Do NOT Fall For This Scam

By Lance D. Reedy

I have two clients that I know of that have gotten scammed by phishing emails. Don’t let this happen to you!

I just received this email in my inbox.  The footnotes in parenthesis are mine. It looks like this:


From:  (1)

Subject:  Payment details update required                                       4/11/2019  7:00 PM

To:  Undisclosed recipients

Message from Customer Service

We recently failed (2) to validate your payment information, (3a) we hold on record (2) for your Amazon account, (6)

therefore (3b) we need to ask you to complete a brief validation process in order to verify your billing and payment details (3g)

Click here to verify your account    (Don’t do this!!!)

Failure to complete the validation process will result in a suspension (4) of your Amazon membership.

We take every step needed to automatically validate our users, (5) (3c)

unfortunately (3d) in this case we were unable to verify your details.

The process will only take a couple of minutes (3e)

Thank you (3f)


How do you know this is a phishing email? Well, there is fraud written all over it.

1) Amazon never sends emails like this. The look is all wrong. Additionally, this email is in a black font only. If you have previously ordered from Amazon, you know that their emails are always multi-colored. As the scammers become more sophisticated, expect to receive multi-colored emails that mimic legitimate ones.

2) Look at footnote #1. The origin of this email is from “” That has nothing to do with Amazon, so you know right off the bat that this email is bogus. A genuine email from Amazon would have a return address of exactly

3) Look at footnote #2. The language is awkward and stilted.  Amazon would NEVER say, “We recently failed…”  or “…therefore we hold on record…”  No major company would use language such as this. 

4) Look at footnotes #3. The punctuation is atrocious. The author could be from Russia, Nigeria, of some other scam-infested country. 3a and c are run-on sentences. 3b, d, and f need a comma. 3e and g need a period. Spell-check likely helped them get their spelling correct, but getting the punctuation up to snuff is another matter.

5) Look at footnote #4. Phishing and scam emails almost invariable attempt to motivate you to action by scaring you with dire consequences if you don’t comply with their request. Think for a moment, why would Amazon want to suspend your account? Really? Total nonsense!

6) Look at footnote #5. “validate our users…”   What does that mean? It’s gibberish!

7) Look at footnote #6. The scammer hit “enter” rather than continuing his sentence after the comma. That’s careless. A professional email would not do that.

8) Such emails are also designed to arouse your curiosity. A person’s thought might go like this, “It’s only a tiny little click. Let’s see what’s there.”

Remember the old saying, “Curiosity killed the cat?” Do you want to stick your hand into the mouth of a rattler so see what it will do? If a powerline is downed in a storm, do you want to grab a live wire to see if it’s hot?”

When you get these, study them if you want, but stay away from these “Click/Tap Here” tantalizers.

9) Lastly, you might ask yourself, “How does the sender of this email know that I have an Amazon account? Answer: They most likely don’t. Millions of people shop at Amazon. It’s like carpet bombing. If a scammer sends this email to enough people, he will hit folks with an Amazon account.

You’re welcome to stop reading here.

Advanced study

This second part is for those that would like to dig a little deeper into these phishing emails.  When I highlighted and copied the email into my word document, it looked like this:


WDhjM5Se recently failed to valDhjM5Sidate your paDhjM5Syment inforDhjM5Smation, we hDhjM5Sold on record for your AmDhjM5Sazon acDhjM5Scount,

therefore we need to ask you to complete a brief valDhjM5Sidation proceDhjM5Sss in orDhjM5Sder to veDhjM5Srify your billing and paDhjM5Syment deDhjM5Stails

Click here to verify your account

FaiDhjM5Slure to complete the validDhjM5Sation procDhjM5Sess will result in a suspeDhjM5Snsion of your AmDhjM5Sazon memDhjM5Sbership.

We take every step needed to automDhjM5Satically validDhjM5Sate our users,

unfortuDhjM5Snately in this case we were unable to veriDhjM5Sfy your details.

The prDhjM5Socess will only take a couple of minutes

Thank you


What? Possible Explanation…

I asked my son Isaac if he could help me understand this. First, remember that email and website programming is done in HTML. Isaac opened up the HTML for this email and saw that the scammer had inserted these extra letters, DhjM5S, in the middle of various words. The font size was set to zero, meaning that they are there, but we the readers can’t see them.

Why would someone want to do this? Isaac postulated that this is done to fool spam filters. The gibberish seems to be inserted into words that spam filters might look at. Examples are validate, failure, verify, and payment. The scammer has now spoofed the spam filters, but we don’t see it. Kind of clever, I’d say. End

The Hacking of the American Mind Report #8—Picking the Lock to Nirvana

The Hacking of the American Mind by Dr. Robert Lustig

Remember the 1967 Beatles song, Lucy in the Sky with Diamonds? As soon Lustig referenced this song at the start of the chapter, I knew this chapter had something to do with LSD, a hallucinogenic drug.

LSD was first manufactured in 1938 in a Swiss lab by the pharmaceutical chemist Albert Hoffman. He tried out his new drug on himself in 1943. At first LSD was used to treat convicts and to try a cure for autism. The first commercial product hit the European market in 1947 under to name Delysid.

Native Americans have used Mescaline in religious ceremonies. Psilocybin is found in “magic mushrooms” used by indigenous people in Mexico. These hallucinogens have been used for a long time in their ceremonies. However, their hallucinogens had not been used in the mainstream culture.

However, LSD was a game changer concerning the use of hallucinogens in mainstream society. Hoffman’s LSD discovery opened up Pandora’s box and scientists wanted in.

