Sell your cigarette stocks - smoking to end.

[billvon]

Nope, you don't quite get it either.

Oh, I get it. It would be uncomfortable and painful, because you'd be changing something that you have become very comfortable with, and that your brain has been "trained" to anticipate. Antabuse works for drinking in a very similar manner - if people are willing to take it. In programs where people are told "just take it" it doesn't work at all, because it makes you feel bad when you do drink, and thus people stop taking it so they can drink. But in programs where people take it regularly it works very well.

But that's if your goal is quitting drinking (or smoking) - not if your goal is to feel good all the time.

 

[Aladdin]

You probably think something like a toothache or gunshot wound hurts pretty bad, right? Well, I can tell you first-hand that I've experienced both of those (more than once, actually) [...]

Please tell me your dentist is not using a loaded gun instead of anesthesia.

 

[quadraphonics]

"... scientists at Cornell Medical School might have the ultimate solution – a nicotine vaccine.

Essentially, it’s an injection to the liver that blocks nicotine from reaching the brain. So smokers would get zero pleasure from lighting up, no matter how many puffs they take. ..."

If that were going to bring about the end of smoking, then the multiple drugs already on the market that do the same thing would already have done so.

 

[quadraphonics]

Yes it is and will save millions in healthcare costs.

No, it will add millions in healthcare costs. Non-smokers live a lot longer than smokers, and during those later years consume a lot of expensive healthcare (not to mention, Social Security benefits and the like).

I have made that same argument in another thread, but one needs to consider the loss of productivity, both of the smoker and those who care for the smoker in hospitals etc.

Even when you account for all that, smoking ends up being a net savings to society.

I concluded that from economic POV, all already retired should get free cigarettes but none of those still working, paying taxes.

That's stupid. The lifetime-shortening effect is the primary cause of the savings, but to get that you have to smoke over your whole life. People who start smoking after retirement aren't going to significantly shorten their lives, they're just going to get sicker than they would otherwise and so incur even more medical costs.

Also your (preposterously rightwing, statist) "economic POV" might as well suggest we summarily execute all retirees and use them as fertilizer. After all, they're just a drain on the economy right?

 

[quadraphonics]

I'm guessing you're not a smoker...

I would love to quit smoking. It's a nasty habit, and an expensive one at that.

But, I'm not ready to go thru the withdrawal symptoms just yet. Come up with a "painless" way to quit, and I'd be willing to bet many of us would toss our ashtrays out.

Sure, there are patches and gums... But they cost more than the smokes do.

So, until there is a better way to quit, I will continue to light up. *sigh*

Don't be such a pussy. Just stop smoking, within a couple of days you'll feel much better overall, and the cravings taper off after a week or so.

All these pills and patches and whatnot are just a scam to capitalize on your weakness. It's as simple as just not smoking any more. It can also help to time quitting with a big change in your daily routine (change of jobs or living space), so that you are not still in a routine that you associate with smoking. Short of that, you can try going on a vacation somewhere new for a week and quitting while you're there, to get you over the hump.

 

[Mrs.Lucysnow]

Don't be such a pussy. Just stop smoking, within a couple of days you'll feel much better overall, and the cravings taper off after a week or so.

That is simply not true. When I stopped smoking (cold turkey) one month and two weeks after the fact I would get cravings so bad they would make me MISERABLE, and I mean a severe smoking cravings like it was the first 24hrs. I've known people who stopped smoking for over a year who had one cigarette at a party and then couldn't stop afterwards. I know people who were plagued for six months with cravings. There are people who have literally smoked longer than they haven't. Quitting on vacation is the worse idea I have ever heard. Why would anyone want to withdraw, be so crabby they want to eviscerate everyone for the the slightest transgression while on a vacation. Worse of all you would have nothing to do but lounge around. NO. Work is better, especially if its work where you don't have to deal with too many people. I say send the family away on vacation for a month and take up farming...or painting the house...or replacing the roof.

 

[Trippy]

Correct - you didn't say that in so many words - it's your rather brash overall assumptions that prompted that comment from me.

I clearly told you that I HAVE tried every possible product and approach that's ever been proposed - and that clearly includes your snail's-pace slow approach. And I would assume that it should be obvious that I have not tried it with this particular drug since it isn't even available on the market yet. I also reported that none of them worked for me and I also explained in detail WHY they all failed.

