Hacker News Reader

Comment by dpflan | Hacker News Reader

This passage feels like it is premise of the article; the author eventually comes to terms with her tea-sipping and resting as recovery, and this doctor explains the reasoning behind the medical decision-making which is very clear (and mindful/thoughtful) I think.

“To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.”’

View on HN

The US mind programming of painkillers / drugs as an answer to everything is killing you by the thousands.

I'm glad Australia is taking steps to avoid falling into the same pit.

Sometimes, and at least on scale, a dose of HTFU can be much, much better.

On the flip side, Australia prescribes antibiotics like they're candy. I'm always amazed at how easy it is to get a flight of them here.

Compared to where? I found US doctors much more likely to prescribe them than Australian doctors.

The undertreatment of pain in the US is affecting my grandparents in a huge way. My poor grandfather spends a week or more a month suffering from the rapid taper the doc is putting him through. We are trying to get him into pain management, apparently every doc in CA is scared of prosecution.

The irony is he would be just fine if they never rescheduled hydrocodone. When they did thst he had to be put on fentanyl and dilaudid, forcing us to seek out a pain specalist to get my grandfather the quality of life he needs to keep going.

The guy fell twice in two years and they just keep cutting him back, while abusers switch to heroin.

Genius tactic IMO. Deny those who need it, deny those who seek to abuse it, and force everyone to switch to heroin. Kidding of course- but thats where the abusers will go.

The legit QoL patients suffer with zero alternative. They cant take ibuprofen without shitting blood for a week.

Its like drm. The legit consumer is punished by those who abused the system.

Its more nuanced than that, but thats how it affects my life directly. Watching my grandparents in extreme pain because of crackdowns in all the wrong places. It makes me hurt and sick.

I'm not sure how amenable you are to alternatives, but after suffering myself with chronic pain in the past and discovering kratom to help with the pain in lieu of a narcotics prescription, I would suggest looking into this to improve your grandfather's quality of life. Years ago, my dad had surgery to "fix" a turn muscle that healed poorly, and was prescribed Tramadol for long-term pain management. After the docs started cutting everyone off, my dad suffered greatly from the pain, and I couldn't stand to see him like that, so I introduced him to kratom, as well. He takes it once in the evening before bed and he has also stopped getting regular migraines. The kratom subreddit is a good place to start looking for information. Just be aware that special interests have been spreading disinformation for a couple of years now, so take everything you read with a grain of salt. Do your own research and draw your own conclusions. There is a growing body of research available to help.

Highly controversial statement: you can still get Kratom legally online and in some states. There is an opiode like effect. It's worth looking into if your grandfather is suffering.

*edit: didn't see the comment right below this one! Thats +2 for Kratom!

That's not how I would describe the situation.

In America you can buy topical antibiotics at convenience stores, but you get a lecture if you ask for something stronger. Painkillers are prescription only and there's very little stigma for something like Tylenol 3.

In Australia you can buy codeine over the counter, but you get a lecture if you ask for something stronger. Antibiotics are prescription only but have no stigma.

Codeine is prescription only in Australia from 2018-Feb-01. Other crackdowns are being considered; thus my original remark.

I've read a few coherent accounts of what happened here in the US, and several of them blame changing Medicare/Medicaid quality-of-care guidelines. Specifically, that at one point one of the guidelines -- which factor into how much various entities in the system get paid -- changed from measuring whether pain was appropriately managed, to measuring whether pain was being eliminated. Which in turn led to an explosion of prescriptions of high-strength pain medications in order to hit the measure.

Having some experience with Medicare's version of the guidelines, most of them are sensible and do directly relate to whether someone's being treated in a way that will lead them to be healthy and happy in the long term. But it appears that one was a major mistake.

I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?

Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

I agree that there is no "one-size-fits-all" medical solution, but perhaps having this base-line allows building up when discussed with one's doctor - the article does not discuss this post-operation re-negotiation of how to manage the pain. Perhaps some HNers have experience with a similar situation that they could share.