Drinking the Electric Kool-Aid

In the early 1950s Scientists discovered incredible structural similarities between serotonin and these hallucinogenic compounds, LSD and psilocybin in particular. Please refer to pages 110 and 111 for more details. Here is the key part:

One set of scientists started altering the molecular structure of these compounds to increase their potency, while another set of scientists labeled them with radioactivity to look at their binding sites in the brain and their mechanisms of action. After years of trial and error, they discerned that these compounds acted as a serotonin agonist, meaning that they mimicked serotonin and would bind to specific serotonin receptors in the brain.; namely the -1a and -2a receptors.

Lustig recalls the turbulence of the latter 1960s, meaning the Viet Nam War protests, disillusionment with the U.S. government, and the civil rights movement. Many young people tuned in to Dr. Timothy Leary’s mantra, “Turn on, tune in, and drop out.” Needless to say, turning on with LSD became a popular thing to do in many circles, particularly middle-class young adults.

Lustig mentions that some users had “bad trips” and others had “good/mellow trips.” The bad trips involved unwanted fear and paranoia. His key point is that in general, hallucinogens magnify the emotional and mental state of the user at the time.

Later research showed that few users of psychedelics demonstrated either dependence or withdrawal upon quitting. Most were able to walk away.

The Feds Raid the Party

Congress passed the Controlled Substance Enforcement Act in 1970 and established the Drug Enforcement Administration in 1973. They were charged with regulating “all dopamine, opioid, cannabinoid, and serotonin agonists. Heroin, marijuana, and all psychedelics were classified as Schedule 1.

Lustig asserts that during this time President Nixon was concerned about the spreading use of drugs among American youth. He continues by saying that Nixon’s concern was that America needed healthy soldiers to fight in the Viet Nam war, and young men spaced out on drugs wouldn’t be of much use to the military.

Lustig makes another reference to the Beatles’ Lennon and his song Imagine. It told young people to “lay down their guns, part with their worldly possessions and learn to live as one.” Lustig asks a rhetorical question, “Why did Lennon believe this?” Because he was singing Kumbaya with Lucy in the Sky with Diamonds?

Lustig poses another question: Can hallucinogens make you happy or, at a minimum, content? Answer: Not always.

A New Death with Dignity?

Lustig explains that there is ongoing research to see if psilocybin, the active ingredient in magic mushrooms, will be of beneficial value for hospice patients. The studies are showing a reduction in long term anxiety and depression.

Special on Receptors—Buy One, Get One Free

Lustig poses this question: What ties serotonin, hallucinogens, and contentment together?

He makes this key comment:

…Through painstaking experiments on animals and humans, the mind-altering effects of all psychedelic compounds has been traced to the stimulatory effects on the serotonin -2a receptor.

My Comments; This section gets very technical and clinical. Please read pages 117-119 for his complete explanation.

Continuing:  …virtually the entire tryptomine class of psychedelics to which psilocybin and LSD belong, bind to both the -1a and -2a receptors. Mescaline only binds to the -2a receptor, so the user doesn’t have the afterglow as with the two afore-mentioned drugs.

Lustig asks another rhetorical question: Can this extra effect really treat alcohol and tobacco addiction? He expresses his doubt.

The Psychedelic Hangover

Recent studies suggest that LSD administration in normal volunteers suggests that the drug induces profound perceptual changes in the way these subjects see the world around them.

Lustig makes further comments:

The big issue with all centrally acting drugs is the concern over tolerance and either withdrawal or dependence—in other words their addiction potential. Despite demonstrating tolerance, these serotonin agonists have rarely been shown to lead to withdrawal or depression . . . they do not appear to be classically addictive.

He states that these serotonin agonists are not completely safe. There is no doubt that repeated daily dosing of LSD leads to reduction of effect.

Some of the new designer hallucinogens can still elicit the occasional bout of agitation, rapid heartbeat, and combativeness that requires an ER visit and IV sedation until the drug wears off.

Better Living Through Biochemistry

Lustig quotes research that suggests that our emotions are just the inward expression of biochemical processes in the brain.

In the case of hallucinogens, signaling of the serotonin -1a receptor drives contentment whereas signaling of the serotonin -2a receptor drives the mystical experience.

He concludes by saying in our modern society the role of mind-altering drugs to achieve heightened consciousness and/or contentment has yet to be determined.

Lustig says that we are our biochemistry and that this biochemistry can be manipulated, and this manipulation can be done for good or for ill.

My comments: My take is that Lustig does not wholesalely condemn the use of hallucinogenic substances. I think it’s safe to say that he holds that there may be some therapeutic value for some of these drugs in certain situations. One example is using these substances to ease anxiety for hospice patients.

On the other hand, he referred to the Harvard psychiatrist Dr. Timothy Leary as being public enemy number one due to his mantra of “Turn on, tune in, and drop out.” We can assume that since Dr. Lustig is a pediatric endocrinologist by training, he has seen countless young people’s lives ruined by drugs. We certainly can imagine that this drug use includes LSD and/or other psychedelic drugs. Many of the “drop-outs” are now living on the fringes of society, particularly as homeless and in many cases, just bums.

There’s one final point I’ll make. When I studied for my Master’s degree in education at the University of Montana, a requirement was to take a drug class. This was taught by the pharmacy department. We learned that drugs such as alcohol, caffeine, and nicotine and other more potent controlled substances like marijuana and opioids, were mood-altering drugs. Hallucinogenics, such as LSD, were mind-altering drugs. The takeaway for us is that in general the mood-altering drugs deal with our dopamine receptors and mind-altering drugs deal with our serotonin receptors. End

Have Your Medicare Supplement’s Rates Gone Up?

Note: We have revised and updated this article from a previous publication.

Unfortunately, Medicare supplement (Medsupp) rates continue to increase. The good news is that if your health is stable, you may be able to qualify for a lower cost plan.

For a more detailed explanation about the causes of these increases, please click here for our companion article, Why My Medicare supplement Rates Increase.

