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What to Know About Newly Approved Alzheimer’s Drug



Jan. 6, 2023 — The extremely anticipated Alzheimer’s drug lecanemab was granted accelerated approval status this afternoon by the FDA, providing hope the place there was little for sufferers and their households affected by the devastating illness.

Greater than 6 million folks within the U.S. reside with Alzheimer’s.

It’s not a treatment, however the drug, given intravenously each 2 weeks, has proven average constructive results in scientific trials in slowing early-stage illness.

However many are cautious. As defined in an editorial final month within the journal The Lancet, “The Alzheimer’s illness neighborhood has turn into accustomed to false hope, disappointment, and controversy.”

Some fear about lecanemab’s security as some folks in scientific trials skilled severe unintended effects of bleeding and swelling within the mind. Scientists not too long ago attributed a 3rd loss of life to lecanemab, model identify Leqembi, although the drugmaker disputed the treatment was the trigger.

So what ought to sufferers and their households make of at the moment’s information? Right here we reply a number of the prime questions surrounding the drug.

What Does At the moment’s FDA Motion Imply?

The FDA granted accelerated approval to Leqembi after it confirmed constructive trial leads to slowing the development of early-stage illness. 

The FDA can grant accelerated approval for medicine that deal with severe situations and fill an unmet medical want whereas medicine proceed to be studied in bigger trials.

With the FDA approval in hand, medical doctors can now prescribe the treatment.

Rebecca Edelmayer, PhD, the Alzheimer’s Affiliation senior director of scientific engagement, says that with the FDA’s transfer at the moment, ramping up manufacturing — and ultimately nationwide distribution and implementation — will take a while. 

“Ask your physician about availability,” she says. “The primary concern is that, with out insurance coverage and Medicare protection of this class of remedies, entry for individuals who
may gain advantage from the newly accepted remedy will solely be out there to those that pays out-of-pocket. With out protection, folks merely received’t be capable of get the remedy.”

The Washington Submit stories that with accelerated approval, drugmaker Eisai is predicted to instantly apply for full FDA approval, which wouldn’t be more likely to come earlier than later this yr. Full approval might assist clear the trail for Medicare protection of the drug.

Potential Profit?

Those that obtained Leqembi in a scientific trial for 18 months skilled 27% much less decline in reminiscence and considering relative to the group who obtained a placebo. It additionally lowered amyloid within the mind, the sticky protein that builds up within the brains of individuals with Alzheimer’s and is taken into account an indicator of the illness.

Howard Fillit, MD, co-founder and chief science officer of the Alzheimer’s Drug Discovery Basis, says, “It’s the primary section III research in our area of a disease-modifying drug the place the scientific efficacy was very clear.”

Issues About Facet Results

The drug has raised security issues because it has been linked with sure severe hostile occasions, together with mind swelling and bleeding. Within the trial, 14% of sufferers who acquired the drug skilled unintended effects that included mind swelling and bleeding, in comparison with about 11% within the placebo group.

Scientists have reportedly linked three deaths throughout the scientific trial to lecanemab, although it’s unclear whether or not it induced the deaths. 

Fillit notes that the primary two individuals who died have been on blood thinners after they acquired lecanemab. 

“There are issues about the usage of the drug in the true world that we have to work out, particularly within the context of individuals with comorbidities,” he says.

The third loss of life is somewhat totally different, Fillit says. The affected person, who had a stroke, confirmed indicators of vasculitis, or irritation of the blood vessels.

“We don’t know precisely what occurred, however we do understand it was very, very uncommon” among the many folks concerned within the trials, he says.

Edelmayer says that the commonest reported unintended effects throughout the trials have been infusion-related reactions, headache, and amyloid-related imaging abnormalities (ARIA). In response to the FDA, these abnormalities “are recognized to happen with antibodies of this class. ARIA normally doesn’t have signs, though severe and life-threatening occasions not often could happen.”

The FDA has added these as warnings to the drug’s label, describing the doable infusion-related reactions as flu-like signs, nausea, vomiting, and adjustments in blood strain.
How A lot Will It Value?

Eisai says that lecanemab will price $26,500 a yr.

In a draft report launched in December, the Institute for Scientific and Financial Evaluation (ICER) stated a value starting from $8,500 to $20,600 a yr would make the drug cost-effective. Whereas the group has no authority to set costs, many giant well being insurers take into account its stories after they negotiate costs and a few drugmakers consider ICER’s suggestions when setting costs.

