Psychiatric Profession Has Lost Its Mind

Psychiatric Profession Has Lost Its Mind
April 17, 2013  
American Free Press

Nearly every expression of normal emotion can now be classified as a syndrome in need of medication

By Pete Papaherakles

In May 2013, the American Psychiatric Association (APA) is scheduled to release its fifth Diagnostic Manual of Mental Disorders (DSM-5) superseding the DSM-IV published in 1994 and revised in 2000. The new “psychiatry bible” has been criticized by many as a testament to the insanity of the industry itself. Virtually every emotion experienced by a human being—sadness, grief, anxiety, frustration, impatience, excitement—is now being classified as a “mental disorder” demanding chemical treatment with—you guessed it—pharmaceutical drugs.

Ironically, one of its harshest critics is Allen Frances M.D., professor emeritus from the Department of Psychiatry at Duke University who was chair of the DSM-IV Task Force.

“DSM-5 opens up the possibility that millions and millions of people currently considered normal will be diagnosed as having a mental disorder and will receive medication and stigma that they don’t need,” said Frances. “This is the saddest moment in my 45-year career of studying, practicing, and teaching psychiatry. [The] approval makes it likely that DSM-5 will start a . . . dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.”

The DSM is now larger than ever, and it includes Orwellian disorders such as “obedience defiance disorder” (ODD), defined as refusing to follow authority. Rapists who feel sexual arousal during their raping activities are given the excuse that they have “paraphilic coercive disorder” (PCD) and therefore are not responsible for their actions. You can also get diagnosed with “hoarding disorder” if you happen to stockpile food, water and ammunition, among other things. Being prepared for possible natural disasters now makes you a mental patient in the eyes of modern psychiatry.

The entire industry of psychiatry has become such a laughing stock that even many supporters of the industry are turning their backs in disgust. To many scientists today, psychiatry is no more “scientific” than astrology or palm reading, yet its practitioners call themselves “doctors” of psychiatry in order to sound credible.

The authenticity of already established “disorders” such as attention deficit hyper-active disorder (ADHD) and social anxiety disorder (SAD) have been called into question.

Frances admits that even the 1994 DSM-IV was a huge mistake that has resulted in the mass over-diagnosis of people who are actually normal.

The major victor in this is the pharmaceutical industry, which is having a field day with sales of billions of dollars of psychotropic drugs such as Prozac, Ritalin, Zoloft, Paxil and others.

Since the introduction of Prozac in 1987 there has been an explosion in the number of people using psychiatric drugs. One in five Americans, or 65M people, is now taking at least one psychiatric drug such as anti-depressants, anti-psychotics and anti-anxiety medications, according to an analysis of pharmacy claims data released on November 2011. In 2010, Americans spent $16.1B on anti-psychotics to treat depression, bipolar disorder and schizophrenia, $11.6B on anti-depressants and $7.2B on treatment for ADHD, according to IMS Health, which tracks prescription drug sales. The report showed that, between 2010 and 2011, the use of psychiatric drugs had increased a staggering 21%.

The adverse effects from these drugs are devastating. Over 200K people a year in the United States enter a hospital with anti-depressant-associated mania or psychosis. There have been 66 school shootings and over 1,300 murders and suicides by psych-drug users since 2000. The Columbine, Virginia Tech, Red Lake Reservation and Northern Illinois University shootings were all committed by individuals on psych drugs, as were many other mass shootings. At least 5K other news stories, including school shootings, link psychiatric drugs to violent crime, according to the website “SSRI Stories,” which tracks these cases.

Peter Papaherakles, a U.S. citizen since 1986, was born in Greece. He is AFP’s outreach director. If you would like to see AFP speakers at your rally, contact Pete at 202-544-5977.

Newtown, Psychiatric Drug Connection to Mass Murders not covered

World News Daily
NEWTOWN MASSACRE
The giant, gaping hole in Sandy Hook reporting
Exclusive: David Kupelian
January 6, 2013


Since last month’s horrifying and heartbreaking school massacre in Newtown, Conn., politicians and the press have, as everyone knows, been totally obsessed with firearms.

Indeed, President Obama has vowed to impose strong new gun-control measures on the nation – very soon, with or without Congress.