During the past few years most all companies have had rate increases to some extent or another. What can be done about this? The solution, of course, is to have us shop on your behalf for lower premium (if available) plans. Remember, you can change your Medsupp plan any month of the year, providing that you medically qualify. More about medical qualification shortly.

Another smart move may be to change plan letters. For example, if you have an increasingly spendy Plan F with Company X, a good solution is to switch to Plan G or even Plan N.

What if I have a health issue that no new company will accept?

The solution for the people in this situation may be switching to a Medicare advantage (MA) plan during the fall Annual Election Period (AEP and also known as Medicare open enrollment) that runs from October 15th through December 7th. There are pros and cons involved in switching to an MA plan. Please contact us for details. On the other hand, many people are happy enough that they just stay with their current plan. Nothing says that you have to change.

Why is it much easier to switch to a Medicare advantage (MA) plan?

The only health question on an MA application is kidney failure. You could have had a recent stroke, been treated for cancer in the past two years, or have multiple sclerosis, and you still can qualify for an MA plan. Those conditions will likely cause a decline on most any Medsupp company’s application.

However, switching to an MA plan is not feasible for some people if they live in a county that has no available MA plan. The exception is the new Medical Savings Account MA plan that currently is available in all counties in Montana and Wyoming.

How do I qualify for a new Medicare Supplement plan?

To qualify for a new Medsupp plan, in general you will need “No” answers to the following health questions. The language on each companies’ application will vary, but here are the key questions.

1) In the last two years have you had or been treated for circulatory or heart disease including a heart attack, heart bypass surgery, stent placement, atrial-fib, or pacemaker implantation?

2) Have you been treated for internal cancer, melanoma, or lymphoma in the last two years? (Does not include most skin cancers.)

3) Have you had a stroke or TIAs in the past two years?

4) Have you been diagnosed or treated for COPD, emphysema, or chronic bronchitis in the past two years?

5) Have you been hospitalized more than two times in the last two years?

6) Have you been diagnosed with any type of dementia, Alzheimer’s, or Parkinson’s disease? Note: One of our companies will take people with these conditions providing that there are no other major issues.

7) Do you have any planned surgeries such as a joint replacement or a cataract procedure recommended to be completed in the next twelve months?

8) Do you have any auto-immune disease such as AIDs, HIV, multiple sclerosis, rheumatoid arthritis etc? (Other diseases may be included depending on the company.)

These are the major categories. A company may request additional information.

Routine prescriptions such as blood pressure, cholesterol, and type 2 diabetes meds are usually okay. Most companies have a drug decline list. Examples are opioids and many cancer related drugs. Most companies require that you list all prescriptions on your application. Certain combinations of drugs such as ones used to treat diabetes (particularly insulin) and hypertension may cause a decline with one or two companies.

Why do we pre-qualify you before applying?

If you have a medical condition that is iffy, we can shop for the company that is most likely to accept your application. One company may be more picky about one particular health issue compared to another. Through the years, we have learned that a certain health issue that may not fly with one company can go through with another.

Why are some people reluctant to change if they can quality for substantially lower rates?

The biggest reason that we have seen is fear. They are afraid that the new company won’t pay its claims. However, this fear is completely unfounded. The plans are standardized, and all companies pay their claims. We have seen some situations where a person could save $80 per month or more by changing out of an old, expensive plan. She won’t budge because she is deathly afraid that the new company won’t pay its claims.

Do you ALWAYS shop for the lowest rate available?

Not necessarily. In fact, there are a couple of companies that we want to avoid like the plague. One of them was owned by one hedge fund that pawned it off to another hedge fund. The game they play is to come out with absurdly low rates. People will chase those rates only to discover that within two years or so the rates are going through the roof.

The game is called “buying the business.” A company is willing to break even or even lose money to get a bunch of people signed up. They also entice agents to peddle their product with high commissions and lucrative production bonuses. Within two years or so they go to the state insurance department, show their losses, and file for big rate increases. Meanwhile, If a person has developed an uninsurable condition, he/she is stuck with that company. Sorry, that’s not a game we’re going to play. We’ll stick with legitimate companies.

How do I find out if I can get lower rates?

Please call us at (208) 746-6283 or (888) 746-6285, or by email us at If you have a health situation that you believe may be an issue, contact us anyway, and we’ll see what we can do. End

Causes of Medicare Supplement Premium Increases

by Lance D. Reedy

Note: This article has been updated from a previous one.

In our companion article, Have Your Medicare Supplements Rates Gone Up?, we discuss what you can do if your rates have gone up.  Here we explain about the two main causes of these increases.

Cause #1: This one is the attained-age pricing that most states allow for their Medsupp plans. Here’s how it works. Company X has a rate, let’s say of $100 per month for a Plan G at age 65. Their rate chart says “Attained -age.” Company X takes its first attained-age increase at age 66. From there it increases at the rate of 3.5% per year. Their rate chart would look like this:

Attained-age Plan G
Age 65: $105.00
Age 66: $108.68
Age 67: $112.48
Age 68: $116.43
Age 69: $120.49
Age 70: $124.71

In this case, your premium increases 3.5% beginning at age 66 and every year thereafter. Some companies end their attained-age increases at age 80, and others go to age 99.

There are some variances for attained-age pricing. Company Y takes its first attained-age increase at age 68, again with a rate increase of 3.5% per year. Their rate chart would look like this:

Age 65: $105.00
Age 66: $105.00
Age 67: $105.00
Age 68: $108.68
Age 69: $112.48
Age 70: $116.43

Everything else being equal, I would choose Company Y over Company X for someone signing up at 65.