At this point, I've no idea what additional info you want from me or anyone else. So I will restate what I've already said: This drug is BOUND TO FAIL simply because it does NOT address the larger, more important and powerful part of smoking addiction. I personally wish it would work (just as I did with all the other things I've tried!!) but I honestly see no hope for it to succeed.

I, personally, do not smoke - above and beyong a few attempts to bum a fag when drunk and stressed, but I have been through what I recognize as nicotine withdrawl.

I have also known a large number of smokers, and have had the chance to observe their experiences of trying to quit, and it has taught me one thing. Different people have different experiences trying to quit. I've known people who have gone cold turkey after twenty years worth of smoking and never looked back. I've also known people in the same boat as you who have been trying to quit for twenty years without success, and have literaly tried every method under the shining sun, from weaning themselves to Nortriptyline. The point being that there's clearly a component aside from the physical and psychological addictions that come into play, and as you say, quitting is not equally easy for everybody.

 

[quadraphonics]

That is simply not true. When I stopped smoking (cold turkey) one month and two weeks after the fact I had craving so bad they would make me MISERABLE, and I mean a severe smoking like it was the first 24hrs.

And yet you apparently made it, without any crazy injections - no?

I've knows people who stopped smoking for over a year, have one cigarette at a party and then couldn't stop afterwards.

The word for those people is "pussies."

There are people who have literally smoked longer than they haven't.

I had smoked for right about half of my life, when I quit. I am not some dilettante who never really got into smoking and couldn't fathom the perspective of long-time smokers.

Quitting on vacation is the worst idea I have eve heard. Why would anyone want to withdraw, be so crabby they want to eviscerate everyone for the the slightest transgression.

I suppose it depends on the person, but my experience has been that when I'd go on vacation and get outside of the regular smoking routine, I would smoke much less and have much fewer cravings for cigarettes. It's a set and setting thing - if you're in a setting where you aren't used to smoking all the time, then not smoking shouldn't bother you as much.

Worse of all you would have nothing to do but lounge around.

Maybe on your vacations. Mine tend to feature intensive adventure sports, family events, outings, etc.

 

[Mrs.Lucysnow]

@Quad

Oh yeah I agree you don't have to take antidepressants or go through crazy surgery. No you can quit but its really really hard and it usually takes quitting and starting and quitting a number of times and when people simply cannot quit I don't quite blame them. I cannot say I was a happy non-smoker even when I felt the positive physical and economic benefits to not smoking, I really really missed it and the idea of smoking never quite goes away. They are not "pussies" because they cannot stop, its really a difficult habit. The problem with going outside of your regular routine is that eventually you have to go back to your regular routine. Again adventure sports are fine but then you have to go back to your regular routine. I would recommend a lot of physical activity once you stop. But hanging around family and other people? Hell no! Hell is other people when you've stopped smoking and its terrible for all those innocents when you blow up at them for simple transgressions. I do believe you have to keep yourself very very busy and stay busy, anything physical that keeps you moving. Cleaning the house, throwing away things in the attic, buy a bicycle, whatever. But again there are a lot of smokers who have been smoking more years than not and so being a non-smoker is no longer a natural state of being.

And emotionally? It was HELL. I would cry for no reason, it was like the mother of PMS all the time. HELL

But here's the thing, you can never ever have one or a half of one or a puff of one. This idea that you can go to being a controlled smoker, a "Oh I'll just have one and then stop" business is foul. It'll get you back on the habit in no time.

I would never tell a smoker to stop in a setting that's very different from what they will face. The triggers are always going to be in your every day routine, so its about replacing different habits and having different coping skills within those routines.

And as smokers who've given up the habit we should never get so cocky as to think we could never end up back on the habit. I know too many people who stopped for like ten years or at least one year who went back to cigs. If we stay quit we should be grateful that we were able to do so and not pretend it was a duck walk.

 

[Fraggle Rocker]

There is one huge advantage of this new thing: It forces the smoker to give up, no matter what. If I get it correctly, just one vaccine can make smoking a not-pleasurable/wished thing. So once you got this shot, you are not going to enjoy smoking, although you might suffer withdrawals, eventually you are going to give it up. After all, why take/smoke something if it has no effect on you?

