Monday, June 2, 2014

Cleveland Clinic Starts Ambulance for Stroke Patients

My opinion: I'm glad to see that they're doing this for the public - I think this will benefit people in all locations around town, as time is of the essence when treating strokes.  I am surprised, though, that a regular ambulance cannot give the same care.  I suppose they may be able to treat heart attack victims, but maybe the emergency personnel aren't trained to handle strokes.  Is it possible to utilize this mobile stroke unit in a regular ambulance?  And if not, should there be other ambulances with different specialty treatments, like for seizures or asthma attacks?  Feel free to comment.

Monday, May 19, 2014

Website Posts Public Opinions to Solve Medical Mysteries

My opinion:  While I certainly think this website can do wonders for some people, the founders need to be careful of liability issues.  For example, say someone takes the medical advice of just anyone who posts online, and then suffers serious consequences because of it.  The company could find itself in numerous lawsuits.  I think it may be a good idea to take some of the ideas on the website and discuss them with the doctor to verify their potential credibility.  Also, if some of the information seems insecure, then perhaps users should all be anonymous.  Then again, this would also make it impossible to know who is evaluating the patient.  What's more, unless the company insists that its users who provide answers undergo a background check, people with no credentials at all may be posting answers.  Any other ways to improve the site, or is it just too difficult to carry out?  Feel free to comment.


Wednesday, May 7, 2014

Doctors Fail to Know if Patients can Afford Medication

My opinion: Again, this is a very important piece of information that doctors should be aware of, but there are only so many things that go into conversation during a meeting with the patient.  I think, in addition to asking this in the end, doctors should also ask if the patient may have trouble taking their medication, as this is often a problem in our society.  Then, the doctor should ask the patient if there are any other problems at all that the doctor needs to know.  This will help cover all potential issues, as the doctor cannot ask dozens of specific questions about the patient in one meeting, not to mention the fact that it may appear obnoxious.  Finally, in the cases in which the patient doesn't reveal a problem when there actually is one, the doctor will need to rely on social cues to figure out what is going on.  For example, the doctor in the article could see that the patient seemed nervous when he received his prescription.  These are the skills that are developed over by interacting with people and patients for a long time.  So what should doctors do if their patients can't pay?  Should they pay themselves?  Feel free to comment.

Article found at:

Tuesday, April 15, 2014

Medical Conspiracy Theories Popular in USA

My opinion:  I think the main thing that might be driving these theories forward is fear.  The medical landscape is so full of mysteries that people are likely to believe in one conspiracy theory or the other, especially if it is already quite popular.  It may also be driven by anger against the waning healthcare system in general.  I wonder how much research people do into conspiracy theories before they believe in them, and, if they actually have done research, how credible is it?  I wish the authors of this study had accounted for this and asked for a potential cause in their beliefs.  They could at least find out if these beliefs were inherent or not by asking how long the respondent has seriously considered such a theory.  This way, if the respondent indicates that they developed their belief recently, it is clear that a there must be a cause for this and the belief is not inherent.  Lastly, on another note, I wonder if this data isn't accurate because it was done through an online survey.  Are people without easy internet access more likely to believe in conspiracy theories because they cannot view scientific research?  Feel free to give thoughts and/or comments.

Half of Americans believe at least one medical conspiracy theory, study shows

"Our data suggest that medical conspiracy theories are widely known, broadly endorsed, and highly predictive of many common health behaviors."
By JC Sevcik   |   March 19, 2014 at 4:05 PM   | 
A nurse prepares a shot of H1N1 Flu vaccine for a patient. According to a new survey, almost two thirds of Americans have heard the theory that vaccines cause autism and nearly 20 percent believe it. UPI/Roger L. Wollenberg
| License Photo
March 19 (UPI) -- Do you believe that vaccines cause autism or that GMOs are being used to shrink the world’s population? Or that the government is preventing access to alternative medicines to benefit Big Pharma? That the government knows cell phones cause cancer but do nothing to stop it? That water fluoridation is suspicious? Or that the CIA infected African Americans with HIV?According to a study released Monday by researchers at University of Chicago, some 49 percent of Americans believe at least one of these medical six conspiracy theories to be true.
The study, published in JAMA Internal Medicine, questioned 1,351 adults in an online survey, asking whether they have heard of each of the above theories and whether they agreed or disagreed.
The survey also found that people who believed in conspiracies were more likely to seek out alternative medicine, with only 13 percent of nonbelievers taking herbal supplements compared to 35 percent of conspiracy believers.
Among those who believed conspiracies, 35 percent identified as liberal and 41 percent identified as conservative.