An editorial in The Lancet final month warns that the fee will seemingly be “prohibitive” for low- and middle-income international locations and lots of well being techniques don’t have the infrastructure for a widespread rollout.

Will Medicare Cowl it?

The Facilities for Medicare and Medicaid Companies (CMS), which runs Medicare, which covers most individuals with Alzheimer’s, has indicated it received’t broadly cowl amyloid-lowering medicine till the drug will get full U.S. approval primarily based on scientific advantages, versus accelerated approval.

Which means folks must pay hundreds out of pocket at first to get it.

The CMS resolution successfully denies Medicare protection of fast-tracked FDA-approved drugs for Alzheimer’s illness until the particular person is enrolled in an accepted scientific trial. 

On Dec. 19, the Alzheimer’s Affiliation filed a formal request asking CMS to take away the trial-only requirement and supply full and unrestricted protection for FDA-approved Alzheimer’s remedies.

CMS says in an announcement after at the moment’s announcement: “As a result of Eisai’s product, lecanemab, was granted accelerated approval by the FDA, it falls below CMS’s present nationwide protection dedication. CMS is inspecting out there info and will rethink its present protection primarily based on this overview.”

“If lecanemab subsequently receives conventional FDA approval, CMS would offer broader protection,” the assertion says.

Who Advantages Most From This Drug?

Lecanemab is a remedy for folks with early-stage Alzheimer’s illness who’ve amyloid of their mind. This implies folks with different sorts of dementia, or these within the later levels of Alzheimer’s illness, usually are not seemingly to enhance with this drug.

Who Makes Lecanemab?  

Japan-based Eisai is growing the drug, a monoclonal antibody, in collaboration with the U.S. firm Biogen.

What’s the Alzheimer’s Affiliation’s View?

The affiliation urged accelerated FDA approval. In an announcement, it says it “welcomes and is additional inspired” by the scientific trial outcomes. 

It says knowledge revealed within the New England Journal of Medication confirms lecanemab “can meaningfully change the course of the illness for folks within the earliest levels of Alzheimer’s illness.”

“We’re energized on the progress we’re seeing within the analysis pipeline. The science is telling us that though anti-amyloid remedies usually are not a treatment — they aren’t going to be the top of
treating Alzheimer’s — they’re definitely the start,” Edelmayer says.
Are There Options? 

The FDA gave accelerated approval to Biogen to provide one other drug for Alzheimer’s, Aduhelm (aducanemab), in 2021, however the transfer was controversial because the drug’s effectiveness was extensively questioned. It has since largely been pulled from the market. 

Aduhelm had been the primary accepted early-stage Alzheimer’s remedy since 2003.

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Mosquito Repellents: Choosing the Best Repellant




Mosquitos do not simply whine in your ear and drive you mad with itching, however in addition they unfold illness to greater than 700 million individuals yearly. This is the best way to keep off a mosquito’s menu.

Do you appear to get eaten alive when others are left alone? You are in all probability not simply imagining it.

Everybody’s physique chemistry is a bit of completely different, and a few persons are extra prone to entice undesirable insect advances than others are.

Mosquitoes can sense your presence from distant. Once you breathe out, you emit a plume of carbon dioxide that carries on the breeze, and CO2 additionally seeps out of your pores and skin.

Mosquitoes are interested in carbon dioxide in addition to the heat and humidity you are giving off, says Renee Anderson, PhD, a medical entomologist at Cornell College in Ithaca, N.Y. They comply with the path, flying in a zigzag sample, till they discover the supply. As well as, they’re additionally interested in sure chemical compounds in your sweat. And mosquitoes love a transferring goal — it helps them zero in.

Typically, mosquito repellent works by masking the chemical cues that welcome mosquitoes to dine.

DEET: Potent, However Protected

One of the crucial efficient mosquito repellents is without doubt one of the oldest round. DEET was first developed to be used by the U.S. Military in 1946, and it turned obtainable to the general public in 1957. Many different merchandise have hit the market since then, however few evaluate to DEET. The truth is, it is one in every of two elements in mosquito repellent that the CDC recommends for stopping mosquito-borne ailments. The opposite is picaridin, and the CDC believes these two elements are more practical than different mosquito repellents.