I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.

I'm perfectly understanding the concern for long term morpohine derivatives for treating post-surgical pain (although there are plenty of studies that show pain delays healing) so there is a bit of picking-n-choosing going on. Many nurses would recommend OTC acetaminophen in combination with ibuprofen as they work quite well and you're definitely still going to "feel it" if you're pulling out stitches with no risk of addiction. Since you aren't using a narcotic, you won't need a stool softener either.

http://www.worldwidewounds.com/2001/march/Pediani/Pain-relie...

I'm a bit concerned by the reliance on ibuprofen for pain (it's great for inflamation but prevents blood coagulation) since it can cause bleeding, although I'd note that she didn't even need that to sleep so her lapro-surgery was either extremely minor or she has high pain tolerance. Normally, combination with acetaminophen is preferred, because the dosage of each can be minimized.

Frankly, this all just sounds like German doctoring. I've also been told that you don't need decongestants (when flying) because your "nose should flow". It's normally acceptable (if inconvenient) advice, but if you're flying it could lead to eat infection and damage. It's not like your ear pain is going to get a pilot to turn a 747 around or help your cold pass faster. Suffering is not the answer to everything any more than a painless existence is.

> Luckily, he died before I had any significant issues

Did they find his drill embedded in his occipital lobe?

> I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.

I (German) openly prefer it, if the dentist gives the option whether to get a anaesthetic injection or not for dental fillings, not to get one, since I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.

I am of course aware that there are really painful dental treatments such as dental root canal treatments - but in these cases no dentist will give you the choice whether to get a anaesthetic injection or not.

> Luckily, he died before I had any significant issues,

Why didn't you simply change your dentist?

You're welcome to have your teeth drilled as you like. However, if you have a younger family member with more sensitive teeth you may understand that it's not for everyone. Imagine if your child jerked away for just and instant that caused the drill to cause more harm than good. The modern novacaine derivative my dentist uses lasts only about 30-60min after the appointment.

Because I was under the age of 18 and he was my parents dentist I didn't really have a choice. I didn't have any cavities as a child so my first negative dental experience was at 17 when he filled 4 molars "preventatively" (because he didn't know that epoxy capping was a thing). It didn't kill me, but it was an excruciating 30 min and an absolutely miserable day. The muscle tension pain from not moving took days to subside. Not a reasonable trade-off for me.

I had your experience at ages 6-9 in Alaska. The only available dentist had moral qualms about using novocaine.

The resulting aversion conditioning kept me away from dentists until I was 36, when my then-girlfriend coerced me to see a dentist. I needed lots of work, all of which was done using novocaine.

Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.

> Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.

I he has really "moral qualms" even when asked explicitly, I accept that you better look for another dentist. My claim is rather that it is as a dubious practise to just apply an anaesthetic injection by default.

> I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.

Is it possible only a minority would consider the pain of a drill into the core of their tooth an inconvenience?

not all procedures are the same. my doctor also asks me if i want anaesthetics - but only if he thinks i can get away without one (i.e. minor work - he wouldn't ask if he expected the operation to last for more than a couple of minutes).

i've also skipped the anaesthetics on occasion without problems, but there were surgeries where this would have been madness where the doctor didn't ask.

It depends on the procedure. I had a minor cavity filled when I was younger, and it really wasn't all that horrible. Something like a root canal would be unimaginable.

As I mentioned higher up the thread, pain thresholds vary dramatically. My father has had more than one root canal with no anesthetic because it was cheaper. He said the pain wasn't that bad. He just has a very high threshold for tooth pain, or lack of nerves there.

That's interesting. My dad (half German) is the same way. After having gone to the dentist and seeing that, I though to myself, if he can do it, so can I. I now prefer it over having a numb mouth the whole day.

I've never had to to anything beyond simple fillings so I'd like to think that's the limit for me.

Funny.

> I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.

