Chapter 8

And Everything Nice

Herbal remedies.
Absorption, Herbs, Vehicles. Caffeine,
Drug development and marketing, drug regulation,
MAOIs, Melatonin, St John's wort, Vitamins.
(Ryan); (bathtub analogy)

Ryan had arrived for his first appointment.

Doctor, I get agitated at times. I feel just awful. I don't sleep well. My head aches, particularly when there are things going on at work. I want to get better.

Well, Ryan, what are you currently taking?
Nothing really, Doctor. My family practitioner suggested a little bit of antidepressant, but I've just been on it for a week or two.

Are you aware that antidepressants take a time to work?
Yes, he explained that it might take three or four weeks, but I haven't noticed very much change. In fact, I've been feeling rather strange during this time.

Are you sure you're taking nothing else?
No, nothing, Doctor. Well, you know, besides my regulars.

Your regulars? Which ones?
Well, I don't know, I like to take a lot of vitamins, and I take these anti-oxidants. My wife gave me this St John's wort, and I've been trying that.
Do you take anything for sleep?
Yes, Doctor. I like to go natural, so I have some Melatonin, but it doesn't seem to really help.

And that's all?
Yes Doctor, that's all that I take.

What about coffee?
Oh, yeah, well you know, obviously I like my coffee. In fact, it's my favorite beverage. I have maybe two or three cups to get me going in the morning, then I have another two or three in the afternoon to get me over the mid-day slump.

And you're a non-smoker?
No, you know, I've tried to kick the habit, but I vary. Some days I have five, some days I have twenty-five; mainly a pack a day I'd say, on average.

I assume you drink no alcohol.
Well, you know, when I get home after a hard day's work, I like to have a whisky or two and maybe a brandy sometimes over the weekend. Also, when I go out with the boys or watch the games, I drink a lot of beers. We can have a 6-pack each on some nights, maybe two or three days out of the week.

And what about recreational drugs?
Well, Doctor, you know, I don't know if I should be telling you this, I find marijuana really relaxes me and so I have it sometimes, you know, occasionally.
How occasionally?
Well, maybe two or three times a week.

Anything else?
No, Doctor. It used to be that we would sniff a little bit of cocaine, but I've stopped that for the most part much of late.
You say "for the most part." When was the last time?
Well, I'd say about two weeks ago.

What about other things?
I've had a few dots of LSD in my time.

Can you think of any other substances? Medications, non-prescribed drugs?
Oh, absolutely nothing, Doctor!

I see.
Do you always have your medications with water?
No, you know, I drink it down with a soda or coffee sometimes. I really like grapefruit juice, too.

What else do you drink for beverages?
Oh, I love my latt� in the morning. One more at lunch and in between plenty of Coke to cool me down.

There were so many places to begin with this patient, but I decided the coffee would be a good starter. Ryan was taking so much and, I suspected, with significant side-effects, that I was concerned for this beloved mind. Possibly, he would improve with some education, which may in turn lead to more rational understanding of herbs, alternative medicine, and medication.

I analyzed his caffeine consumption. By the time I had elicited everything, he clearly was drinking the caffeine equivalent of about six cups of coffee per day. I launched into education mode aimed at behavioral alteration in pharmacological habits, in other words, getting him off his caffeine.

Is caffeine the same as coffee, Doctor?
Not exactly. Caffeine occurs in its most potent form in coffee. However, also significant amounts of it occur in tea and soda pop drinks. We regard it as the most commonly used non-prescription drug in the world.

Really?
Did you know that if you averaged it out for the world's population, every person would drink 70 mg a day-that's about half a cup of coffee per day.

Andrew took off the plastic lid to his styrofoam cup of coffee and added:

I heard it's even more in the United States.
True, the average American uses caffeine equivalent to about one and a half cups of coffee per day. This may be from tea or soda pop drinks. A cup of tea or a can of soda pop like Coke or Pepsi contains about half the amount of caffeine as a cup of coffee.

This made Ryan wonder:

But is coffee drinking a recent habit?
Actually, it dates back thousands of years: Tea was apparently made in China 5000 years ago, and coffee beans were recorded 1500 years ago in Africa. Moreover, coffee was popular in Arabia 800 years ago.

(The chapter continues...)

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