None of you understood my original point: Nicotine is a psychoactive drug that cheers people up when they're depressed and calms them down when they're agitated. Most smokers can, in time, overcome the withdrawal symptoms that come with quitting. But that leaves them still vulnerable to the original problems that encouraged them to start smoking in the first place.

You have to replace the tobacco with something else, or eventually they'll go back to it because their life is as miserable as it was before they started.

It's almost exactly like telling someone he can stop taking aspirin. Sure he can. But then what will he do to alleviate the pain that he took the aspirin for?

This new idiotic tactic by Big Nanny is going to turn loose hundreds of millions of people who no longer have the ability to regulate their moods. Raise your hands, everyone who thinks that sharing the planet with them is going to be a really good time for everybody!

No, it will add millions in healthcare costs. Non-smokers live a lot longer than smokers, and during those later years consume a lot of expensive healthcare (not to mention, Social Security benefits and the like). Even when you account for all that, smoking ends up being a net savings to society.

That's a common argument given by smokers, but it's completely fallacious.Those are not the years you give up. You have all of those conditions anyway, just at a much younger age.

They are not "pussies" because they cannot stop, its really a difficult habit.

It's widely acknowledged by professionals who work with addiction, that the withdrawal symptoms from nicotine are worse than those from any other commonly-used drug. Sure, going cold-turkey on heroin will literally make you wish you were dead, but it's possible to back off slowly and after a few weeks the symptoms are gone. Nicotine, on the other hand, causes new receptors to grow which mesh with the nicotine molecules, and if those molecules stop coming it can take a very long time to adapt to their absence. In many people the receptors never disappear, and they spend the rest of their lives putting up with constant low-level withdrawal symptoms. In other people they do eventually attenuate, but it can take many months to complete.

Synanon was one of the first private-charity residential drug rehab centers in L.A., back in the 1960s. When it started they gave their residents free cigarettes. But eventually they had to cut back on expenses and they decided that the weeds had to go.

More people left Synanon because of the lack of tobacco, than withdrawal from the so-called "hard" drugs.

Hell is other people when you've stopped smoking and its terrible for all those innocents when you blow up at them for simple transgressions.

I was lucky. Mrs. Fraggle had smoked for about fifteen years when we met. She quit more-or-less cold-turkey, in less than a week. She was not in agony at the time and in the ensuing 30+ years there have never been any crises to deal with.

Why did she quit? Whenever she lit one up I always used to grab it from her and take a hit. She asked me why, and I said, "It dulls my taste receptors so I can stand to kiss you." She thought that was just too disgusting.

 

[Promo]

I smoked for roughly 15 years and quit no problem. My secret I suffered from a nasty upper chest infection and was bed ridden for almost 6 days. I used that time to not light up anymore, you don’t have to worry about withdraws when you’re sleeping 20+ hours a day and you already feel like shit. That’s the best time to quit.

 

[Billy T]

... Nicotine, on the other hand, causes new receptors to grow which mesh with the nicotine molecules, and if those molecules stop coming it can take a very long time to adapt to their absence. In many people the receptors never disappear, and they spend the rest of their lives putting up with constant low-level withdrawal symptoms. In other people they do eventually attenuate, but it can take many months to complete. ...

That is interesting (and very surprising to me). Do you have a link telling that?

Reason I ask is many drugs have been developed which bind to specific receptor site and block them.* For example, Bicalutamide binds to the androgen receptors, so testosterone can not stimulate them. Unfortunately, after a few years, prostate cancer cells soon "learn" how to grow and divide, without the testosterone so that is not a long term cure nor are other drugs that reduce the production of testosterone ("chemical castration") for the same reason.

Do you know why is there not a drug on the market that blocks the Nicotine receptors both new and old? If I were a smoker and wanted to quit, I would prefer to take such an oral drug every week or so than get an injection into my liver like the OP´s drug. Surely the Nicotine receptors have some other function as Nicotine has not been used during much our evolution. Perhaps that "other function" they evolved for is why no drug for blocking Nicotine receptors exists? If smoking does increase the number of Nicotine receptors, why is that "other function" not over performed? I am trying to see if what you state is self consistent here.

*Many of these site specific drugs are "magic bullets" also in that they have a toxin attached that then only kills the target cells, etc. You don´t dare do that with Bicalutamide to kill prostate cancer cells as it binds to androgen sites in the brain too. (The brain has a large role in regulating the production of testosterone so has sensors detecting its level. Taking Bicalutamide will block these brain receptors making brain "think" your testosterone is low and then it jacks your testosterone level way up, but don´t do it to be a "He Man" as you get painful tits too.)

