiled rich kid has a lot to do with his attitude, I'm not so sure that he sees himself as being a gift to anyone he bestows a hookup upon. On the contrary, I think Noah is very insecure and hooking up is as much for verification of his worth as for getting his rocks off. Nicky gave him something different and it was only after he lost Nicky that he realize just how much more valuable Nicky was as a boyfriend than as a fuck buddy. That said, should Nicky give Noah a second chance? Not on your life. That relationship can only bring Nicky more pain and sorrow. Will Nicky give him a second chance? More on that in a moment. For being so far into this story, we know surprisingly little about Nicky! We know he has a mother who's a physician and is seldom home. We know his father died 5 years ago and that they were extremely close. Although he might have had time to adjust, losing a parent who's also a best friend at such a young age can be devastating and have lifelong effects. We know that public school wasn't working out for him, but we don't know anything more than that. I've read many stories about boys who were sent to a boarding school against their will, only to suffer horrible abuse from hazing, bullying and oftentimes rape. Although most boarding schools probably aren't like that, undoubtedly there's a social order that looks down on kids from the middle class. How many kids would choose to go to a boarding school? Why not a local private school? If the family has the resources to send their kid to a boarding school or if the kid can get a scholarship, wouldn't they opt for something closer to home? Even more commonly, most parents when faced with their kid having problems in the local public schools would move. There's a hell of a lot of backstory that's being withheld from us — by the author and by extension, by Nicky. Most kids are insecure to some degree, but Nicky is insecure to an abnormal degree. Nicky is damaged in ways we're only now beginning to see. With more than half the story to go, I have a feeling we're going to learn a lot more about his past and why he's so insecure. And don't be surprised if Nicky gets back together with Noah. Sincerely, I hope he doesn't, but already we are seeing how he doesn't think he deserves his friends. In his mind, he isn't worthy of Jack and if Noah hurts him, then he's getting what he deserves.

Friday, April 14, 1972 I’d been on pins and needles for the past two weeks. Tomorrow, I’d celebrate my sixteenth birthday. Sweet sixteen. I was nearly a man, but my birthday was the farthest thing from my mind. The acceptance letters were supposed to go out the first week in April, but exactly when during the week was never stated. Mail, whether from across town or across the country, typically took a week, so today was the last day I expected to receive my letter, be it an acceptance, condi

To an extent, it was regional, but also cultural. The youth culture was much more a phenomenon on the coasts than in the American interior, but Jeff was a geek with a capital G. There were kids in his class (and mine) who were much more into the counterculture of the youth movement. The character introduced in chapter 2, Mitch Townsend, was a perfect example. The character was based on a real person who was heavily into rock music and the artistic fringe. Of course in 1969, we were only thirteen. Even if we’d wanted to go to Woodstock, our parents wouldn’t have let us. Jeff is introverted, shy and focused on his studies. He doesn’t have many friends and he doesn’t pay much attention to pop culture. I didn’t either. In a later chapter, you’ll see that Jeff is ignorant of groups such as Led Zeppelin and The Who, yet he likes their music. I listened to a lot of music, but other than The Carpenters, Carole King, Simon and Garfunkel and Chicago, most of it was classical. My cultural awakening didn’t happen until my college years. A lot of the kids in the accelerated class curriculum were like that.

Not that this hasn't been coming for a while, but come on Noah. Really? Skipping out on you supposed boyfriend's birthday party so you can plough an upperclassman? Couldn't you have had the decency to break up with Nicky first? Not that you know what decency is. Or were you planning to have your cake and eat it too? Didn't you even pause to think about the optics of ignoring your boyfriend's birthday entirely? What a douchbag you are! It appears that Nicky is exhibiting classic transference - projecting his anger at Noah and at himself onto Jack. That can only lead to even more pain for both of them. I suspect it will take Jonah to knock some sense into him. I just hope Jack doesn't go off the deep end first.