Read more:

Saturday, April 12, 2014

Scientists Capable of Making Artificial Vaginas

My opinion:  I know this seems kind of silly, but its importance cannot be underestimated, especially for others organs that may be grown in the future.  First off, this just goes to show that there may be more to a body part than meets the eye, suggesting that replacements are complicated to make.  However, now that this is made, I'm wondering if the same thing can be done except for male body parts.  What's more, doctors may use this method for sexual reassignment surgery.  Some downsides are that we don't know how these body parts will work in the future.  What if they're easier to break or malfunction as the body grows older?  Nonetheless, this is still a remarkable achievement and it seems to be working well as of now.  Feel free to give comments.

 Scientists grow viable vaginas from girls’ own cells

Wake Forest Institute for Regenerative Medicine/WFBMC Photography
Eight years after they received implants, four young women report they have functioning sexual and excretory organs
Four young women born with abnormal or missing vaginas were implanted with lab-grown versions made from their own cells, the latest success in creating replacement organs that have so far included tracheas, bladders and urethras.
Follow-up tests show the new vaginas are indistinguishable from the women's own tissue and have grown in size as the young women, who got the implants as teens, matured.
Two of the four implant recipients, who were born with a working uterus but no vagina, now menstruate normally.
It is not yet clear whether these women can bear children, but because they are menstruating, it suggests their ovaries are working, so it may be possible, said Dr. Anthony Atala, director of Wake Forest Baptist Medical Center's Institute for Regenerative Medicine in North Carolina.
All implant recipients also reported that they are sexually active and satisfied with their arousal and orgasms, according to a press release from The Lancet, the medical journal where information on the implants was published Friday. They report no unusual pain.
The feat, which Atala and colleagues in Mexico describe in the article, is the latest demonstration from the growing field of regenerative medicine, a discipline in which doctors take advantage of the body's power to regrow and replace cells.


Sunday, March 30, 2014

Doctors Produce 3-D Skull, Save Patient

My opinion:  I know there are medical miracles, but then there are medical miracles!  This really is quite the invention, and it all happened because of 3-D printing.  Still, I have some concerns for the new skull.  If part of it breaks, is it possible to replace that part with another 3-D reproduction?  Also, the skull is clear.  Can hair grow out of it, or can it at least be made to look like a real skull?  I'm very glad that the patient has healed, but what would people think of you if they saw that you had a plastic skull?  Nonetheless, a very fine and amazing idea!  It's just important, however, to try and fix the smaller problems as well, at least at some point.  Any thoughts?  Feel free to comment.

Medical First: 3-D Printed Skull Successfully Implanted in Woman

Another day, another advance in 3-D printing technology.
Doctors in the Netherlands report that they have for the first time successfully replaced most of a human’s skull with a 3-D printed plastic one — and likely saved a woman's life in the process.
The 23-hour surgery took place three months ago at University Medical Center Utrecht. The hospital announced details of the groundbreaking operation this week and said the patient, a 22-year-old woman, is doing just fine.

Image: 3-D printed skull UMC Utrecht
Doctors at UMC Utrecht in the Netherlands replaced the top part of a woman's skull with a 3-D printed plastic one.

The woman, whose name wasn’t released, suffered from severe headaches due to a thickening of her skull. She slowly lost her vision, her motor coordination was suffering and it was only a matter of time before other essential brain functions would have atrophied, Verweij said in a press release issued by UMC Utrecht.
Verweij noted that in some brain operations it’s common for part of the skull to be temporarily removed to reduce pressure on the brain, then put back later or replaced by an artificial implant. In this case, doctors inserted nearly an entire plastic skull that was manufactured with the help of Anatomics, an Australian medical device company that specializes in 3-D printing,


Sunday, March 23, 2014

Does Vitamin D Help Depression?