Other possible factors – from violent video games to the “failure of our mental-health system” to the unintended consequences of making schools “gun-free zones” – have taken a back seat to guns. Within hours of the gruesome mega-crime, the media had provided extensive, round-the-clock coverage of precisely which firearms, manufacturers and calibers the perpetrator had used, how he had obtained them from his mother, where they were originally purchased, and so on.

But where, I’d like to ask my colleagues in the media, is the reporting about the psychiatric medications the perpetrator – who had been under treatment for mental-health problems – may have been taking? After all, Mark and Louise Tambascio, family friends of the shooter and his mother, were interviewed on CBS’ “60 Minutes,” during which Louise Tambascio told correspondent Scott Pelley: “I know he was on medication and everything, but she homeschooled him at home cause he couldn’t deal with the school classes sometimes, so she just homeschooled Adam at home. And that was her life.” And here, Tambascio tells ABC News, “I knew he was on medication, but that’s all I know.”

It has been more than three weeks since the shooting. We know all about the guns he used, but what “medication” may he have used? (One brief mini-hoax emerged when the New York Daily News published a story claiming the shooter, according to his uncle, had been on the controversial antipsychotic drug Fanapt. That story was quickly withdrawn after the “uncle” turned out to be a fraudster with no relation to the murderer.)

So, what is the truth? Where is the journalistic curiosity? Where is the follow-up? Where is the police report, the medical examiner’s report, the interviews with his doctor and others?

Get autographed copies of both of David Kupelian’s classics: “The Marketing of Evil” and “How Evil Works.”

But let me back up. Perhaps you’re wondering why this issue of psychiatric medications should be so important.

As I documented in “How Evil Works,” it is simply indisputable that most perpetrators of school shootings and similar mass murders in our modern era were either on – or just recently coming off of – psychiatric medications:

    Columbine mass-killer Eric Harris was taking Luvox – like Prozac, Paxil, Zoloft, Effexor and many others, a modern and widely prescribed type of antidepressant drug called selective serotonin reuptake inhibitors, or SSRIs. Harris and fellow student Dylan Klebold went on a hellish school shooting rampage in 1999 during which they killed 12 students and a teacher and wounded 24 others before turning their guns on themselves.Luvox manufacturer Solvay Pharmaceuticals concedes that during short-term controlled clinical trials, 4 percent of children and youth taking Luvox – that’s 1 in 25 – developed mania, a dangerous and violence-prone mental derangement characterized by extreme excitement and delusion.

    Patrick Purdy went on a schoolyard shooting rampage in Stockton, Calif., in 1989, which became the catalyst for the original legislative frenzy to ban “semiautomatic assault weapons” in California and the nation. The 25-year-old Purdy, who murdered five children and wounded 30, had been on Amitriptyline, an antidepressant, as well as the antipsychotic drug Thorazine.

    Kip Kinkel, 15, murdered his parents in 1998 and the next day went to his school, Thurston High in Springfield, Ore., and opened fire on his classmates, killing two and wounding 22 others. He had been prescribed both Prozac and Ritalin.

    In 1988, 31-year-old Laurie Dann went on a shooting rampage in a second-grade classroom in Winnetka, Ill., killing one child and wounding six. She had been taking the antidepressant Anafranil as well as Lithium, long used to treat mania.

    In Paducah, Ky., in late 1997, 14-year-old Michael Carneal, son of a prominent attorney, traveled to Heath High School and started shooting students in a prayer meeting taking place in the school’s lobby, killing three and leaving another paralyzed. Carneal reportedly was on Ritalin.

    In 2005, 16-year-old Native American Jeff Weise, living on Minnesota’s Red Lake Indian Reservation, shot and killed nine people and wounded five others before killing himself. Weise had been taking Prozac.
    In another famous case, 47-year-old Joseph T. Wesbecker, just a month after he began taking Prozac in 1989, shot 20 workers at Standard Gravure Corp. in Louisville, Ky., killing nine. Prozac-maker Eli Lilly later settled a lawsuit brought by survivors.

    Kurt Danysh, 18, shot his own father to death in 1996, a little more than two weeks after starting on Prozac. Danysh’s description of own his mental-emotional state at the time of the murder is chilling: “I didn’t realize I did it until after it was done,” Danysh said. “This might sound weird, but it felt like I had no control of what I was doing, like I was left there just holding a gun.”