I am not sure you'd say the same after 3-4 hours of treatment. I've done some root canal treatments here and there, which can take a long time. I'll take a numb jaw for a couple of hours afterwards over being in pain for 3 hours.

But I guess you're right, for 5-10 minutes of pain, it isn't worth it.

I have had my teeth filled by a dentist that didn't "believe" in novocaine.

I would have asked if he believed in repeat business—if so, give me the novocaine.

> If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.

What do you mean by a filling? Just for a minor cavity? I've never received local anesthetic for a minor plastic filling, just for root canals/crowns, and the pain has never been a problem. This seems to be common practice where I've gotten dental care (Sweden and Japan)

It varies by doctor. Usually, the more awful stuff they have to actually do, the less willing they are to issue pain pills for minor inconsequential things.

The guy who operated on my penis gave me a grab bag of pills that went right up to serious prescription pain killers and said just to call by if I needed more. I never even took the first day's pills, it barely hurt at all, but then he's a penis surgeon, it's not even essential to _have_ a penis, half the population don't have one so how important can that surgery be?

The guy who used to be my dentist before he retired was a Max Fac surgeon in his day job, dentist was how he relaxed before the weekend. So, normally he's putting back together ruined faces from car accidents and that sort of thing. Need a filling? "I can numb that, but it's in your lower jaw, and it's not touching the root, so I suggest we go without, then you won't drool for the rest of the day". "OK, but it will hurt?" "Barely at all, slight discomfort, weird sensation, no real pain". He was right, it was fine, definitely worth the small amount of discomfort to be in and out quickly and not drooling like an idiot.

On the other hand, when I was a kid I got hit by a car (my fault), they used Entonox (medical laughing gas) back then, I was high as a kite, and given the car smashed me good, that was probably the right call. So I'm not saying "I never use pain killers" but more like "I think pain killers are something to reserve for when it's really bad, not the first thing to reach for every time".

Well from experience 3 ops 2 minor 1 major in the UK last year they normally ask you to rate your pain on a 1 -10 scale and base meds partially on that.

I seem to be lucky and don't feel much pain so did not need any really strong painkillers after the first day or so and Tylenol made me nauseous so I stopped taking them.

I wonder if you have ever actually been about to die or, rather, you felt as if you were going to die but were in no actual danger.

Not GP but I have, and I wonder why you ask?

What's the relevance?

> I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?

Since when is that a requirement for knowing what is best for your patients? The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.

Empathy from the doctor is always nice, not just adherence to the current dogma that flips back and forth every decade or so.

Having surgery may not be required. But an appropriate knowledge of what’s going on certainly is.

> The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.

Medicine is unfortunately not nearly as scientific as you might wish - I worked for the British Medical Journal a while back and they are all about evidence-based medicine... unfortunately, there is still a lot of medicine that's based off of received knowledge or observational evidence, which may or may not be accurate. The situation is changing though as things get proper studies done, but it's not always easy to get decent results and so current consensus can and does change over time as research gets done.

Since the world stopped being completely black and white. (It never was.) And most definitely, medical science is not either.

With every medical decision there are trade-offs. Sure, it's best to walk soon after surgery... sometimes. Sometimes it's too early. And sometimes there are trade-offs like torturous pain that no person should have to bear. Many people might choose to forgo the day after walk knowing that their chances of a full recovery might be 0.01% lower.

It reminds me of the mantra that "breast feeding is best". Yes, according to some studies, there appears to be positive relationship. But what if continuing to breast feed causes a mother to stay clinically depressed. What if she can't handle the every 2 hours and it is driving her crazy and she wants to shake her crying baby. Maybe in this case, "formula is best".

A good medical practitioner works with their patients to communicate the risks and rewards clearly and help guide them to make the decisions that work best for them.

Yes I managed after a kidney transplant on the odd paracetamol after the first 24 hours or so.