My opinion:  I think this whole vitamin D prophecy may be easy to believe in, especially with all the hype from drug companies.  But depression is a physiological illness that is very difficult to heal, and frankly, a vitamin pill probably will not do the trick.  I have read, however, that being malnourished can trigger depression.  On a related note, the article notes that vitamin D supplements appeared to work best with people who were vitamin D deficient.  Perhaps taking of overhaul of one's eating patterns would be an effective supplement to antidepressants, as this study seems to imply.  Additionally, studies need to investigate if vitamin pill supplements are better or if actually eating foods with vitamins are better.  Finally, I'd be really curious to see if drug companies promote research that benefits them, while not mentioning other research that harms them.  It's kind of like how colleges say they are all #1, but each one uses a different scale.  Anyone with any prior knowledge on this?  Feel free to comment.

Vitamin D supplements 'do not reduce depression'

Sunday 23 March 2014 - 12am PST

Past studies have suggested that vitamin D deficiency may lead to depression. In response, other studies propose that increasing vitamin D levels with supplements may reduce depressive symptoms. But new research, published in the journal Psychosomatic Medicine, has found no evidence that vitamin D supplements reduce depression.
The research team, led by Dr. Jonathan A. Schaffer of the Columbia University Medical Center (CUMC) in New York, NY, conducted a systematic review of clinical trials that looked at how vitamin D supplementation affected depression.
The team identified seven trials involving 3,191 participants that looked at the effects of vitamin D supplementation against depression and compared this with no vitamin D supplementation.
The investigators say that almost all trials were "characterized by methodological limitations" and only two studies included participants who had clinical depression at study baseline.
The researchers found that vitamin D supplementation itself had no overall impact on depression.
However, further investigation revealed that for patients with clinical depression, particularly those who were taking standard antidepressant medication, vitamin D supplementation may help reduce depressive symptoms.
But Dr. Schaffer says that before this association can be confirmed, new trials that monitor the effects of vitamin D supplements in these patients need to be conducted.


Saturday, March 8, 2014

"Pay-to-Play" Meetings Help Get Drugs on Market

My opinion:  Frankly, I'm not surprised that this is going on.  Everybody knows that drug companies pay doctors to promote their products, but now it is apparent that they can use money to get past the FDA.  This may be even worse than before, as now drugs are on the market that are potentially very dangerous.  I am wondering what other methods there are to getting around obstacles.  I know that drug companies often withhold possibly bad experimental data, but perhaps there's more.  What if they pay lobbyists to pass more lenient drug laws?  Do you have any opinions or additions to this?  Feel free to comment.

Senators Allege That Drug Companies Paid To Help Get Approval For A Dangerous New Painkiller

FDA Commissioner Margaret Hamburg

Ever since a coalition of doctors came out against the controversial new painkiller Zohydro, health officials have been questioning how the drug got approved by the Food and Drug Administration in the first place. Now, two senators are questioning the ethics of a series of meetings between drug companies and federal regulators, MedPage Today reports.
Senators Joe Manchin (D-W.Va.) and David Vitter (R-La.) want answers about what they call "pay-to-play" meetings in which pharmaceutical manufacturers allegedly shelled out thousands of dollars to meet with FDA officials who oversee safety regulations on painkillers. The senators suggest these meetings might have helped Zohydro get approved by the FDA despite an advisory committee voting against it.


Sunday, February 23, 2014

Battling Bad Medicine - What You're Missing from The Title of this Article

In the video TED talk (link below), Ben Goldacre discusses some of the problems with research discoveries in our day and age.  What really gets to me is that, obviously not all studies can be accurate.  But when I see them in the title of an article, I often take it for granted - seldom do I actually read the article, and even if I do, so much information is being withheld.  It would be interesting to see if a study could possibly be done on the effect of title reading - how does it affect people's minds, and do they discuss the title as if they actually believe in it? 

Anyway, that's similar to some of the issues addressed by Goldacre.  Apparently, there was once a study that determined that eating salads and vegetables could increase the lifespan, but since green-eaters often engage in many healthy habits anyway, it is impossible to know if the vegetables actually do this.  Not all factors can always be considered, and in some studies, very few are at all, which is why they're inaccurate.  More importantly, Goldacre mentions that drug companies often withhold information from being released.  I loved Goldacre's analogy to this - if you flip a coin numerous times and withhold 50% of the data, it is possible to convince another person that the coin has two heads.  So how come the government can't force them to release the data?  Is anything really that accurate at all, as far as we know?  Feel free to comment AND watch the video!