Your insights are very welcome. The focus in this chapter was on Jeff's growing interest in politics and the profound effects the events of 1968 had on his psyche. I'm embarrassed to admit that I don't remember anything about the protests in France. They weren't discussed in my sixth-grade classroom, nor did my parents discuss them at the dinner table. Sadly, the protests just didn't register. However, I remember the Prague Spring very well, and how crushed we all were when the tanks rolled into Czechoslovakia. Even so, I didn't have any concept of what it was like to live in Eastern Europe under communism. I've since traveled extensively in Europe, both East and West, both before and after 1989. The memory of what it was like before the fall of communism is fading, even in places where it had a stranglehold on life for more than forty years. All traces of the Berlin Wall are gone, replaced by glittering high-rise apartment buildings, shops and hotels. Prague, which was so dark and bleak, is breathtakingly beautiful. Warsaw, which was leveled by the Nazis and rebuilt with monotonous apartment blocks by the Soviets, is awash with the bustle of other modern European cities. Even Russia itself has changed, although the lives of most Russians have not, which in part explains the rise of Putin. The same might be said for Trump in the U.S. I'd forgotten that the film adaptation of 2001 came out in 1968. Of course I saw it and was confused by the ending, as might be expected of a twelve-year-old kid. I've since read the whole series of books and marvel at how Arthur C. Clarke was so ahead of his time. His concept of first contact was much more realistic than that in Star Trek, where every intelligent life form encountered is at about the same level of technological development. Life is so incalculably improbable that if we ever do encounter intelligent life elsewhere, it will be so technologically advanced as to be beyond anything we can comprehend. As far as Stanley Kubrick's film is concerned, the emphasis on special effects and vast panoramas did little to convey the genius of the author. If nothing else, it was useful in discrediting the idea held by so many today that the moon landings were faked. As the joke goes, NASA hired Stanley Kubrick to stage the faked moon landings, but he was such a stickler for detail that he insisted in filming on location.

The rise, fall and rise of Dick Lugar was a very special case. For context, Lugar was the first mayor elected under Uni-Gov, a novel attempt by the Republican government of Indiana to grab power from the Democrats, who had a stranglehold over politics in the capital city. It was one of the first and last attempts at metropolitan government. Lugar was elected the first Republican mayor of Indianapolis in decades, elected by the majority of city residents who lived in the suburbs. As he soon discovered, being in charge meant that it was up to him to fix things. He invested heavily in revitalizing the downtown and his success bread further success. He might have been Nixon's favorite mayor, but he took the lessons learned from Watergate to heart and was known as one of the most honest people in the Senate. Not that I agreed with his politics, but he was very popular in Indiana. I might add that Uni-Gov was a resounding success, but it didn't take Republicans long to discover that running city government meant that they only had themselves to blame for city problems. It's far more advantageous to be able to point fingers and blame Democrats for a city's failures than to actually have to come up with solutions. Hence most cities are stuck with the status quo.

Monday, March 13, 1972 Six weeks had passed since I sent in my application to the SSTP and four weeks since the deadline for submission of applications. Letters of acceptance and rejection wouldn’t be mailed out until the first week in April, with as many as 20% receiving a letter of conditional acceptance. Although I certainly didn’t want to receive a rejection letter, in many ways conditional acceptance was even worse. Conditional acceptance meant that getting into the program was continge

I'm with you there. There is accumulating evidence, not only that artificial sweeteners may have deleterious effects on their own, but that they're ineffective, both in terms of weight loss and in reducing glycemic load. Even the so-called natural non-nutritive sweeteners such as stevia are problematic. The most likely explanation is that the body still reacts to stimulation of the taste buds, releasing insulin in anticipation of the glycemic load that's sure to follow. When that doesn't happen, the body responds by breaking down glycogen and fat, which is worse than the effect of eating raw sugar in the first place.

It's good to hear from you, Talo. I really appreciate such an honest critique. It's is far more useful to me than all the platitudes I get from everyone else - not that I'm inviting everyone to rip my stories apart. 😐 The funny thing is that Rob, my editor for the last couple of years, thought that this chapter was the best thing I've written so far. I'm not at all sure I would agree with that assessment either. If the story has the feel of being more of a documentary than fiction, it's because it's being told from the memories of Jeff as a man in his mid-late sixties. That said, there's no reason I couldn't have described young Jeff's raw emotions as he went through the roller coaster of a meal in which his future hung in the balance. I might add that this chapter is purely fictional. My father didn't die until October of 1972, so he was still around when I spent my summer in Iowa, and he was fully behind my attendance. His earlier demise and the love interest between Jeff's chemistry teacher and his mom was an important plot element used to explain why Paul wasn't aware that his summer love had gone on to win a Nobel prize. Jeff Lindsey attended the SSTP in 1972, whereas it was Jeff Franklin who won the Nobel. As to my chemistry teacher's grasp of the future of computers, although I might have embellished some of the specifics, he was one of the most forward-thinking teachers I ever had. Indeed, he made use of the new computer labs that opened in my high school, late in the spring semester. Our instruction in NMR spectroscopy was taught entirely by computer using AV materials he prepared. He used music as a background as we worked through the exercises on the computer. I remember how much I thoroughly enjoyed his music selections and in particular, I remember listening to Dobie Gray's Drift Away and thinking, what a great song! It's still a great song, but it wasn't released until 1973! I could've sworn it was on the playlist, yet it couldn't have been. The next chapter, which will be posted Wednesday morning, is the most autobiographical in the story. It's an accurate description of my political awakening during the very turbulent years of 1968 and 1972.