The pain buster don't realy do that much as neither did the oral morphine

Anecdotally, I had a very intricate horizontal impacted wisdom tooth removal surgery done on barely any anesthesia because the thing was dangerously close to a nerve and I needed to be able to inform the dentist when he was getting too close to it (AR people: there is a market here for in-surgery diagnostic image overlays). It wasn't that bad (the healing process was more annoying), I was more focused on the ongoing procedure (but then again I was in med school before I decided to switch to computer science).

Slightly less anecdotally, I have a lot of doctor friends and while they may indulge in overwrought "look at how clever I am" medication schemes for ailments that do not really warrant it, I think that it's mostly because they feel that they don't have the time to rest like the author of the article (and this doesn't involve routine painkiller use either).

Some people argue that in my country (Italy) there is a cultural aversion to painkillers due to the historical influence of the Catholic Church, but it's hard to measure the effect.

I have a very relevant anecdote:

My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it.

Later in life, he underwent a surgery requiring general anesthesia and found himself in the same position. He said, "If I had known it was like that, I would not have made them do it."

So I think the surgeon's personal experience of the situation is -- in fact -- highly relevant in practice, even if not in theory.

Makes sense. They make nurses sit with a wet diaper in bed in medschool.

I was reading "Dr. Mutter's Marvels" a while back. The eponymous surgeon was working around the time that anesthesia was being invented in the US, and it talks a bit about how some competing traditionalists believed that pain needed to be part of the actual bone-sawing surgery itself. (Also a natural part of all childbirth, with biblical overtones.)

As human as that anecdote is, there are a long list of issues here. In particular, was the original idea that it would be a valuable part of the recovery in error?

It is easy for me to imagine a pain that I would never voluntarily experience or inflict (this isn't even a very profound level of pain, I don't like suffering even in small doses). This threshold is regularly breached and I often come out of it as an improved person.

Sometimes, and I'm thinking doctors and the military when I say this, people end up in situations where choices must be made. The situations are not emergencies and the choices affect other people in ways that the decider might not willingly accept for themselves. This is an unfortunate fact of the world not being a nice place.

I had my gallbladder removed a few years ago. It required a major incision and I was in the hospital for five days after surgery. I had to get up and walk a lap around the hallway a few times a day. I felt it get easier every day, but those first few times were excruciating.

It was good that they made me do it—by the last day, I was starting to develop nerve pain from so much sitting, propped up in the hospital bed. Walking was torture, but so was sitting.

I'm not sure we should forgo pain management after major surgeries, but the benefit of getting up and walk even just 50m a few times a day is well documented. So no, it isn't fun, but it is a highly beneficial thing to do.

Note that this is the exact opposite of the advice given in the article: you're told to ignore the pain and take walk, whereas the article states that the pain warns you to not disturb the healing process.

Do as the docs says not as the doctor does.

>I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

You should be hesitant, unless you're a doctor.

As if all doctors make correct decisions all the time. Doctor's should be hesitant as well.

I've heard it somewhere...

Now imagine your pain as a white ball of healing light

That's right, your pain

The pain itself is a white ball of healing light

I laughed until I realized, wait you're right! I've noticed that the healing process seems to accelerate and inflammation is reduced when I put my attention on the pain (which takes practice, as the natural tendency is to try and escape it).

Reminds me of the commercials here. Back killing you while lifting pianos all day? Knees aching from gardening at age 80? Pop a pill and ignore the signals that you're damaging your body!

"And please be careful with ibuprofen"

Ibuprofen is what allows me to get out of the bed for the past 3 months. I'm not sure that doctor knows how bad pain can be without medication.

Without knowing your situation, plenty folks take (liberal amounts of) painkillers to numb the pain and thus never find out or work on the real cause of the pain.

Warmth and daily stretching, massage and exercise fixes most sore tight spots that, if left untreated, can escalate to chronic pain setting you up for an unending painkiller loop eventually making you a walking stiff.

Almost my whole body was a painful solid wreck until I started to work on it more or less every day. My lower back still has some tight achy spots but it's getting there. These days I can actually flex some muscles I had no idea I had or could control.