Sunday, February 16, 2014

Fruit Juice Worse than Natural, Solid Fruits

My opinion:  I think to some people this may already be obvious, but it still is remarkable how much sugar they put into these drinks.  I've actually tried some fruit juices that are unsweetened, and they taste much, much different than the others.  Perhaps one could experiment by making a small glass of orange juice from regular oranges, and then comparing this to the orange juice bought at the store.  An alternative to pure fruit juice is simply to put a little bit in a glass, and then fill the rest up with water.  I've been doing this with fruit juices for years, and frankly, I think it tastes better when it isn't sickeningly sweet.  Lastly, it's important to remember that eating the equivalent in regular fruit isn't likely to do much harm to the body.  I think this is because these are more complex sugars that are slowly processed and don't cause blood sugar spikes, but in juices, they likely add simple sugars to the mix.  Any thoughts?  Feel free to comment.

Fruit juice is not a low-sugar alternative to sugar-sweetened drinks

Dr. Gill says "there seems to be a clear misperception that fruit juices and smoothies are low-sugar alternatives to sugar-sweetened beverages."
Prof. Sattar explains:
"Fruit juice has a similar energy density and sugar content to other sugary drinks, for example: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; and 250 ml of cola typically contains 105 kcal and 26.5 g of sugar."
He says research is beginning to show that unlike solid fruit intake, for which high consumption appears linked either to reduced or neutral risk for diabetes, high fruit juice intake is linked to raised risk for diabetes.
Pieces of fruit and fruit juice
"One glass of fruit juice contains substantially more sugar than one piece of fruit."
"One glass of fruit juice contains substantially more sugar than one piece of fruit; in addition, much of the goodness in fruit - fibre, for example - is not found in fruit juice, or is there in far smaller amounts," he adds.
Also, although fruit juices contain vitamins and minerals that are mostly absent in sugar-sweetened drinks, the levels of nutrients in fruit juices many not be enough to offset the unhealthy effect that excessive consumption has on metabolism, says Dr. Gill.
In their paper they refer to a trial where participants drank half a liter of pure grape juice every day for 3 months. And the results showed that despite grape juice's high antioxidant properties, it led to increased insulin resistance and bigger waists in overweight adults.


Sunday, February 9, 2014

CVS to Stop Selling Cigarettes

My opinion:  The bigger question, besides if this is a PR stunt, is will other similar stores start doing it too, and will other products also go?  I think that the other stores, like Walgreens, will wait to see what happens with CVS.  In a way, CVS is the guinea pig for the experiment.  Similarly, others questioned whether CVS should stop selling chips and soda, too.  However, there is no health warning from the surgeon general on these types of junk food - the stigma just isn't as bad.  Furthermore, it is ok to have some of it every once in a while - this won't drastically change one's health.  Ultimately, I don't think this will do much to stop people from smoking - the cravings are strong, and they will simply go somewhere else.  But can the fight against smoking be taken further?  What if cashiers are instructed not to sell more than a certain amount of cigarettes?  Would this work?  Feel free to comment.


CVS calls it quits on cigarettes: Regina Brett

By Regina Brett, The Plain Dealer  
CLEVELAND, Ohio -- CVS drugstores will no longer sell cancer sticks.
What a powerful move by the company to place people above profits. It makes me want to give them all my drugstore business. CVS Caremark will stop selling all tobacco products in October even though it stands to lose $2 billion in sales related to tobacco.
Is a drugstore a retail store or healthcare provider? CVS had to choose and made the right choice. CVS quit for good.
Larry J. Merlo, chief executive of CVS, said: "We came to the decision that cigarettes and providing health care just don't go together in the same setting."
Is a drugstore a retail store or healthcare provider? CVS had to choose and made the right choice. CVS quit for good.
Critics might call it a marketing ploy or a PR move that stands to give the drugstore chain enough publicity to draw more people into the stores to make up for the loss in cigarette sales. Even if that's true, so what? It's still the right decision.


Saturday, February 1, 2014

The Biggest Loser Effect: Is it Healthy?