I only wish it was that simple. The problem is that Jack is a resident of California. His parents are the ones paying his tuition at Harrison West. If Nick were to show the photos to his mother, as a physician, she’d have a legal and moral duty to report the abuse to the authorities in Michigan. I fear that that would virtually ensure that Jack would be sent back to California. Unless Jack admits to the abuse having been from his father, he might even end up back with his parents. Things are complicated when it comes to dealing with state agencies from different states. Perhaps Nick could send the pics to his mother as being from a friend without saying which friend. That would certainly put his mom right in the middle of a mess, but it wouldn’t necessarily obligate her to report the abuse and it wouldn’t per se violate his promise to Jack. Nick needs his mother to act as a mother with the knowledge of a physician, rather than as a physician with the emotions of a mother. Regarding Noah, are we sure he’s the one Nick has decided to dump? I can’t imagine otherwise, but we aren’t even halfway through the story yet. More likely, I think Nick has decided to break up with Noah, but he’ll lose his resolve and the relationship will continue for several more chapters.

Sunday, January 16, 1972 The delay in getting Mom’s approval to apply to the SSTP was killing me. I spent much of the weekend working on the two essays. They couldn’t be any longer than 750 words, which was about two or three pages, typed, double-spaced. Fortunately, with my terrible handwriting, Mom sat me down in front of a typewriter when I was twelve, so typing the essays wasn’t gonna be a problem for me. To most people, 750 words sounded like a lot, but to me, that was terribly lim

One of my readers pointed out to me that Christmas Eve in 1968 was historic. He didn't need to remind me why it was historic, but he couldn't understand why there was no mention of it in the story. There wasn't even a mention that the TV was on. How well I remember watching the Apollo 8 crew make their Christmas Eve broadcast in 1968. A quarter of the earth's population was watching and certainly Jeff would've been watching too, even as he worried about his father. I've corrected my oversight and the story now includes that important part of history.

In 1972, $5 would buy a popular vinyl record album, or a steak dinner in a nice restaurant, or a tank of gas with full service, no less. On the other hand, a Zenith 25" color television cost around $500. Adjusted for inflation, the monthly cost of a land line with a primary phone and one extension was equivalent to what I now pay for gigabit FiOS internet, a land line and two cell phone lines. There was no Wikipedia and there were salesmen that went door to door, trying to sell parents on buying a set of encyclopedias for their children.

I can definitely speak to that. Nick lost his father at a young age - when he was nine, I think. That by itself has a maturing effect on a young boy. Add to that a mom who's an ER physician and never home and you have a boy who's isolated and alone. Social media are a poor substitute for physical contact, but even so, I get the impression that Nick really isn't all that interested in social media. Losing a parent makes a kid feel different from everyone else. I didn't lose my father until I was sixteen and better able to handle things, but I remember how profoundly it affected the way I saw myself. How could others understand? I realize a lot of parents are divorced, but having a parent die is completely different. Obviously, it's much more permanent. Losing a parent leaves a kid felling vulnerable and insecure. I can only imagine how that would affect a 9-year-old. Nick had to mature very fast, but there's no speeding up the process of social development. Add to that the discovery that he's gay and that's just one more thing making him feel different from the other kids. It's no wonder that he comes off as sounding like an older teen, but his social development is probably behind that of his peers.