Just because a state’s insurance department allows attained-age pricing, doesn’t necessarily mean that all companies use it. A company at its own prerogative may choose issue-age pricing instead. Issue-age pricing means that if you sign up for a Medsupp at 65, let’s say with Company Z, you are always in the 65 year-old rate category. Since you are issued at age 65, your premium does NOT increase just because you advance in age.

Company Z’s rate chart may look like this.

Issue-age Plan G
Age 65: $112.00
Age 66: $112.00
Age 67: $112.00
Age 68: $112.00
Age 69: $116.00
Age 70: $120.00

If you come in at age 69, for example, your premium will be $116.00 per month, and then you will always be in the 69 year-old group.

Here’s the breakdown of how attained age pricing (if allowed) works in the five states we work in.

Idaho: An Issue-age state. Does not allow attained-age priced policies. The premiums typically start around $20 per month higher compared to attained-age pricing.

Montana: An attained-age state. Virtually all companies use attained-age pricing. Many of you have a company that is the exception and uses issue-age pricing.

Oregon: An attained-age state. All companies that I know of use attained-age pricing. Male-female rates are allowed; males are higher.

Washington: A community rated or flat-rate state. Each Medsupp plan letter has its own flat rate. It doesn’t make any difference for smoker or non-smoker, your age, or male vs. female. The rate is flat, period. Plan G’s might run around $190 per month.

Wyoming: An attained-age state. All companies that I know of use attained-age pricing. Male-female rates are allowed; males are higher.

Here’s the bottom line. Many people in Montana (but not all), Oregon, and Wyoming will have attained-age rate increases. Idaho, Washington, and those in Montana with an issue-age policy do not. However, the trade-off is that premiums usually start a little higher.

Note: One company in ID, MT, OR, and WY has its own unique pricing structure, which functions similarly to attained-age pricing.

Cause #2: All Medsupps eventually increase in premium due to the claims experience that any given company incurs. Let’s say Company W offers Medsupp plans F, G, and N.

As far as claims and premiums go, the people on Plan F are in one bucket, the people on Plan G are in their own bucket, and the Plan N folks have their own bucket. Premiums are money going into the bucket, and claims experiences (losses) and administrative expenses are money going out of the bucket.

Let’s say that the policyholders in Company W’s Plan F bucket as a group, begin to have more medical procedures. Bob Goodfellow has an unexpected open-heart surgery and Shirley Masters starts a chemo therapy regimen after a mastectomy.

Those two cases will incur substantial claims for the company and cause more money to flow out of the bucket. Let’s say that other Company W policyholders that increase their medical utilization of their Medsupp plan. The losses mount.

Finally, it gets to the point where Company W goes to the State Insurance Department, documents their increased losses, and files for a rate increase. If it’s 6%, for example, then everyone in Company W’s Plan F bucket goes up 6%. It makes no differences whether a policyholder has huge bills and another has had no claims at all. If the premium increase is 6%, then everyone goes up 6%.

As the people in any company’s block of business begin to age, the claims experience inevitably increases. The older standardized plans purchased prior to June 1, 2010 are all closed blocks of business and have increasingly greater rates of claims experience. That has put more pressure on rates.

More claims experience = more losses = premium increases.

There is another factor that leads to increased. claims. When Medsupps were initially offered, beginning in 1966, most plans covered the Hospital Part A deductible, just as most plans do today. In 1966 the Medicare Part A deductible was only $40. It wasn’t too long ago that it crossed over $1,000. More recently it looks like this.

  • 2016: $1,284
  • 2017: $1,316
  • 2018: $1,340
  • 2019: $1,364

Each year, as a policyholder is hospitalized, Company W has to pay out more money in claims. Even if the rate of hospitalizations is the same on a per 1,000-policyholder basis, the insurance company continually has to pay out more money.

Other Medicare deductibles and co-insurances also increase. As the Medsupp company continues to pay its own share of the costs, it has to pay out more and more every year coinciding with the increased obligations from Medicare. In fact, the companies usually send their policyholders a notice in the fall stating that they will automatically cover Medicare’s increases.

To sum up: As the company’s block of business ages, you have increasing medical utilization as well as gradually increasing deductibles and co-insurances from Medicare. Both of these cause more losses for the insurance company, and unfortunately, this leads to claims experience rate increases.

Conclusion: Both attained-age increases (OR, MT, and WY) along with increased claims experience (losses) will cause your Medsupp premiums to go up. The increases in ID and WA are due to claims experience only. While that’s nice for those two states, keep in mind that their rates start higher from the get-go.

What can I do to find lower rates?

Please refer to my companion article, Have Your Medicare Supplements Rates Gone UP? In addition to shopping for lower rates in general, sometimes switching from a Plan F to Plan G or Plan G to Plan N can be a smart more. If you have an older plan that has had substantial rate hikes and your health is stable, the chances are excellent that we can qualify you for lower rates. Please contact us, and we’ll start shopping for you. End

The Hacking of the American Mind Report #7—Contentment and Serotonin

Robert Lustig opens this chapter with a rhetorical question, which prescription medication (PM) has had the greatest societal impact. Cholesterol-lowering drugs? No. Anti-malarial drugs? No. Drugs to fight AIDS? No. Anti-inflammatories such as ibuprofen? Narcotics used for anesthesia? Viagra? No, no, and no.

The answer is Prozac (fluoxetine). Lustig explains that 16 to 18 percent if the population will at some time experience a major depressive disorder (MDD) in their lives. At any given time, 6-8 percent of the population are affected.

How were modern anti-depressants discovered? People with tuberculosis (TB) have been and still are treated with the drug, isoniazid. TB patients back in the 1950s out of the blue experienced a lifting of their depression. This led to further research, and scientists discovered that serotonin was responsible, in part, for the feeling of happiness and contentment. The serendipity effect of the drug is that it helped boost serotonin.