    John Hinckley, age 25, took four Valium two hours before shooting and almost killing President Ronald Reagan in 1981. In the assassination attempt, Hinckley also wounded press secretary James Brady, Secret Service agent Timothy McCarthy and policeman Thomas Delahanty.

    Andrea Yates, in one of the most heartrending crimes in modern history, drowned all five of her children – aged 7 years down to 6 months – in a bathtub. Insisting inner voices commanded her to kill her children, she had become increasingly psychotic over the course of several years. At her 2006 murder re-trial (after a 2002 guilty verdict was overturned on appeal), Yates’ longtime friend Debbie Holmes testified: “She asked me if I thought Satan could read her mind and if I believed in demon possession.” And Dr. George Ringholz, after evaluating Yates for two days, recounted an experience she had after the birth of her first child: “What she described was feeling a presence … Satan … telling her to take a knife and stab her son Noah,” Ringholz said, adding that Yates’ delusion at the time of the bathtub murders was not only that she had to kill her children to save them, but that Satan had entered her and that she had to be executed in order to kill Satan.Yates had been taking the antidepressant Effexor. In November 2005, more than four years after Yates drowned her children, Effexor manufacturer Wyeth Pharmaceuticals quietly added “homicidal ideation” to the drug’s list of “rare adverse events.” The Medical Accountability Network, a private nonprofit focused on medical ethics issues, publicly criticized Wyeth, saying Effexor’s “homicidal ideation” risk wasn’t well-publicized and that Wyeth failed to send letters to doctors or issue warning labels announcing the change.And what exactly does “rare” mean in the phrase “rare adverse events”? The FDA defines it as occurring in less than one in 1,000 people. But since that same year 19.2 million prescriptions for Effexor were filled in the U.S., statistically that means thousands of Americans might experience “homicidal ideation” – murderous thoughts – as a result of taking just this one brand of antidepressant drug.Effexor is Wyeth’s best-selling drug, by the way, which in one recent year brought in over $3 billion in sales, accounting for almost a fifth of the company’s annual revenues.

    One more case is instructive, that of 12-year-old Christopher Pittman, who struggled in court to explain why he murdered his grandparents, who had provided the only love and stability he’d ever known in his turbulent life. “When I was lying in my bed that night,” he testified, “I couldn’t sleep because my voice in my head kept echoing through my mind telling me to kill them.” Christopher had been angry with his grandfather, who had disciplined him earlier that day for hurting another student during a fight on the school bus. So later that night, he shot both of his grandparents in the head with a .410 shotgun as they slept and then burned down their South Carolina home, where he had lived with them.”I got up, got the gun, and I went upstairs and I pulled the trigger,” he recalled. “Through the whole thing, it was like watching your favorite TV show. You know what is going to happen, but you can’t do anything to stop it.”Pittman’s lawyers would later argue that the boy had been a victim of “involuntary intoxication,” since his doctors had him taking the antidepressants Paxil and Zoloft just prior to the murders.Paxil’s known “adverse drug reactions” – according to the drug’s FDA-approved label – include “mania,” “insomnia,” “anxiety,” “agitation,” “confusion,” “amnesia,” “depression,” “paranoid reaction,” “psychosis,” “hostility,” “delirium,” “hallucinations,” “abnormal thinking,” “depersonalization” and “lack of emotion,” among others.The preceding examples are only a few of the best-known offenders who had been taking prescribed psychiatric drugs before committing their violent crimes – there are many others.Whether we like to admit it or not, it is undeniable that when certain people living on the edge of sanity take psychiatric medications, those drugs can – and occasionally do – push them over the edge into violent madness. Remember, every single SSRI antidepressant sold in the United States of America today, no matter what brand or manufacturer, bears a “black box” FDA warning label – the government’s most serious drug warning – of “increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24.” Common sense tells us that where there are suicidal thoughts – especially in a very, very angry person – homicidal thoughts may not be far behind. Indeed, the mass shooters we are describing often take their own lives when the police show up, having planned their suicide ahead of time.

    So, what ‘medication’ was Lanza on?