Wow! What a powerful chapter! I'm really worried about Jack, though. I don't think LB would write a story about teen suicide, but you never know… In spite of what Jack said, he really does have options available, even with rich parents. The problem is that he's dependent on them to send him to Harrison West. Harrison West is his only real support system and Nicky is the only thing that matters to him now. How easily his parents could take that away from him. I presume the only reason they still send him there is because it not only keeps them from having to see him, but it's important for them to maintain the illusion of a perfect family with a trophy son who goes to one of the best boarding schools in the nation. Sending him to a military academy wouldn't have the same cachet. It must be difficult for Jack to bide his time, doing as little as possible to ruffle his parents' feathers, so they'll keep sending him to Harrison West. If he goes home for the summer, I can't imagine what his summers must be like. I can only hope that they send him to someplace far away from them for the summer. At 14 or 15, another 3 or 4 years must seem like forever, and then there's the likelihood that they'll cut him off as soon as he turns 18. He might not even have the resources to go to college and certainly not an art school - not unless he gets a full-ride scholarship. Suicide would be so much easier. Please hang in there, Jack, and Nicky, give him the love he needs.

Just to clarify, although there are flashbacks to 1968 and 1969, the story takes place in 1972. Although I’m well aware of ARPANET and the history of the Internet, I wasn’t aware of it before the mid to late 1970s, when I worked on what became my dissertation. I’m pretty sure the University of Iowa was one of the original nodes, but I wasn’t aware of it when I was there during the summer of 1972, so I chose not to make it a part of the story. I distinctly remember making use of email, however. It’s amazingly difficult to write a period-specific story about computers because the field changed so rapidly and it’s easy to get confused about when specific advances occurred. I spent inordinate amounts of time looking things up, just to be sure my memory hadn’t been corrupted by later events. Fortunately, my editor, Rob, was a computer scientist and he corrected me when I included technology that hadn’t been introduced yet in 1972.

Saturday, January 8, 1972 Mom dropped me off at 9:00 as usual. It was the first Saturday after New Year’s Day and the first Saturday physics session in 1972. I’d been going to a special program at Butler University for exceptional junior high and high school students since October, a year ago. I wish I’d known about it sooner! It changed my life. After Dad died, I’d pretty much lost interest in everything. Before then, I wanted to become an engineer like my father and planned to study s

Good God, why are so many of the readers so down on Nick? He’s only fourteen! Nick isn’t an adult with experience in relationships. He’s inexperienced, naïve, conflicted… and he’s hurting. Am I the only one who’s picked up on the underlying issue of Nick’s relationship with his father? Unless I missed something, we still don’t know how Nick’s father died. With each chapter, we’re learning how close they were, and we now know that his father died rather recently — probably within the last year. I sense there’s an incredible amount of underling pain, grief, anger and perhaps guilt involved, and that it’s Nick — not Jack — who’s the more damaged of the two. Unlocking Nick’s relationship with his father is the key to unlocking his heart. This is writing at its best. The subtlety and the slow, patient way the story unfolds are the mark of a truly great writer.

Somehow I missed responding to this three years ago. In chapter 51, it was mentioned that the penthouse in their building had made the news four years earlier when it sold for $50 million. The penthouse was twice as high up and more than three times larger than the apartment JJ and Henry bought. Undoubtedly, prices went up in the interim, but $25 million was probably a fair price for a 4,500 sq ft duplex with a terrace on the fifteenth and sixteenth floors.

I’d forgotten about that. Like was discontinued in 1969, when the FDA banned sodium cyclamate for use as an artificial sweetener. Later evidence suggests the FDA may have jumped the gun and cyclamates are still available in Europe.

Sunday, January 2, 1972 Even though I’d gone to bed early, the sound of the phone ringing so early on a Sunday morning was jarring. Okay, 9:00 wasn’t all that early, but it was a Sunday on a holiday weekend… and I was still recovering from my first experience with alcohol. There was no phone in my bedroom, so it was Mom that answered the phone. I’d been lobbying to add an extension in my bedroom ever since I turned twelve, but Mom thought I was too young. She promised me I could get one when

Friday, December 31, 1971 “Are you sure this is okay?” I asked my mom for about the tenth time. “Honey, you look fine,” she responded. “You’re a teenager — you’re only fifteen. No one expects you to dress up like an adult. You look great in your burgundy turtleneck. It’s perfect with your black slacks and black dress shoes. You look handsome. “Yeah, but we’re going to Aunt Milly’s,” I countered. “She looks down on us as it is. Maybe if it were a cashmere turtleneck instead of a cot