Lustig explains that there are two types of depression, retarded depression and agitated depression. Those with retarded depression can’t get out of bed and would kill themselves if they could. They require hospitalization. Much more common is agitated depression. These people can be anxious, irritable, sleepless, and just plain miserable. Both types of depression can be associated with individuals either eating and sleeping too much or too little. When Prozac was introduced in 1986, it helped people with both types of depression.

Pharmaceutical companies rushed their own versions of anti-depressants to the market. The common ones are as follows:

  • Zoloft or sertraline
  • Celexa or citalopram
  • Paxil or paroxetine
  • Lexapro or escitalopram
  • and others

These PMs are also know as selective serotonin reuptake inhibitors or SSRIs and are now prescribed to alleviate a great many metal disorders. SSRIs and the third most prescribed class of drugs and are the most prescribed for people under 65. Shockingly, 11% of adolescents are taking an SSRI, not just for depression but for anxiety, anger management, premenstrual syndrome, and obsessive-compulsive disorder.

Serotonin differs from dopamine in many ways. First, about 90% of the serotonin is produced in your gut, where serotonin is involved in neural and hormonal response to feeding and how full you are. About 9% can be found in your blood platelets. That means that only 1% of your serotonin is produced in your brain. Doing a urine test for serotonin levels is more reflective of what’s going on in your gut than it is in your brain.

There’s no biomarker for depression, no blood test that your doctor can administer. To diagnose clinical depression, doctors use a questionnaire known as the Beck Depression Inventory…

Serotonin neurons fan out to many different parts of the brain. Happiness can have many different definitions, manifestations and inputs because different interactions between regions of the brains influences different phenomena—joy, elation, love, etc. Please read pages 101-103 for more details.

The Sublime Science of Serotonin

Serotonin physiology has the same points of regulation as does dopamine.

1) Synthesis: The primary building block is tryptophan. Your body does not produce tryptophan,;it must be obtained from your diet. It’s found in small quantities in eggs, fish, and poultry. Vegetable protein sources are notoriously low in tryptophan.

Most of the tryptophan consumed is going to be used to produce serotonin in your gut…tryptophan is in competition with at least two other amino acids, phenylalanine and tyrosine, which are the building blocks for dopamine.

Put another way, dopamine completes with serotonin.

My Comment: This issue with tryptophan is one of many problems associated with a vegan diet.


2) Action:

Similar to dopamine, serotonin is released from its nerve terminals and must traverse the synapse to meet up with its receptor. Serotonin nerve terminals are all over the brain in order to bind to different receptors to exert different effects…

One receptor in particular, the serotonin-la receptor seems to be uniquely involved in decreasing anxiety and mitigating depression. It’s the binding to this receptor that is equated to well-being and contentment…Buspurone (Buspar) is a commonly used serotonin-la agonist in the treatment of severe anxiety.

3) Clearance:

After the packets of serotonin transmitters are released from the neuron, they need to traverse the synapse to get to the receptor. After they have bound to the receptor, they hang out in the synapse waiting to be recycled or deactivated.

This is the site of action of the newer SSRIs such as Prozac and the above-mentioned others. The intent of these drugs is to increase the amount of serotonin within the synapse to elevate mood. Having too much serotonin in the synapses can also be a problem.

For complete details of Lustig’s synthesis, action, and clearance discussion of serotonin, please read pages 104-106.

Always Look in the Bright Side of Life

Lustig explains that how well the serotonin mechanism in your brain depends on how happy you are.

Temperament goes a long way in explaining happiness, and differences in the serotonin transporter go a long way in explaining differences in temperament.

My comments: The four classic temperament types are sanguine, choleric, melancholic, and phlegmatic. There’s no question that people are born with these different and distinct temperaments. That there may be a serotonin connection is most intriguing.

Continuing: Lustig points out that blacks tend to exhibit less anxiety compared to whites and Hispanics. He suggests that perhaps one explanation is that the questionnaires used to derive this data are “culturally biased.” He also suggests that considering the history of slavery and discrimination, blacks might suffer from more anxiety.

Conversely, he mentions that blacks as a group have a higher percent of religious affiliation compared other racial groups. He suggests that this may provide then with a social basis for achieving happiness despite socioeconomic adversity.

Lustig also suggests that there may be a genetic difference or a biochemical reason as well. There is a known genetic difference in blacks which may slow down the clearance of serotonin. It’s like blacks have their built in SSRIs enabling them to become less depressed in adverse circumstances.

Too much serotonin can become a bad thing. Some of the side effects are irritability and suicidal thoughts and actions. There can also be negative levels of mood and impulsive aggression.

Serotonin syndrome, which results from too much serotonin activity because of SSRI overdose or interactions with other drugs, is characterized by changes in mental state and muscle tone, and autonomic nervous system problems. Going overboard on serotonin can take someone who’s morose and give them just enough brain activity and mental energy to make them suicidal, which is why people on anti-depressants shouldn’t dose themselves.

Lustig points out that there is no magic pill. A dose of Prozac for an 18 year-old may not work the same way for a 40 year-old. He mentions the use of anti-depressants for a woman suffering from post-partum depression. Her serotonin levels may return to normal after a year, but only 25% of those who take anti-depressants experience a full remission. Lustig ends the chapter with two rhetorical questions: Short of SSRIs, what hope do we have of achieving any meaningful happiness in life? Are we really a Prozac nation? Not quite. Read on.

How Different Antidepressants Work

I’ve taken some excerpts from WebMD explaining how antidepressants work. Please click here for the link if you care to read it in its entirety.

Note: Using WebMD as a source is not necessarily an endorsement of WebMD. While they have much good information, they also promote misinformation, especially when discussing diet and nutrition. Consider this:

Cut back on Fats and Oils: Eating too many fats can cause high cholesterol and heart disease. With DASH [Dietary Approaches to Stop Hypertension], you’ll limit fats and oils to two to three servings a day. A serving is 1 teaspoon of margarine or vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of low-fat salad dressing. When cooking, use vegetable oils like olive or canola instead of butter.