    The Sandy Hook school massacre, we are constantly reminded, was the “second-worst school shooting in U.S. history.” Let’s briefly revisit the worst, Virginia Tech, because it provides an important lesson for us. One would think, in light of the stunning correlation between psych meds and mass murders, that it would be considered critical to establish definitively whether the Virginia Tech murderer of 32 people, student Cho Seung-Hui, had been taking psychiatric drugs.

    Yet, more than five years later, the answer to that question remains a mystery.

    Even though initially the New York Times reported, “officials said prescription medications related to the treatment of psychological problems had been found among Mr. Cho’s effects,” and the killer’s roommate, Joseph Aust, had told the Richmond Times-Dispatch that Cho’s routine each morning had included taking prescription drugs, the state’s toxicology report released two months later said “no prescription drugs or toxic substances were found in Cho Seung-Hui.”

    Perhaps so, but one of the most notoriously unstable and unpredictable times for users of SSRI antidepressants is the period shortly after they’ve stopped taking them, during which time the substance may not be detectable in the body.

    What kind of meds might Cho have been taking – or recently have stopped taking? Curiously, despite an exhaustive investigation by the Commonwealth of Virginia which disclosed that Cho had taken Paxil for a year in 1999, specifics on what meds he was taking prior to the Virginia Tech massacre have remained elusive. The final 20,000-word report manages to omit any conclusive information about the all-important issue of Cho’s medications during the period of the mass shooting.

    To add to the drama, it wasn’t until two years after the state’s in-depth report was issued that, as disclosed in an Aug. 19, 2009, ABC News report, some of Cho’s long-missing mental health records were located:

        The records released today were discovered to be missing during a Virginia panel’s August 2007 investigation four-and-a-half months after the massacre.

        The notes were recovered last month from the home of Dr. Robert Miller, the former director of the counseling center, who says he inadvertently packed Cho’s file into boxes of personal belongings when he left the center in February 2006. Until the July 2009 discovery of the documents, Miller said he had no idea he had the records.

        Miller has since been let go from the university.

    Although Cho’s newly discovered mental-health files reportedly revealed nothing further about his medications, the issues raised by the initial accounts – including the “officials” cited by the New York Times and the Richmond paper’s eyewitness account of daily meds-taking – remain unaddressed to this day.

    Some critics suggest these official omissions are motivated by a desire to protect the drug companies from ruinous product liability claims. Indeed, pharmaceutical manufacturers are nervous about lawsuits over the “rare adverse effects” of their mood-altering medications. To avoid costly settlements and public relations catastrophes – such as when GlaxoSmithKline was ordered to pay $6.4 million to the family of 60-year-old Donald Schnell who murdered his wife, daughter and granddaughter in a fit of rage shortly after starting on Paxil – drug companies’ legal teams have quietly and skillfully settled hundreds of cases out-of-court, shelling out hundreds of millions of dollars to plaintiffs. Pharmaceutical giant Eli Lilly fought scores of legal claims against Prozac in this way, settling for cash before the complaint could go to court while stipulating that the settlement remain secret – and then claiming it had never lost a Prozac lawsuit.

    All of which is, once again, to respectfully but urgently ask the question: When on earth are we going to find out if the perpetrator of the Sandy Hook school massacre, like so many other mass shooters, had been taking psychiatric drugs?

    In the end, it may well turn out that knowing what kinds of guns he used isn’t nearly as important as what kind of drugs he used.

    That is, assuming we ever find out.

Beware pf ghost(writer)s of medical research, Well placed journal articles sell more pills than sales staff do

Straight Goods News
by Dr. Marc Andre Gagnon and Dr. Sergio Sismondo
June 28, 2011

The medical research world has been concerned about the problem of ghostwriting for more than a decade. The issue has been repeatedly raised in the mainstream media over the past few years, with most of the commentary focused on the ethics of academics serving as authors on papers they did not write and on some of the most egregious actions by pharmaceutical companies.

Big Pharma firms spend twice as much on promotion as on research and development (R&D).
But these efforts miss the ways in which Big Pharma has developed new forms of medical research to serve its own interests.