My opinion:  I'll have to agree with Professor Wittert here, the show really does push people too hard.  I remember hearing a teacher of mine years ago say that all reality TV is bad except for The Biggest Loser, because it actually helps people.  But you could argue that it hurts them more than it helps.  I remember watching one show with my mom and seeing most of the contestants passing out on the floor the first day in.  It just seems crazy to work them really hard the first day when they've hardly exercised in their lives before.  And furthermore, many of them put the weight back on after they leave.  But now that a health expert has complained about it, it will be interesting to see what the government does, but I doubt anything will happen to the show.  What kind of movement would it take to get the show canceled?  Is it even possible?  Feel free to comment.

Exercising until you vomit is not OK

Exercising until you vomit is not OK

The Biggest Loser is a crass attempt to make entertainment out of a serious problem, according to an Australian obesity expert who has officially complained to the national media watchdog.
Professor Gary Wittert says the reality TV show is devoid of academic, artistic or scientific purpose.
These views have led to an official complaint about the show to the Australian Communications and Media Authority, which he says has so far gone unanswered.
Professor Wittert, Chair of Weight Management Australia, was particularly scathing about a recent episode where competitors were reported to have collapsed and vomited while attempting to scale 10,000 stairs.
“There is nothing healthy about exercising until you vomit and collapse,” he said. “The participants are subject to tactics that induce guilt, shame and fear. A reasonable person would easily form the view that the contestants are demeaned and exploited.”


Saturday, January 25, 2014

Should People Visit the Doctor in Groups?

My opinion:  I think this might be a potential solution to a lot of problems, but it definitely won't work in all scenarios.  This may be best among people who share the same disease.  Hence, the doctor's appointment becomes somewhat like a therapy session where patients can learn how to prevent their conditions from worsening.  Moreover, it saves time and money for doctors, which could address the doctor shortage dilemma.  But this kind of thing isn't right for everyone.  You'd have to be willing to spend a longer amount of time in the appointment, and what if you have a severe problem and would like the doctor to extensively focus on you?  But with healthcare reform around the corner, I think we'll be seeing this practice pop up in a lot more places, despite the possible disadvantages.  Is this the thing of the future?  Feel free to comment and give your thoughts.

Need to See the Doctor? You May Have Company on Your Next Visit

Getty Images/OJO Images RF / Getty Images/OJO Images RF
Shared medical appointments, or group visits, are becoming a popular — and possibly more satisfying — way to see the doctor.
“As soon as I mention shared medical appointments, everybody automatically pictures a room full of people in their underwear,” says Dr. Richard Kratche, a family physician at Cleveland Clinic who conducts group visits for physicals. Rest assured, he says, these shared medical appointments don’t literally involve having an audience during a physical exam.
But they do require divulging and discussing private medical information in front of strangers (albeit ones who have signed waivers not to talk about other patients’ medical histories outside of the visit). And while that makes some people understandably uncomfortable, a surprising number of patients are finding these appointments to be rewarding and effective ways of getting more out of doctor’s visits. Since 2005, the percentage of practices offering group visits has doubled, from 6% to 13% in 2010. With major provisions of the Affordable Care Act due to be implemented by next year, such group visits are also becoming attractive cost savers — patients who learn more about ways to prevent more serious disease can avoid expensive treatments.
“It’s a different way of speaking about health that is more about friends around a circle learning together than talking with an authority figure in a white coat,” says Dr. Jeff Cain, president of the American Academy of Family Physicians, in describing shared medical appointments. Think of them as a blend between group therapy and support groups. The net effect is the same – a sense of comfort, support and even motivation that comes from sharing similar experiences.

Read more: Shared medical appointments streamline doctor's visits |

Saturday, January 18, 2014

Google to Produce Bloodless Glucose Meter, but is it Reasonable?

My opinion:  Though I think this idea is cool and exciting, I'm not sure it will actually be that popular.  Let's think about the kind of people who have diabetes.  They are very often the elderly.  Unfortunately, I don't believe very many old people wear contacts, making it difficult for this product to reach them.  Maybe it would be better if people could somehow take a tear or extract drop of liquid from their eyes and put it into a machine.  What's more, I can see this type of technology being replaced by something more efficient.  If we are supposed to have tiny robots traveling through are bodies to destroy cancer in the next couple decades, these machines will probably also detect blood glucose levels.  What's your opinion?  Feel free to comment.