 

[quadraphonics]

You have to replace the tobacco with something else, or eventually they'll go back to it because their life is as miserable as it was before they started.

Nicotine gum and patches have been available for a long time now. If people want to quit smoking, but stay addicting to nicotine, it's trivial for them to do so.

It's almost exactly like telling someone he can stop taking aspirin. Sure he can. But then what will he do to alleviate the pain that he took the aspirin for?

Except that alternative, smoke-free nicotine delivery systems have been widely available for years.

That's a common argument given by smokers, but it's completely fallacious.Those are not the years you give up. You have all of those conditions anyway, just at a much younger age.

No, that isn't what happens. You get different conditions (emphysema rather than alzheimers, say).

But it really depends a lot on many factors: how medical care is apportioned in a given society, how much people smoke, what is the impact on productivity, etc. You'll find studies that give results either way, depending on the assumptions they make about those factors.

At the least, it is unjustified to assert that doing away with smoking will reduce medical expenditures. It really depends on how the extended lifespans and increased healthiness relates to productivity and to medical costs.

It's widely acknowledged by professionals who work with addiction, that the withdrawal symptoms from nicotine are worse than those from any other commonly-used drug.

I'd like to see a citation for that. Should be easy to produce, if it's really true that such is the consensus of addiciton professionals in general.

Until then, I call bullshit. Nicotine withdrawl is minor league stuff. Alcohol withdrawl can be fatal, in comparison.

I suspect that you are confusing the statistics that shows that nicotine is the hardest drug to "quit," with an attribution of that fact to the severity of withdrawl symptoms. But that's not the reason nicotine is (statistically) "harder" to quit than heroin. The reasons have everything to do with the differences in social acceptability, costs, stigma, lifestyle impacts, availability, etc. between those drugs.

Sure, going cold-turkey on heroin will literally make you wish you were dead, but it's possible to back off slowly and after a few weeks the symptoms are gone. Nicotine, on the other hand, causes new receptors to grow which mesh with the nicotine molecules, and if those molecules stop coming it can take a very long time to adapt to their absence. In many people the receptors never disappear, and they spend the rest of their lives putting up with constant low-level withdrawal symptoms. In other people they do eventually attenuate, but it can take many months to complete.

I think you are understating the severity and neuromorphic aspects of heroin addiction, there.

More people left Synanon because of the lack of tobacco, than withdrawal from the so-called "hard" drugs.

That doesn't imply that it is more difficult to quit smoking than to quit hard drugs, or that the withdrawl is worse, etc. Many drug addicts depend on cigarettes as a crutch to help them cope with quitting the hard stuff - demanding that they also quit cigarettes at the same time is too much to cope with at once. Likewise, many of them don't want to quit smoking at all. They aren't quitting because their habits are bad for their heath in the long run (like smoking is), but because the hard drugs are destroying their lives and families in a way that smoking cigarettes does not. They can perfectly well hold down a job and pay the rent and have a decent family life as smokers, but not as coke fiends or junkies.

 

[KilljoyKlown]

I'm guessing you're not a smoker...

I would love to quit smoking. It's a nasty habit, and an expensive one at that.

But, I'm not ready to go thru the withdrawal symptoms just yet. Come up with a "painless" way to quit, and I'd be willing to bet many of us would toss our ashtrays out.

Sure, there are patches and gums... But they cost more than the smokes do.

So, until there is a better way to quit, I will continue to light up. *sigh*

I've recommended this before. Chantix is the very best way to quit. It absolutely takes away all withdrawal symptoms. For me, I was able to quit using Chantix after 2 months and continued non-smoking with no withdrawals, I actually think one month would have been enough for me.

 

[Trippy]

That is interesting (and very surprising to me). Do you have a link telling that?