Big Pharma firms spend twice as much on promotion as on research and development (R&D). Worse, more and more medical R&D is organized as promotional campaigns to make physicians aware of products. The bulk of the industry's external funding for research now goes to contract research organizations to produce studies that feed into large numbers of articles submitted to medical journals. Internal documents from Pfizer, made public in litigation, showed that 85 scientific articles on its antidepressant Zoloft were produced and coordinated by a public relations company. Pfizer itself thus produced a critical mass of the favourable articles placed among the 211 scientific papers on Zoloft in the same period. Internal documents tell similar stories for Merck's Vioxx, GlaxoSmithKline's Paxil, Astra-Zeneca's Seroquel, and Wyeth's hormone-replacement drugs.

To promote the now-notorious Vioxx, Merck organized a ghostwriting campaign that involved some 96 scientific articles. Key articles did not mention the death of some patients during clinical trials. Through a class action lawsuit against Vioxx in Australia, it was discovered that Elsevier had created a fake medical journal for Merck — the Australasian Journal of Joint and Bone Medicine — and perhaps 10 other fake journals for Merck and other Big Pharma companies.
In another example, GlaxoSmithKline organized a ghostwriting program to promote its antidepressant Paxil. According to internal documents made public in 2009, the program was called "Case Study Publication for Peer-Review", or CASPPER, a playful reference to the "friendly ghost". Such strategies are not exceptions; they are now the norm in the industry.

Most new drugs with blockbuster potential are introduced accompanied by 50, 60, or even 100 medical journal articles. Any firm that refused to play this game in the name of ethics would likely lose market share. Profits in the pharmaceutical industry depend on companies' capacity to influence medical knowledge and create market share and market niches for their products.
In 2008, research showed that pharmaceutical companies systematically failed to publish negative studies on their SSRIs, the Prozac generation of antidepressants. Of 74 clinical trials, 38 produced positive results and 36 did not: 94 per cent of the positive studies were published, but only 23 per cent of the negative ones were, and two-thirds of those were spun to make them look more positive. Physicians reading the scientific literature got a biased view of the benefits of SSRIs. This helps to explain the huge number of antidepressant prescriptions, in spite of the fact that, according to a meta-analysis in JAMA in January 2010, for 70 per cent of people taking SSRIs, the drug did not bring more benefits than a placebo. Compared to placebos, however, SSRI antidepressants can result in serious adverse drug reactions.

There we see one of the problems with the ghost management of medical research and publication. Pharmaceutical companies want upbeat reports on their drugs. They design, write, and publish studies that are likely to show their drugs in positive lights — and there are myriad ways to do so. Ghosts sometimes bend the truth, and sometimes even commit fraud, with grave results.

Why do academics serve as authors on scientific articles they did not write, using research they did not perform? Because they are rewarded, both by their universities and by their colleagues for how much they publish and for its prominence. Pharmaceutical companies and their agents are very good at placing articles in prestigious journals, and then make them even more prominent by having their armies of sales reps circulate them and talk them up.
Researchers who serve as authors on studies and analyses (perhaps scientifically correct) that are favourable to the industry can expect to see these articles increase their prestige and influence, and possibly even funding.

What happens, however, when a researcher produces studies and analyses (also scientifically correct) showing that some products are dangerous or inefficient, as some did about Vioxx before the scandal broke? Reading Merck's internal e-mails, revealed during the class lawsuit, it was exposed that the company drew up a hit list of "rogue" researchers who needed to be "discredited" or "neutralized" — "seek them out and destroy them where they live," reads one e-mail. Eight Stanford researchers say they received threats from Merck after publishing unfavourable results.

In the ghost management of research and publication by drug companies we have a new model of science. This is corporate science, done by many unseen workers, performed for marketing purposes, and drawing its authority from traditional academic science. The high commercial stakes mean that all of the parties connected with this new corporate science can find reasons or be induced to participate, support, and steadily normalize it. It also biases the available science by pushing favourable results and downplaying negative ones — and sometimes through outright fraud. As long as pharmaceutical companies hold the purse strings of medical research, medical knowledge will serve to market drugs, not to promote health. And as long as universities grovel for more partnerships with these companies, the door will remain wide open to proceed with the corruption of scientific research.

Dr Marc-André Gagnon is assistant professor with the School of Public Policy and Administration at Carleton University. He is also an expert advisor with EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada. Dr Sergio Sismondo is professor of Philosophy and Sociology at Queen's University. His current research is on the pharmaceutical industry's relationships with academic medicine and practicing physicians.