In a research printed within the New England Journal of Medication in 2002, researchers in contrast a number of forms of mosquito repellents head-to-head in laboratory checks. Fifteen courageous research volunteers took turns sticking an arm handled with mosquito repellent right into a cage stuffed with hungry bloodsuckers. The researchers took be aware of how lengthy it took a mosquito to chew.

“OFF! Deep Woods” repellent, a product containing about 24% DEET, fared one of the best. Its safety lasted a mean of 5 hours.

The least efficient merchandise have been wristbands handled with DEET or citronella, which supplied nearly no safety. Based on the researchers, this wasn’t a shock. It is recognized that mosquito repellent solely works on the floor to which it is utilized straight. Mosquitoes are completely happy to chew pores and skin solely 4 centimeters away from the repellent slick.

DEET has a superb security file, regardless of some individuals’s issues. N,N-diethyl-3-methylbenzamide does not sound like one thing you’d need to spray in your pores and skin, and maybe its acronym reminds individuals of the harmful and now banned insecticide DDT. They’re nothing alike, nonetheless.

The Environmental Safety Company should approve all pesticides used within the U.S., and though DEET is not a pesticide by definition — it doesn’t kill bugs — it falls beneath the EPA’s regulatory purview.

In 1998, the company re-evaluated DEET, and located that it is rather secure when used in line with label instructions, and it is not labeled as a carcinogen (most cancers-causing agent). The label instructions on DEET merchandise will say it is best to apply it solely as soon as a day to uncovered pores and skin and outerwear — not beneath clothes. Beneath garments, it will possibly soak up into the pores and skin extra readily, and probably trigger irritation. DEET may irritate the eyes.

“The commonest criticism is when DEET will get within the eyes, and clearly, that is one thing to be averted,” says Ed Tate, a spokesman for the Client Specialty Merchandise Affiliation, an business group that funds the DEET Training Program.

Younger kids should not be allowed to use DEET repellent themselves, however it’s secure for them to make use of. This 12 months, the American Academy of Pediatrics issued a press release saying that DEET is secure for kids aged two months and older. Beforehand, the age restrict was set at two years. The academy additionally raised the utmost DEET focus in mosquito repellent for youths from 10% to 30%.

Tate says the adjustments have been welcome, and overdue. “We at all times have been a bit of vexed by the ten% restriction as a result of we noticed no foundation within the science on DEET,” he tells WebMD.

Chunk-Blocking Botanicals

Nonetheless, some nonetheless want for another mosquito repellent. Not less than because the Nineteen Seventies, many have sworn by Avon’s Pores and skin-So-Delicate bathtub oil instead.

“They imagine there’s some magic within the bathtub oil,” says Andrew Pechko, a analysis and growth supervisor at Avon. With apologies to the legions of devotees, there is not.

The NEJM research exhibits that Pores and skin-So-Delicate labored as a mosquito repellent for a mean of roughly 10 minutes, which hardly matched DEET merchandise, and even soybean oil. Within the research, a 2% soybean oil product known as Chunk Blocker for Children protected in opposition to bites for a mean of 94 minutes.

Avon doesn’t market the unique Pores and skin-So-Delicate oil as a mosquito repellent, however the firm has come out with a components containing IR3535, a brand new EPA-approved mosquito repellent.

IR3535 belongs to drug maker Merck, and it has been used as a mosquito repellent in Europe for 20 years. Avon’s merchandise are the one ones with IR3535 obtainable within the U.S.

Within the NEJM research, Bug Guard Plus protected in opposition to mosquito bites for under about 23 minutes, on common. However Avon claims that their new “eXpedition” components lasted so long as eight hours in outside checks.

“The EPA, as a matter of reality, doesn’t acknowledge a mosquito cage check to ascertain product labeling claims,” Pechko tells WebMD. “The EPA requires outside subject research.”

Moreover all of the sprays and lotions that include mosquito repellent, there are various issues that supposedly drive away mosquitoes within the surrounding space.

Citronella candles have been used since 1882 as a way of drawing mosquitoes away from individuals, however one research exhibits that they are not rather more efficient than plain candles, which additionally give off warmth, carbon dioxide, and moisture.

You might have seen adverts for ultrasonic mosquito repellent gadgets, which supposedly emit sounds that irritate or scare away the bugs. Organizations from the Federal Commerce Fee to the American School of Physicians (in a overview in Annals of Inside Medication) cite quite a few research exhibiting that these gadgets do not work.