Soybean oil, canola oil, and cottonseed oil are the worst of the worst fats and should be avoided. For those that followed our reviews and digests of Dr. Stephen Sinatra’s The Great Cholesterol Myth, these already oxidized, seed-based* oils are high in Omega 6 fatty acids. Omega 6 oil are very unstable when heated *Calling them vegetable oils is a misnomer. You get oil from seeds, not vegetables.

Factory, high temperature processing causes these oils to become rancid or oxidized by the time you buy them. Because they are rancid, they throw off free radicals right and left.  When you consume them, this contributes to turning harmless, low-density lipo-proteins into bad cholesterol which in turn, leads to inflammation of your coronary arteries.

Yes, WebMD is still on the bandwagon of demonizing cholesterol. The fact that a supposed “health” website supports the use of margarine, a transfat, suggests that they have an agenda, one that does not have your health in mind.

WebMD has a bias that favors the use of pharmaceutical drugs and processed factory foods. Sites such as WebMD may also be the recipient of hidden corporate sponsorship. If a soybean oil processor, for example, is funding WebMD, that gives WebMD motive for demonizing butter and promoting seed [vegetable] oils and soy-based foods. Condoning the use of margarine, a transfat, is a dead giveaway.

For more revealing information about WebMD, please click here and here.

With these caveats in mind concerning WebMD, let’s learn about the pharmacology behind commonly prescribed antidepressants.

Reuptake Inhibitors: SSRIs, SNRIs, and NDRIs

…We really don’t know what causes depression or how it affects the brain. We don’t exactly know how antidepressants improve the symptoms.

That said, many researchers believe that the benefits of antidepressants stem from how they affect certain brain circuits and the chemicals (called neurotransmitters) that pass along signals from one nerve cell to another in the brain. These chemicals include serotonin, dopamine, and norepinephrine. In various ways, different antidepressants seem to affect how these neurotransmitters behave. Here’s a rundown of the main types of antidepressants…

Some of the most commonly prescribed antidepressants are called reuptake inhibitors. What’s reuptake? It’s the process in which neurotransmitters are naturally reabsorbed back into nerve cells in the brain after they are released to send messages between nerve cells. A reuptake inhibitor prevents this from happening. Instead of getting reabsorbed, the neurotransmitter stays — at least temporarily — in the gap between the nerves, called the synapse.

What’s the benefit? The basic theory goes like this: keeping levels of the neurotransmitters higher could improve communication between the nerve cells — and that can strengthen circuits in the brain which regulate mood.

My comment: simply put, an SSRI slows down the use or reuptake of your serotonin, causing it to last longer in your nerve synapses.


Different kinds of reuptake inhibitors target different neurotransmitters. There are three types:

Selective serotonin reuptake inhibitors (SSRIs) are some of the most commonly prescribed antidepressants available. They include Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. Another drug, Symbyax, is approved by the FDA specifically for treatment-resistant depression. It’s a combination of the SSRI antidepressant fluoxetine (Prozac) and another drug approved for bipolar disorder and schizophrenia called olanzapine (Zyprexa). Aripiprazole (Abilify), quetiapine (Seroquel), and brexpiprazole (Rexulti) have been FDA approved as add-on therapy to antidepressants for depression. Plus, doctors often use other drugs in combination for treatment-resistant depression. Also, the drugs  vilazodone (Viibryd) and vortioxetine (Trintellix – formelrly called Brintellix) are among the newest antidepressants that affect serotonin. Both drugs affect the serotonin transporter (like an SSRI) but also affect other serotonin receptors to relieve major depression.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are among the newer types of antidepressant. As the name implies, they block the reuptake of both serotonin and norepinephrine. They include duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine ER (Khedezla), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq).

Norepinephrine and dopamine reuptake inhibitors (NDRIs) are another class of reuptake inhibitors, but they’re represented by only one drug: bupropion (Wellbutrin). It affects the reuptake of norepinephrine and dopamine.

My comments: In doing Part D prescription plan searches for clients, I have frequently run across the classic SSRIs such as fluoxetine, sertraline, and citalopram. I found it helpful to understand that venlafaxine and duloxetine are SNRIs and that bupropion is an NDRI. Note: These are the generic names for brand name drugs.


Older Antidepressants: Tricyclics and MAOIs

These drugs were among the first to be used for depression. Although they’re effective, they can have serious side effects and can be especially dangerous in overdose. Nowadays, many doctors only turn to these drugs when newer — and better tolerated — medicines haven’t helped. Tricyclics and MAOIs might not be the best approach for someone who was just diagnosed. But they can sometimes be very helpful for people with treatment-resistant depression, or certain forms of depression (such as depression with anxiety).

Tricyclic antidepressants (TCAs) include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor). Like reuptake inhibitors, tricyclics seem to block the reabsorption of serotonin and epinephrine back into nerve cells after these chemicals are released into a synapse. Because of the potential side effects, your doctor might periodically check your blood pressure, request an EKG, or recommend occasional blood tests to monitor the level of tricyclics in your system. These medicines might not be safe for people with certain heart rhythm problems.

My comments: I found it helpful to learn that amitriptyline and nortriptylineare in an older class of antidepressants. It was also interesting to note that these drugs are prescribed when the newer antidepressants haven’t worked. Using WebMD. Reading this section about antidepressants was the longest time that I have used this website. One criticism that a reviewer on had of WebMD was the tediousness of reading the site for information because of the bombardment of advertisements and popups. I found the same to be true. Nevertheless, despite the shortcomings and conflicts of interest concerning WebMD, it is possible to ferret out some useful information. End


The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Common Anti-Depressants

In Dr. Robert Lustig’s book The Hacking of the American Mind, Chapter 7, Contentment and Serotonin, Dr Lustig references older and common Selective Serotonin Reuptake Inhibitors (SSRIs) anti-depressants. Let’s learn a little more about them.