Nicotinic acetylcholine receptors (nAChRs) are a superfamily of ligand-gated ion channels which mediate nicotine reward, dependence and addiction. Throughout the central nervous system, neuronal nAChRs exist as multiple, diverse subtypes comprising unique pentamers of genetically distinct subunits. These subtypes each exhibit different function and pharmacology, but their precise roles in nicotine addiction remain elusive. This special issue and accompanying web focus provide an overview of the possible mechanisms of different nAChR subtypes in the mediation of nicotine reward and reinforcement.​

​

Acta Pharmacologica Sinica​

For up to 6 weeks after smokers quit, their brain cells have more nicotine-binding receptors than nonsmokers' cells do, according to a recent NIDA-funded study. Scientists speculate that the brain develops extra receptors to accommodate the large doses of nicotine from tobacco and that the resulting expanded receptor pool contributes to craving and other discomforts of smoking withdrawal.​

NIDA​

Following chronic nicotine exposure, nicotine receptors increase in number, an upregulation that contributes to nicotine's addictive properties. While a current belief is that this process is independent of the type of nicotine receptor, researchers have now uncovered this is not the case: the transient and prolonged changes in the nicotine levels of smokers each affect a specific receptor subtype.​

​

Science Daily​

Although it has been known for many years that alcoholism and tobacco addiction often co-occur, relatively little information is available on the biological factors that regulate the co-use and abuse of nicotine and alcohol. In the brain, nicotine acts at several different types of receptors collectively known as nicotinic acetylcholine receptors (nAChRs). Alcohol also acts on at least some of these receptors, enhancing the function of some nAChR subtypes and inhibiting the activity of others. Chronic alcohol and nicotine administration also lead to changes in the numbers of nAChRs. Natural variations (i.e., polymorphisms) in the genes encoding different nAChR subunits may be associated with individual differences in the sensitivity to some of alcohol’s and nicotine’s effects. Finally, at least one subtype of nAChR may help protect cells against alcohol-induced neurotoxicity.​

ALCOHOL’S ACTIONS ON NEURONAL NICOTINIC ACETYLCHOLINE RECEPTORS​

 

[Saturnine Pariah]

I'm guessing you're not a smoker...

I would love to quit smoking. It's a nasty habit, and an expensive one at that.

But, I'm not ready to go thru the withdrawal symptoms just yet. Come up with a "painless" way to quit, and I'd be willing to bet many of us would toss our ashtrays out.

Sure, there are patches and gums... But they cost more than the smokes do.

So, until there is a better way to quit, I will continue to light up. *sigh*

Nothing ever worth doing is easy. Take me for example for almost a year now i've been trying to get my insurance company to approve of an elective surgery(gastric lap-band) every time i submitted the package they (somehow) found a loop-hole or fallicy( i've submited at least 20 times now.) But now it's rock-soild, no loop holes. even if they do reject it i'll just keep going at it until those money-grubing bastards pay out.

 

[Captain Kremmen]

This doesn't add up. From article:

Dr. Ronald Crystal from the research team at Cornell describes it in more detail…
“We’ve developed a vaccine where we genetically modify the liver to produce an antibody against nicotine… The antibodies [float] around the blood like little Pac-Man [cells] that like nicotine. If you smoke and the nicotine passes across the lung, the idea is that these little anti-nicotine Pac-Man [cells] will gobble it up and prevent it from reaching the brain.”

As far as I know, antibodies are produced by white blood cells, not the liver,
and vaccines are not usually made by genetically modifying the liver.

On the other hand, if they do this and it is safe, a voluntary injection at age 16 would save a lot of lives.

 

[Fraggle Rocker]

Nicotine gum and patches have been available for a long time now. If people want to quit smoking, but stay addicting to nicotine, it's trivial for them to do so.

Have you not been keeping up with the news for the past four or five years? It's not the smoke from cigarettes that causes cancer. It's the nicotine itself. They've done forty-year studies on heavy marijuana smokers in Jamaica (where they're not hard to find) and autopsies found minimal damage to their lungs.

Sure, using a vaporizer for tobacco (or the other methods you mention) will spare you from emphysema and a few of the other side effects. But it will still cause lung cancer (if you inhale it) or cancer of your tongue, esophagus, stomach, skin, or other point of entry.

Nicotine is poisonous, regardless of how you put it into your body.

No, that isn't what happens. You get different conditions (emphysema rather than alzheimers, say).

Yes, I oversimplified. In fact I recently read that the incidence of Alzheimer's among smokers appears to be significantly lower than the rest of the population, for those who live that long.

I'd like to see a citation for that. Should be easy to produce, if it's really true that such is the consensus of addiciton professionals in general.