Anderson says that individuals typically ask her about two newer gadgets known as Mosquito Deleto, made by the Coleman firm, and Mosquito Magnet, made by American Biophysics Corp.

This stuff are transportable traps that emit carbon dioxide and a chemical known as octenol. They’re presupposed to lure mosquitoes away from individuals and into the lure.

“They do accumulate heaps and plenty of mosquitoes,” Anderson says. But it surely’s not but recognized whether or not they actually cut back the variety of bites for individuals close by.

“Proper now the jury continues to be out,” Anderson says.

As for the standard electrical bug zappers, do not use them. The violet mild could also be irresistible to some flying bugs, however mosquitoes largely ignore it. “It is a number of useful bugs which can be getting fried,” Anderson says.

The easiest way to maintain swarms of mosquitoes from descending in your yard barbecue is to eliminate standing water, the place mosquitoes lay their eggs.

Some mosquito species lay eggs straight in stagnant water. Others lay eggs in containers — a tree hole, a birdbath, a kiddie pool, and so forth. — above the water line. Then, when it rains, the eggs are submerged and so they hatch.

“You have to scrub out these containers,” Anderson says. “Merely dumping the water out is not going to dislodge these eggs which can be hooked up alongside the facet.”

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Is It a Cold or a Sinus Infection? Symptoms & Treatments




Watery eyes, a stuffy nostril, sneezing: How lengthy these signs final could be a clue to what’s inflicting your congestion. Is it a chilly or a sinus an infection?

If it’s a chilly virus, you might end up near a tissue field for a number of days. More often than not, colds get higher on their very own in 10 days or much less.

Colds convey on a nasty mixture of signs that may actually put on you down. They’ll embrace:


As a result of the widespread chilly is a virus, antibiotics received’t assist. However over-the-counter drugs could make you’re feeling higher.

“The treatments you select must be focused at particular signs, so one thing to your headache, to your congestion, to your fever,” says Camelia Davtyan, MD, a professor of drugs at UCLA.

Davtyan additionally stresses getting loads of fluids and relaxation. The latter, she acknowledges, is commonly laborious.

“Getting sufficient relaxation could be a downside, as a result of folks don’t need to skip work and so they have so many issues to do,” she says. You might also have a tough time staying asleep at evening as a result of you may’t breathe by way of your nostril.

Davtyan recommends sinus irrigation. A neti pot helps skinny mucus and flush out your sinuses with a mixture of distilled water and salt.

“Individuals who irrigate after they have a chilly often do higher,” says Davtyan.

When your nasal passages change into contaminated, that’s a sinus an infection. And so they’re tougher to do away with. Viruses, micro organism, and even allergic reactions can result in sinus infections.

Colds don’t often trigger sinus infections, says Davtyan, however they do supply a breeding floor for them.

“You contact your nostril loads once you’re sick, and every time you convey extra micro organism to the sinuses,” she says. “As a result of your sinuses can’t drain, the micro organism keep there and develop.”

Search for the next signs:


In case you suppose you’ve gotten a sinus an infection, you might must see your physician.

“Principally, these acute infections go away on their very own or after a easy course of antibiotics,” says ear, nostril, and throat specialist Greg Davis, who practices on the College of Washington Medical Heart in Seattle.

Davis recommends sinus irrigation for sinus infections. It might help ease your signs whilst you watch for the antibiotics to do their job. Steroids, decongestants, and over-the-counter mucus thinners can even ease your discomfort, he says.

See an ear, nostril, and throat specialist in case your sinus an infection doesn’t go away after one or two programs of antibiotics, Davis says.

Some folks have sinus infections again and again. The one identified danger components, Davis says, are allergic reactions and smoking (another excuse to stop!) In uncommon instances, an acute an infection can change into continual if it’s not handled efficiently.

If in case you have continual infections, and antibiotics and different therapies don’t assist, you might want sinus surgical procedure, Davis says.

Your physician will enlarge the small or infected and swollen openings of your sinuses, permitting them to empty, and letting you breathe extra simply.