This article previously appeared in Troy Media.

Accident risk doubled by SSRI use: study

Pharmacy News
Chris Brooker
3 May 2011

The use of psychotropic medications, especially SSRIs, significantly increases the risk of having a traffic accident, a large study has confirmed.

Findings from a Dutch study of 3963 users of psychotropic medications showed that, when compared to controls, users of anxiolytics had a 54 per cent greater risk of an accident, while SSRI users had more than twice the risk of such an accident.

Other classes, including other antidepressants, and sedatives had a lesser, but still significant risk. Hypnotics were associated with .... Please login to read full article.

Top Ten Legal Drugs Linked to Violence - "Time Mag"

TIME Magazine
Maia Szalavitz
January 7, 2011
When people consider the connections between drugs and violence, what typically comes to mind are illegal drugs like crack cocaine. However, certain medications — most notably, some antidepressants like Prozac — have also been linked to increase risk for violent, even homicidal behavior.

A new study from the Institute for Safe Medication Practices published in the journal PloS One and based on data from the FDA's Adverse Event Reporting System has identified 31 drugs that are disproportionately linked with reports of violent behavior towards others.

Please note that this does not necessarily mean that these drugs cause violent behavior. For example, in the case of opioid pain medications like Oxycontin, people with a prior history of violent behavior may seek drugs in order to sustain an addiction, which they support via predatory crime. In the case of antipsychotics, the drugs may be given in an attempt to reduce violence by people suffering from schizophrenia and other psychotic disorders — so the drugs here might not be causing violence, but could be linked with it because they're used to try to stop it.

Nonetheless, when one particular drug in a class of nonaddictive drugs used to treat the same problem stands out, that suggests caution: unless the drug is being used to treat radically different groups of people, that drug may actually be the problem. Researchers calculated a ratio of risk for each drug compared to the others in the database, adjusting for various relevant factors that could create misleading comparisons. Here are the top ten offenders:

10. Desvenlafaxine (Pristiq) An antidepressant which affects both serotonin and noradrenaline, this drug is 7.9 times more likely to be associated with violence than other drugs.
9. Venlafaxine (Effexor) A drug related to Pristiq in the same class of antidepressants, both are also used to treat anxiety disorders. Effexor is 8.3 times more likely than other drugs to be related to violent behavior. (More on Time.com: Adderall May Not Make You Smarter, But It Makes You Think You Are)
8. Fluvoxamine (Luvox) An antidepressant that affects serotonin (SSRI), Luvox is 8.4 times more likely than other medications to be linked with violence
7. Triazolam (Halcion) A benzodiazepine which can be addictive, used to treat insomnia. Halcion is 8.7 times more likely to be linked with violence than other drugs, according to the study.
6) Atomoxetine (Strattera) Used to treat attention-deficit hyperactivity disorder (ADHD), Strattera affects the neurotransmitter noradrenaline and is 9 times more likely to be linked with violence compared to the average medication.
5) Mefoquine (Lariam) A treatment for malaria, Lariam has long been linked with reports of bizarre behavior. It is 9.5 times more likely to be linked with violence than other drugs.
4) Amphetamines: (Various) Amphetamines are used to treat ADHD and affect the brain's dopamine and noradrenaline systems. They are 9.6 times more likely to be linked to violence, compared to other drugs.
3) Paroxetine (Paxil) An SSRI antidepressant, Paxil is also linked with more severe withdrawal symptoms and a greater risk of birth defects compared to other medications in that class. It is 10.3 times more likely to be linked with violence compared to other drugs. (More on Time.com: Healthland's Guide to Life 2011)
2) Fluoxetine (Prozac) The first well-known SSRI antidepressant, Prozac is 10.9 times more likely to be linked with violence in comparison with other medications.
1) Varenicline (Chantix) The anti-smoking medication Chantix affects the nicotinic acetylcholine receptor, which helps reduce craving for smoking. Unfortunately, it's 18 times more likely to be linked with violence compared to other drugs — by comparison, that number for Xyban is 3.9 and just 1.9 for nicotine replacement. Because Chantix is slightly superior in terms of quit rates in comparison to other drugs, it shouldn't necessarily be ruled out as an option for those trying to quit, however.

Read more: http://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/#ixzz1DHvpV500