Herniated disc. During the worst weeks, I could hardly move inside the bed, let alone "work on it". Imagine you desperately need to pee but it takes you ten minutes to get out of bed. It's much better now so I take smaller doeses, do physiotherapy and I can even use the bycicle to work again, but taking Ibuprofen is still necessary to be able to work on it in the first place. Plan is to be able to run again and Ibuprofen helps to get to that point.

They are probably right advising careful use of Ibuprofen, not because of kidney problems but because of heart conditions. There have been a couple of threads in HN recently, e.g. http://time.com/4568552/ibuprofen-naproxen-inflammation-safe... and http://time.com/3952889/painkillers-safety/?iid=sr-link1.

A similar reasoning of a (military) Russian dentist refusing to apply even local anesthetic that a friend seen once - "I prefer to not lose contact with the patient"

I had a tooth taken out without any anesthetic before. It was bad but the pain was so severe I barely remembered it even later that day. It’s almost like I remember it happening to someone else, not me.

My dentist in California said he had several patients from Eastern Europe and Russia who had dental treatment like this, and their teeth were all mangled from treatment without anesthesia. He had done numerous re-drilling’s and re-fillings and root canals on these patients to deal with decay in teeth that had already been treated in their home countries. They had decay underneath fillings because the original treatment had essentially only gone as deep as the patient could stand. The dentist would drill until the patient screamed stop and then fill the hole, even if that left continued decay underneath.

I can only assume that the second round of treatment in their home countries would be either another round of drill torture or tooth extraction.

> They had decay underneath fillings because the original treatment had essentially only gone as deep as the patient could stand.

In the middle of a root-canal my anesthetic completely wore off. I was able to feel the nerve root in my tooth being twisted up into a metal file and snapped out, along with all the canal filing and packing that happens afterwards. White-hot all-encompassing pain. There's no way any of those patients got a proper job done.

Nerves were killed by arsenic. Still very painful, yet not a (fully) live nerve fortunately.

I’ve had a root canal where the anesthesia didn’t wear off but simply wasn’t complete. It was still the most painful thing I’ve experienced. If I needed a root canal without anesthesia I’d just ask for an extraction. No way I’d even attempt a root canal without anesthesia.

Why not ask for more anesthetic? When a friend went to a dentist for a procedure, she repeatedly asked for more anesthetic until she couldn't feel the pain. I think it took two or three additional injections after the first one before that happened. (It's hard for anesthetics to make their way into the jaw bone, I believe.)

Thanks for the nightmares.

Different concept. Anesthesia for an operation leads to better outcome and more comfortable for the patient. Sucicide was common in people who needed a surgery prior to the advent of anesthesia.

Yet moderate Ibuprofen use is harmless to the liver - so much for German rationality: https://livertox.nlm.nih.gov/Ibuprofen.htm, that said you could look at a ~20% reduction of Serum testosterone over time http://www.pnas.org/content/115/4/E715

Agreed with ibrofen but why not take parcetamol

Possible damage to the liver.

which regenerates unlike kidneys :-(

My suspicion is that paracetamol / acetaminophen and ibuprofen are so incredibly not-good for you, and this anaesthesiologist knows this, that he covering his ass by minimising how much he doles out.

Huh?

You don't need a prescription to get paracetamol, acetaminophen, and ibuprofen

I mean to say: the medical profession probably needs to be cautious with regard to how it goes about advising people to take paracetamol or ibuprofen.

We know they aren't good for you, and I know I've seen at least a few people pop them like candy.

In the army, 600 mg pills of Motrin (ibuprofen) are called Ranger candy. Because they get eaten "like candy" by Special Forces units.

Both of them (Acetaminophen is the US name for Paracetamol) are highly dangerous, even in small dosages. Paracetamol poisoning can kill within a day, and the lethal dosage is equivalent to about 20 pills. Ibuprofen is proven to cause heart attacks & stroke.