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Soaring Use of Ketamine Creates a Health Care ‘Wild West’




Nov. 27, 2023 — On a drizzly Wednesday afternoon, Christopher sat in an overstuffed reclining chair, stress-free with a comfortable blanket draped throughout him after his most up-to-date infusion on the Ketamine Therapeutic Clinic of Los Angeles. Identified with despair at age 19, Christopher (not his actual identify), now a 35-year-old graduate pupil, has struggled to beat what’s now treatment-resistant despair. 

He ticked off the therapies, standard and various, that he’s tried: Lithium. Wellbutrin. Paxil. Different antidepressants. Mushrooms. Meditation. Cognitive behavioral remedy.

Nothing supplied long-term aid, and he felt some medicines blunted his feelings. “I grew to become extra robotic, much less social,” he stated. 

Ketamine, he stated, is totally different. He’s discovered some aid, some self-acceptance, and is far much less onerous on himself.  He’s discovering it simpler to train and be social, two beneficial methods to ease despair.

The expense of the therapies ($700 for a single session right here), used off-label and sometimes not lined by insurance coverage, is price it, he stated. And significantly better, he stated, than an alternative choice — ordering ketamine to be used at residence through a telehealth platform. No thanks, he stated. “You don’t know the place it comes from.”

Extra Well-liked however Controversial

In recent times, ketamine and entry to it have turn into extra widespread but in addition extra controversial within the U.S. Nobody is aware of precisely what number of clinics just like the one Christopher goes to are in operation, however consultants consider the quantity is round 700 to 800. . The variety of sufferers with a ketamine prescription rose greater than fivefold from 2017 to 2022. On-line entry to ketamine through telemedicine has grown ever because the starting of the pandemic, when the Drug Enforcement Administration loosened restrictions for prescribing Schedule III managed substances resembling ketamine through telemedicine. Now that flexibility has been prolonged by means of 2024. 

In the meantime, the FDA has issued a warning about compounded ketamine, researchers have discovered widespread misleading promoting practices on telemedicine platforms that supply it, and docs who prescribe it or assist its use are struggling to seek out methods to navigate a system that’s largely unregulated.

It has turn into, many say, a Wild West that wants taming, regulation, oversight, and maybe even a registry. 

The query nobody is aware of the way to reply is: How to try this?

FDA, DEA Voice Ketamine Considerations

Ketamine is a Schedule III managed substance that’s FDA authorised just for basic anesthesia, not for any psychiatric dysfunction. The DEA notes ketamine’s potential for abuse and potential for dependancy and that it’s used a celebration or membership drug, the place it is called Ok or Tremendous Ok, amongst different names. 

In 2019, the FDA authorised the type of ketamine referred to as esketamine, the nasal spray Spravato, for treatment-resistant despair. However it is just obtainable from an authorized physician’s workplace or clinic. Past that, the one accepted medical makes use of of ketamine, within the eyes of the DEA and FDA, are short-term sedation and anesthesia.

In an Oct. 10 FDA warning, the company warned of potential dangers of ketamine, together with oral formulations, for psychiatric dysfunction therapies. The message emphasised that ketamine is just not FDA authorised for treating any psychiatric dysfunction. It warns of security issues, resembling abuse, misuse, blood stress elevations, respiratory despair, and different points. The assertion stated that “we’re not conscious of proof to means that it’s safer, is more practical, or works sooner than medicines which might be FDA authorised for the remedy of sure psychiatric issues.”

Prescribers: Ketamine Works

Whereas ketamine is commonly promoted, off-label, for despair remedy, it’s additionally used at clinics for nervousness, posttraumatic stress dysfunction (PTSD), binge consuming, and dependancy. Protocols range, however one instance is six infusions over 3 weeks, usually accompanied by music; generally with discuss remedy integrated. 

Prices range as properly, with a single session in metropolitan areas usually costing $700 or $800 and generally as much as $2,500. Insurance coverage protection is uncommon to nonexistent, however some sufferers have submitted detailed payments to their plans and gotten reimbursement. And a few clinics supply cost applications. At-home prices range, too. Mindbloom, a telehealth program that gives ketamine tablets, expenses $193 a session for a bundle of six and offers clinician enter and steering. Joyous, one other program, is $129 a month. 

Docs and different well being care suppliers managing ketamine clinics are satisfied of the remedy’s price whether it is given to the best sufferers after a full psychiatric and medical analysis. 

The dosing of ketamine helps to “create a neuroplastic course of within the mind,” stated Steven Radowitz, MD, an inner drugs physician who’s co-founder and chief medical officer at Nushama Psychedelic Wellness Heart in New York Metropolis. The remedy helps sufferers “course of and reframe how they see their lives.”