Prozac (generic name-fluoxetine): It is available as a liquid, tablet, capsule, and as a delayed-release, long-acting capsule.

From WebMD: Fluoxetine is used to treat depression, panic attacks, obsessive compulsive disorder, a certain eating disorder (bulimia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Fluoxetine may lessen premenstrual symptoms such as irritability, increased appetite, and depression. It may decrease binging and purging behaviors in bulimia.

Side Effects: Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning may occur. If any of these effects persist or worsen, tell your doctor promptly.

Precautions: Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

From Wikipedia: Fluoxetine was discovered by Eli Lilly and Company in 1972 and entered medical use in 1986 It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is between US$0.01 and US$0.04 per day as of 2014. In the United States, it costs about US$0.85 per day. In 2016 it was the 29th most prescribed medication in the United States with more than 23 million prescriptions.

Common side effects include trouble sleeping, sexual dysfunction, loss of appetite, dry mouth, rash and abnormal dreams. Serious side effects include serotonin syndrome, mania, seizures, an increased risk of suicidal behavior in people under 25 years old and an increased risk of bleeding. If stopped suddenly, a withdrawal syndrome may occur with anxiety, dizziness and changes in sensation.

From As an SSRI, Prozac works by preventing the brain from reabsorbing naturally occurring serotonin. Serotonin is involved in mood regulation. In this way, Prozac helps the brain to maintain enough serotonin so that you have a feeling of well-being, resulting from improved communication between brain cells.

Research also highlights how medications such as Prozac may help in combination with psychotherapy. In a 2008 study published in Science, it was shown that in mice, Prozac helped the brain to enter a more immature and plastic state, possibly making it easier for therapy to have an effect. We do know that combining medication such as Prozac with talk therapy is effective for anxiety, and this study indicates a potential reason why.

Zoloft: (generic name-sertraline):

From WebMD: Sertraline is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Sertraline is known as a selective serotonin reuptake inhibitor (SSRI). It works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

From Wkipedia: Sertraline was approved for medical use in the United States in 1991 and initially sold by Pfizer]] In 2016, it was the most prescribed psychiatric medication in the United States with over 37 million prescriptions.

From As with all medications, Zoloft may cause certain unwanted side effects. The most commonly experienced in those taking Zoloft include:

Diarrhea, Nausea, Indigestion, Decreased appetite, Fatigue, Sleepiness, Insomnia, Tremors, Agitation, Increased sweating, Sexual problems, including loss of libido and inability to ejaculate, Gastrointestinal problems can occur in as many as one in four people

There are some serious side effects associated with Zoloft use: Black or bloody stools, Chest pain, Fainting, Fast or irregular heartbeat, A severe or a persistent headache, Fever over 100 degrees F, Seizure, Suicidal thoughts, Stevens-Johnson syndrome (SJS), a rare but potentially fatal allergic reaction.

Celexa (generic name-citalopram):

From WebMD: Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Citalopram is known as a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

To reduce your risk of side effects, your doctor may direct you to start taking this drug at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

Side effects: Nausea, dry mouth, loss of appetite, tiredness, drowsiness, sweating, blurred vision, and yawning may occur.

From Wikipedia: Citalopram, sold under the brand name Celexa among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder, obsessive compulsive disorder, panic disorder, and social phobia. Benefits may take one to four weeks to occur. It is taken by mouth.

From Celexa is made by Forest Laboratories, Inc.

From Celexa is an antidepressant medication that’s often prescribed to treat both mood and anxiety disorders. Celexa belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

How Celexa Works: Celexa balances your level of serotonin, a naturally occurring chemical substance or neurotransmitter in the brain. Serotonin is responsible for regulating sleep, mood, and other functions. Research has shown that imbalanced brain chemicals can contribute to mood and anxiety disorders, but the exact cause of panic disorder remains unknown. An SSRI like Celexa can assist in balancing serotonin by preventing the nerve cells in the brain from absorbing it. By reducing the rate at which serotonin is reabsorbed, Celexa changes your brain chemistry, improving mood and reducing feelings of anxiety. Celexa can assist in decreasing the severity of panic attacks and other panic disorder symptoms. Plus, Celexa can also reduce symptoms if you have a common co-occurring condition, such as depression.

Paxil (generic-paroxetine):

From Paxil is an antidepressant medication approved for the treatment of generalized anxiety disorder (GAD) and other anxiety disorders. It is in the same class as Prozac and Zoloft. Like other selective serotonin reuptake inhibitors (SSRIs), it was developed as a treatment for depression.

Paxil was approved for the treatment of generalized anxiety disorder (GAD) in 2001 and social anxiety disorder (SAD) in 1999. It is also a prescribed treatment for panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and obsessive-compulsive disorder (OCD).

Nerve impulses are transmitted chemically between neurons in the nervous system. Neurotransmitters like serotonin are produced by one neuron. They travel between the cells and are deposited on the second neuron. It is theorized by some that keeping the serotonin around longer results in relief of depression.

People with GAD develop chronic and exaggerated worry and tension, even though nothing seems to provoke it. Those with this disorder are always anticipating disaster. They often worry excessively about health, money, family, or work. Just the thought of getting through the day may provoke anxiety.

Many people with GAD realize that their anxiety is more intense than the situation warrants. This knowledge does not reduce the anxiety. They may report being unable to relax and often have trouble falling or staying asleep.

Their worries are usually accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded, out of breath, nauseated or have to go to the bathroom frequently. They might also feel as though they have a lump in the throat.