Your suggestion is the perfect example of why over the counter drugs as so dangerous: a Dr or a pharmacist is aware of the dangers, that we (being the public) may not know about, and should not dispense those without taking them into account.

The problem is you can't make over the counter drugs illegal in the US, not only because of the medical-industrial complex lobbying, but also because of the cost of getting a Rx. Had the US had a public health system…

> the lethal dosage is equivalent to about 20 pills.

It's really hard to accidentally eat 20 pills, especially when the usual does is about 4 per day...

Recommended dosage, which most people take more of – take two every couple of hours, and you're going to need a new liver. And when you're in pain, it's easy to loose count.

Which is why in some countries, the maximum amount allowed over the counter is 16ct or so (sometimes a bit more when bought from a pharmacist who can make sure the buyer is aware of the dangers). It is irresponsible to sell a 1,000 ct bottle of pills, yet the grocery store near my house does, over the counter even.

What if they buy the 16ct packs over multiple days and overdose on them?

the idea is to reduce risk, not eliminate it. thinking is, if you need 1000ct of any drug, you should probably see a health professional first; if you're going through the effort (and extra cost) of buying 63 packs of it, then there's probably nothing that could be done to stop you from whatever you are trying to do.

I just looked at my ibuprofen bottle and it says to take one 200mg tablet every 4-6 hours. That's 800-1200mg per day, which is not something to worry about.

Certainly if you ignore that and take a higher dose or take it more frequently you can have problems, but assuming you don't have existing liver issues and aren't drunk all the time, you need to take like 5x (or more) the recommended dose to run into any trouble. If you're that stupid, you deserve what's coming to you.

What I'm getting at is: what happens if you take 800-1200mg per day for, say, ten of days at a time, or even hundreds of days.

Lots of people take 2 Extra Strength Tylenol at at time. If you do that every 4 hours (instead of 6), you're looking at 12 pills a day. Add to that a few doses of Nyquil or some other multi-medicine that has Tylenol in it, and it's possible to get up to a toxic dose.

I am a practicing doctor and I don't know where this is coming from.

Paracetamol and Ibuprofen while they have potentially lethal side effects are incredibly safe and effective in daily practice and consequently are very widely used. Every known drug has side effects and if you ever read a drug insert you would never pop a pill again. In the case of ibuprofen/paracetamol we are careful to avoid use in patients with ulcers, elevated blood pressure, liver or kidney disease, alcoholics or allergy to either drug.

Unlike opioids they don't cause dependence and their anti-inflammatory effect is very useful post trauma. Most patients self regulate their dosage and usually taper down within a few days. Used in combination a more nuanced effect can be achieved with lower doses.

Paracetamol toxicity in particular frequently occurs in the context of attempted suicide, alcohol abuse or mental impairment and requires a huge pill burden 20 - 24 pills ingested at once or about a 6 - 12 pills in repeated doses over multiple days. This is not as common as you would assume.

Surgery without anaesthesia is cruel and abusive. NSAIDS are not always the right call,but given a choice they are a good alternative.

Tldr: they are dangerous in theory but safe in practice.

> I am a practicing doctor and I don't know where this is coming from.

Well, on the front page at the moment is this: Ibuprofen alters human testicular physiology including testosterone production https://news.ycombinator.com/item?id=16254760

And this has been doing the rounds as well: Acetaminophen reduces empathy for pain https://news.ycombinator.com/item?id=14683173

I'm fortunate enough to never had need to take either, except after having my wisdom teeth out I took a few paracetamol with hydrocodone tablets.

I'm not suggesting that taking a few doses here and there is anything to be concerned about.

What worries me is that some people are consuming probably too much over probably too long and having subclinical negative health outcomes as a result.

would you recommend a patient take any drugs regularly without regular follow ups? that's the danger of 1000ct over-the-counter. taking a couple of ibuprofens when you have a headache is one thing. taking enough to need 100s of them, without a professional recommendation is another.

No I would not.

Reply on news.ycombinator.com