This was forty years ago. I doubt that I can dig it up. Besides, as you say, the relative severity of withdrawal symptoms is highly subjective. Some people can endure some kinds of anguish better than others.

Until then, I call bullshit. Nicotine withdrawl is minor league stuff. Alcohol withdrawl can be fatal, in comparison.

Well sure, but so can opiate withdrawal. The point is that you can wean a person off of alcohol, opiates, and many other drugs slowly. Each reduced dose triggers a low-level withdrawal symptom which can be barely tolerated (especially if the patient is locked up under professional care). Within a few weeks at the most, the physical addiction is gone and only the psychological addiction may still require treatment. Attempting to wean someone off of nicotine this way would take months. If not years, considering that some people who quit cold-turkey still feel the craving a year later.

That doesn't imply that it is more difficult to quit smoking than to quit hard drugs, or that the withdrawl is worse, etc. Many drug addicts depend on cigarettes as a crutch to help them cope with quitting the hard stuff - demanding that they also quit cigarettes at the same time is too much to cope with at once. Likewise, many of them don't want to quit smoking at all. They aren't quitting because their habits are bad for their heath in the long run (like smoking is), but because the hard drugs are destroying their lives and families in a way that smoking cigarettes does not. They can perfectly well hold down a job and pay the rent and have a decent family life as smokers, but not as coke fiends or junkies.

And this is a nice summary of what's wrong with our asinine drug laws. My grandfather was a pharmacist 100 years ago and sold cocaine and morphine over the counter. The prices were affordable, there was little social stigma (the movement against alcohol was arguably more prominent), and being caught didn't result in a prison record. So people didn't lose their jobs, friends and family, and then turn to crime to support their habits. With this social network that is not available to today's drug addicts, they went through the phase and then quit as they got older. Criminal enterprises did not spring up to support the industry, police and other officials were not tempted by bribes, there were no gunfights in the streets, and children did not see bling-draped thugs as role models for a more prosperous life than their hard-working parents.

Heroin had been invented. It's a Bayer trademark after all (a German company), like Aspirin. They were confiscated as spoils of war after the armistice. But it hadn't really caught on yet. I don't recall him mentioning whether he even stocked it. Today compactness is important in order to facilitate concealment and to reduce the frequency of purchase.

 

[Billy T]

to trippy:

Many thanks for post 35 and you effort to make it. It seems Fragle was fully correct, but I will need to delay reading your links. thanks again.

 

[Billy T]

Nothing ever worth doing is easy. Take me for example for almost a year now i've been trying to get my insurance company to approve of an elective surgery(gastric lap-band) every time i submitted the package they (somehow) found a loop-hole or fallicy( i've submited at least 20 times now.) But now it's rock-soild, no loop holes. even if they do reject it i'll just keep going at it until those money-grubing bastards pay out.

It is amazing how they usually find a reason not to pay. My only claim in more than 24 year (last 19 living in Brazil) was not allowed because the Brazilian doctor did not know or supply the US´s "procedure code."

The claim was for a quite commonly done whole body T99 isotope scan. I even supplied copy of the results, both the clinic´s report text and copy of the film showing my full body image with my name recorded in the film. Plus all the billing information with every word translated, etc. and asked them to please enter the missing US procedure code in the claim form.

You´r right. The bastards did not want to, and would not pay, my only claim in 24+ years of paying them based on the technicality of a missing procedure code they surely knew. I supported universal public health services systems like in Europe before this (because of the less than half the cost to society with 2 to 3 years longer life expectancy than the US´s for profit system) but now:

If feel like that if I´m ever near death and in great pain, but still mobile, I would like to blow my self up in the CEO´s office if I could. Unfortunately, all I can do in practice, and have done, is drop the policy after I learned that because Social Security deducts Medicare cost from me, (like that or not) At least I will not need to pay any fines under "Obamacare" as medicare qualifies as its required medical insurance plan. I have never collected a dime from Medicare either. (I have not tried to.) Hard to put into words how much I think the US´s "for profit" medical system stinks.

Fortunately, everything but drugs you need (and special clinical studies, like a T99 isotopic scan) is free to the patient in Brazil. - Even my radical prostatecomy (operation) and the three day stay in the hospital after it. I am also fortunate as my beautiful Brazilian wife was a professor at USP, the best university in all of S. America, so I can go to the university hospital, instead of the one closest to where I live, which would not be as good.