Generalized anxiety disorder is usually treated with psychotherapy, medication, or a combination of the two. It can take some time to figure out the best combination for you, so be patient and keep your doctor informed about what is and isn’t working for you.

Common side effects of Paxil are nervousness, sleep difficulties (either too much or too little), restlessness, fatigue, dry mouth, nausea, headache, sweating, diarrhea, and sexual problems. Typically, these side effects will go away within a couple weeks of taking the medication.

For a complete list of other anti-depressants, please refer to this Wikipedia link.


The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Are Medicare Supplement Plans C and F going Away? Not quite!

Note: I thank Ron Iverson, president of NAMSMAP* for assembling this data. This information comes from the National Association of Insurance Commissioners. *National Association of Medicare Supplement and Medicare Advantage Producers.

1)  Why is the standard model for Medicare supplement (Medigap) plans being revised?

A new federal law was passed on April 16, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medigap policies that cover the Part B deductibles for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.

2) What does MACRA require?

As of January 1, 2020, MACRA does the following:

2a) Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries, so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan.

2b) Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.

2c) Who is considered a “newly eligible” Medicare beneficiary under MACRA?

MACRA defines “newly eligible” as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

3) How much is the Medicare Part B deductible?

Medicare Part B deductible is $185 in 2019.

4) How does this relate to efforts to eliminate Medigap or Medicare supplement “first dollar coverage”?

This accomplishes the efforts to eliminate Medigap “first dollar coverage” (coverage of all claims without paying any out of pocket cost) by discontinuing sale of Plan C and Plan F only for “newly eligible” Medicare Beneficiaries

5) How are people eligible for Medicare on the basis of disability impacted by these changes?

Current beneficiaries are not impacted. The restrictions under MACRA apply to persons who qualify for Medicare as a result of a disability on or after January 1, 2020.

6) Why are plans “re-designated” for only “newly eligible” Medicare beneficiaries?

The Federal Government wanted to eliminate coverage for the Part B deductible making consumers responsible for that first dollar coverage. The only difference between Plans C and F and Plans D and G is the coverage of the Part B deductible under Plans C and F. All other benefits are exactly the same for D and G. Since Plans C and F will no longer be available for “newly eligible” beneficiaries, it was necessary to designate Plans C and F as Plans D and G for these individuals.

7) How are enrollees in current Plans C and F affected by these changes?

Current enrollees (those eligible for Medicare PRIOR to January 1, 2020) can continue with their Plan C or Plan F, including F High Deductible plan, and may continue to buy Plans C and F beyond January 1, 2020. Current enrollees will also be able to buy the new Plan G High Deductible plan on or after January 1, 2020.

8) What changes are made to High Deductible Plan options?

Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020. The effective date of coverage for Plan G High Deductible must be on or after January 1, 2020. If you are not a “newly eligible” beneficiary and are enrolled in a Plan F High Deductible prior to January 1, 2020, you are able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.

9) When can the new High Deductible Plan G be sold and who can buy it?

Plan G High Deductible can be made available beginning on January 1, 2020; “newly eligible” Medicare beneficiaries and current beneficiaries would be able to buy the new Plan G High Deductible.

10) For high deductible plans, does payment of the Part B deductible count towards the plan deductible?

For Plan G High Deductible; while the Part B deductible is not covered (reimbursed), it does count towards the High Deductible plan’s deductible. If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses and Part B Deductible expenses are then incurred, these expenses will not be covered expenses until the beneficiary meets the Medicare Part B deductible.

11) For the new High Deductible Plan G sold on or after January 1, 2020, what happens if a policyholder meets the high deductible amount with all Part A out of pocket expenses?

If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses any Part B Deductible expenses incurred will not count towards meeting the High Deductible nor will they be covered expenses.

12) What changes are made to Guaranteed Issue requirements?

Since two of the current guaranteed issue plans, Plans C and F, will no longer be available for “newly eligible” Medicare Beneficiaries on or after January 1, 2020, Plans D and G will become two of the guaranteed issue plans for these individuals. Current enrollees can remain with or buy Plans C and F and individuals who do not fall within the definition of “newly eligible” Medicare beneficiary will still be able to purchase Plans C and F.

13) How does this change the way Plans C or F, and D or G, may be sold in the state?

Insurers can continue to sell Plans C or F to current Medicare beneficiaries. However, “newly eligible” Medicare beneficiaries cannot apply for or purchase Plan C or F. The “newly eligible” would be offered Plans D or G on a guaranteed issue basis instead. All other currently available plans may continue to be offered to all Medicare beneficiaries regardless of their date of eligibility for Medicare.

You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.  

Key Takeaways

1)  Plans C and F, and High Deductible F, will not be available to anyone who turns 65 (“newly eligible”) after January 1, 2020, including those eligible for Medicare by reason of disability.

2)  People currently with Plans C and F and High Deductible F will be able to keep them after the date.

3)  People who turn 65 and register for Medicare before the date, can still purchase Plans C and F because they are not considered “newly eligible.”

4)  And…even though a person who purchases Part B after January 1, 2020, they can still purchase Plans C or F because he/she turned 65 before the date.

5)  The current Plan C will become (be designated) the current Plan D after the date.

6)  The current Plan F will become (be designated) the Current Plan G after the date.

7)  All High Deductible Plan Fs will be available as they currently are after the date, and will become (be designated) High Deductible Plan G.  Available purchase will include people who turn 65 before the date, but again, not those “newly eligible.”

8) Guaranteed Issue (GI) Plans C and F will not be allowed to be sold to newly eligible, but GI plans D and G will.

9)  Plans K and L will remain the same, with the exception of the yearly raise of out-of-pocket expense.

10)  Plans M and N will not change.

11)  The rules also apply to “Medicare Select” plans.