“It permits the mind to work in a extra free move [way],” he stated. Many sufferers with despair and different points have had some previous trauma, resembling rising up with an alcoholic father or mother, that usually will get retriggered. With ketamine, he stated, the reminiscence of the trauma isn’t taken away, however a affected person’s response to it might probably change.

“Ketamine works organically on the mind to extend the practical capability of the mind,” stated David Mahjoubi, MD, an anesthesiologist who based the Ketamine Therapeutic Clinic of Los Angeles, the place Christopher is handled. Amongst different results, he stated, ketamine can enhance connections between neurons, which different consultants have additionally mentioned. 

When given for despair, Mahjoubi observes elevated motivation and decreased apathy. Sufferers on remedy for despair given by different suppliers can stay on them. After giving infusions in his clinic, he generally additionally writes prescriptions for residence use of tablets or generic spray.  Some sufferers use ketamine and discuss remedy together.

His hope is that state medical boards and the FDA work collectively to arrange requirements for operating the clinics and regulating which well being care suppliers have to be current throughout an infusion.

“IV ketamine works very properly for the best sufferers, who’re evaluated and screened,” stated Katharine Grace Marder, MD, a psychiatrist and affiliate doctor at UC Davis Health System. She beforehand labored at a clinic offering ketamine. She’s noticed ketamine serving to sufferers who haven’t gotten aid from a number of antidepressants. “It’s so gratifying which you can give them their life again.” 

Till additional analysis is finished, she recommends proscribing ketamine’s off label use to main depressive dysfunction and doubtlessly bipolar dysfunction. “I don’t suggest the house use of ketamine, in any formulation. There’s not sufficient proof that the good thing about residence use outweighs the chance.”

Ketamine Analysis

Ketamine was discovered similar to electroconvulsive remedy (ECT) for treatment-resistant main despair, researchers reported in Could within the New England Journal of Medication. Whereas 55.4% of the 195 sufferers within the ketamine group had a response, 41.2% of the 170 ECT sufferers did.

One other research, supported by the corporate Mindbloom, discovered at-home, oral ketamine secure and efficient for average to extreme nervousness and despair in 1,247 individuals who accomplished remedy. Greater than 62% reported a 50% or larger enchancment for despair and nervousness. 

Points With On-line Promoting

Direct-to-consumer promoting of ketamine has quite a few deceptive claims in regards to the security and efficacy of the remedy, researchers from Johns Hopkins College and the College of Colorado discovered. The researchers recognized Maryland clinics with an internet website, discovering 17 advertisers working throughout 26 places.

Many statements in regards to the remedy have been deceptive, stated Michael J. DiStefano, PhD, assistant professor of medical pharmacy on the College of Colorado Anschutz Medical Campus, Aurora and a research co-author.  “We discovered one case of a straight-up, false assertion, saying that ketamine is FDA-approved to deal with despair,” DiStefano stated. He hopes to broaden the analysis nationally. 

Affected person Voices

Those that have tried ketamine report blended outcomes. One former ketamine consumer determined the remedy, beneficial by his psychiatrist on the time, was not efficient for his analysis of PTSD. “I did a complete of three ketamine periods, infusions,” stated the 30-something Southern California resident, who requested that he not be named. “The primary two have been optimistic, however the third was not, and I needed to hung out hospitalized after it.” 

He’s doing higher with a brand new therapist and determined the analysis on ketamine for PTSD is just not definitive but.

Jessa Frequent, 35, identified with PTSD after being a spectator on the end line of the 2013 Boston Marathon bombing, went to speak remedy to assist herself get well, nevertheless it wasn’t sufficient. “I sought out ketamine as a result of I didn’t need yearly to really feel like Groundhog Day round spring,” she stated. Spring, she stated, threw her for a loop yearly, because the reminiscence of sirens and helicopters flooded again.

Whereas Frequent stated it’s onerous to explain the impact, “I might say what ketamine did for me is permit me to see myself and my life and traumas as a part of a a lot, a lot bigger story,” giving her a spiritually linked feeling.

She dropped out of a prestigious pre-med program and gave up her job at a prestigious New York restaurant, now working at one other, much less prestigious one. “I look much less spectacular on paper, however I’m a lot happier.” 


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