Two great big hurdles for Google’s glucose-reading contact lenses: Accuracy, cost
January 17, 2014 4:30 pm by Deanna Pogorelc

If anyone can do it, Google can – right?
Not everyone is so convinced when it comes to the contact lenses Google X just announced it’s developing for people with diabetes. Mixed in with a lot of excitement around the cool technology behind the lenses is some reservation that it’s just too early to tell whether Google is any more likely than others to succeed.
In the quest for a bloodless glucose meter, the diabetes community has seen one promising company after another fail to deliver a product to the market. Google has tech chops, but Amy Tenderich of DiabetesMine underscored the importance of scientific accuracy – not just ballpark numbers – in a usable glucose meter.

For a blog post yesterday, she talked to Brian Otis, the project’s co-founder, who said the team realized that accuracy is the biggest challenge. The good news is, Google isn’t trying to do all of the science and commercialization by itself. The project founders said in a blog post they’re in discussions with the FDA and are planning to look for partners.
The vision is to embed a wireless chip and a miniaturized glucose sensor between two layers of soft contact lens material with a pinhole that would let tears seep into the sensor. It would take a reading every second and transmit it to a mobile device or a separate device specifically tied to the lenses.

Tuesday, January 14, 2014

You'll Never Guess this Device that Medicare is Covering

My opinion:  The reason why waste is so hard to define is because each individual has a different idea of waste.  Since Medicare covers penis pumps, it may improve the sexual health of those suffering from erectile dysfunction, but it refrains from spending the money on people who are suffering even more from life-threatening illnesses.  Not to mention that medicare is overpaying for the penis pumps, as consumers could buy it on their own for less.  Ultimately, waste may be helpful to some people, but it doesn't not prioritize the money to those who need it more.  In this case, I think it's safe to call this waste.  The only issue is, can the money legally be transferred for other uses?  Feel free to comment.


Penis pumps cost U.S. government millions, watchdog cries waste

WASHINGTON Tue Jan 14, 2014 8:25am EST

(Reuters) - Penis pumps cost the U.S. government's Medicare program $172 million between 2006 and 2011, about twice as much as the consumer would have paid at the retail level, according to a government watchdog's report released on Monday.
The report by the inspector general for the Department of Health and Human Services said Medicare, the government health insurance system for seniors, paid nearly 474,000 claims for vacuum erection systems, or VES, totaling about $172.4 million from 2006 to 2011. Yearly claims for the devices nearly doubled from $20.6 million in 2006 to $38.6 million in 2011.
According to the Mayo Clinic, penis pumps are one of a few treatment options for erectile dysfunction.
Government waste is a major issue in budget talks in the U.S. capital as lawmakers try to reach agreement on a $1 trillion spending bill.


Thursday, January 9, 2014

Why Alcohol Content may be Harming us from Behind

My opinion:  No doubt that more alcohol in beer could help producers increase sales.  However, many are concerned that this will make it easier to unwillingly become drunk.  Some even claim that a mere two beers with 21% alcohol can cause a person to exceed the legal limit of 0.08% BAC.  It would be interesting to see if anyone does a study on this in the near future, because right now I think it is difficult knowing if this is actually true.  If it is, though, they'll have to change the saying from "don't drink and drive" to "don't drink then drive."  I really would like to hear what you think about this, given the amount of drunk driving that already occurs in our country.  Please comment, if possible.

Beer-alcohol proposed increase to 21 percent in Ohio draws mixed reviews

You think these fellows on April 7, 1933, could have foreshadowed double-digit alcohol percentage in beer? A proposal aims to hike the percentage in Ohio from a maximum of 12 percent to 21 percent. (Associated Press)

Craft-brewing proponents in Ohio are giving mixed reviews to Rep. Dan Ramos' proposal to raise the alcohol limit on beer made and sold in Ohio to 21 percent.
"Do I think it would be good for the state of Ohio? Yes, because we're (mostly) surrounded by states with no limits," Thirsty Dog Brewing Co.'s John Najeway told The Plain Dealer. There are some specialty brews that "beer geeks and fans are missing out on. I think a lot of Ohio breweries are vying to make bigger beers."
Ramos (D-Lorain) reintroduced the bi-partisan supported proposal this week.
Akron brewer Najeway said the current 12 percent limit "hasn't hindered us. But it would be nice to have the ability" to make higher-alcohol beers, depending on the style being brewed.
"Obviously there's a bunch we make that you can push the limit on – barleywines and bourbon-barrel beers. You have to work to keep them down (in alcohol)."