Scarabin Blog

Jason Scarabin
English 315
Term Paper Critique
April 4, 1995

I have evaluated The Geology of Yellowstone National Park by Justen Nadauld. The purpose of the paper is to inform the reader of the geologic history of Yellowstone Park. In Justen’s section, he outlines the events involved during the Caldera Era. Because of the polishing that still needs to be done, I would assign a B+ to this part of the paper. Overall, I think it was very well written and understandable. It kept my attention the entire time. It could have something to do with the fact that I am currently enrolled in Geology 101.
The Choice of Topic was excellent because of the nature of it. It appeals to everyone’s interest. Yellowstone National Park is one of the most fascinating places on earth and people want to know about its history.
The Breadth of Research lacked significantly because of the lack of a reference page. However, from the reading, I feel that enough sources were used.
It’s very difficult for me to determine the Depth of Research because there aren’t many quotations. In addition, there is only one source noted in the text.
Almost literally, in his Introduction, he begins with the creation of the world. Of course, his topic has much to do with the geologic history of a certain part of the world. In some ways, I feel like his introduction is too storylike, yet effective.
Without question, the paper has Organization. It is a story within itself. It is closely tied to the outline of the paper. One suggestion would be to make the subheadings look more attractive including changing the spacing.

In relation to Mechanics, the author does an excellent job as far as freshman English principles. Because no reference page is provided, I can’t make a judgment on whether or not APA style is properly used. Within the text, it appears to be correct.
His Format is an attractive piece of reading. However, I would strongly recommend a change in the font. I know the student after him used Times New Roman in what appeared to be 14 point type. It was extremely attractive. I would suggest he do the same.
The paper is well-written. The writer is intelligent and obviously familiar with the subject matter. I did not stumble over most of the difficult words because of the way he put things into context. I think the writer was certainly walking a fine line as far as using technical terms. Yet, he stayed on the correct side of that line in most cases. He certainly has an intelligent Style of writing which includes Clarity. Actually, I was very impressed with the way the paper seem to fit me very well as the audience. I am very interested in geologic subjects and this particular one held my interest despite just a few difficult words.
In the area of Illustrations, I cannot commend the writer. There were none. My suggestion to him would be to include perhaps some graphics depicting Yellowstone Park during the Caldera Era.
Although I could sense a “hint” of Technical inAccuracy, I believe he certainly knows what he is talking about. I know that no blatant errors in fact or reasoning were made.
With the word memories, I understand that this is suggesting the Conclusion.
As you read the final paragraph, you get a sense of almost sentimental feeling from the author. I would make the suggestion that the conclusion should be cleaned up and lengthened for more details.
Overall, I commend the writer for his efforts and hope that the necessary “polishing” will be done to improve his grade.

Cocaine: History and Effects on the Circulatory and Reproductive Systems

Jennifer Pearce
Kim Caldwell
Jason Scarabin
Todd Chelius

Running Head: COCAINE

Brigham Young University, English 315
March 28, 1995
I. HISTORY
Integral to the development of the healing arts has been man’s use of plants and other natural products to ease his lot in life- whether for shelter, food, alleviation of suffering, or recreation in the form of mind alteration. “Primitive” cultures have often been the true discoverers of particular compounds, while “modern” society exploits the peculiar attributes of certain plants for beneficial or perverse ends or both. Such has been the lot of the coca plant, the “divine plant of the Incas”.
A. THE ROOTS
“The Divine Plant” of the Incas was originally written by Dr. W. Golden Mortimer in 1901 and reprinted in 1974. Dr. Mortimer, a New York physician, devoted years to this text. It is written in the romantic style of his time and he outlines the origins of the use of the coca plant in South America:
During the early age, when this nature’s garden was unknown to the rest of the world, the Incas, who were then the dominant people of this portion of the continent, regarded this shrub as “the divine plant,” so all important and complete in itself, that it was termed simply khoka, meaning the tree, beyond which all other designation was unnecessary. This plant, which has been described known as Coca, has appealed alike to the archaeologist, the botanist, the historian, and traveler as well as to the physician. Its history is united with the antiquity of centuries, while its traditions link it with a sacredness of the past, the beginning of which is lost in the remoteness of time. So intimately entwined is the story of Coca with these early associations - with religious rites, with superstitious reverence, with false assertions and modern doubts - that to unravel it is like to the disentanglement of a tropical vine in the primitive jungles of its native home.
Coca’s use in the spiritual, political, and everyday life of the Incan Indians was well established and seemingly very structured. For centuries, the Incas had made a habit of inserting leaves from the coca plant between teeth and gums with “lime” -usually wood ashes or burnt crushed shells. In South and Central America, chewing of the leaf of the coca plant dates back to very ancient times. News of this plant and its properties was brought back to Europe by the early explorers and references to coca can be found in European medical texts dating from the 17th century. However, it was not until the 19th century that scientific and chemist, Dr. Albert Neimann, isolated cocaine in the pure alkaloid form from leaves brought to Europe. During the following twenty years or so, cocaine was used extensively by the medical profession as a stimulant, a local anesthetic, and as a “cure” for morphine dependence.
This era of unrestrained medical enthusiasm was short-lived, however, and by the end of the 19th century it had become very clear that the dangers of dependence developing with this drug had been greatly underestimated. There were many reports from both Europe and North America of physicians and nurses who had become dependent and of cases of cocaine dependence, associated with its use in treatment.
In the early part of the 20th century it also became clear that as a result of the uncontrolled availability of this drug it was being used, in certain circles, as a “recreational” drug. The extent of this recreational use, at that time, is difficult to ascertain, but it was certainly extensive enough to arouse concern and to stimulate calls for legislative control- the fact that cocaine is a drug with potential for misuse had become very firmly established.
The middle decades of the 20th century might be viewed as a rather quiescent period as far as cocaine is concerned- coca leaves continued to be chewed in the geographical areas traditionally associated with their use and there was a continuing low-level problem of cocaine misuse in the developed world. This period, however, saw an almost explosive increase in the misuse of synthetic stimulants (amphetamine and phenmetrazine) in many countries. The experiences of the countries where these “epidemics” of misuse occurred gave ample confirmation of the threat to public health posed by any type of central nervous system stimulant. Today it is the use of cocaine that threatens to erupt into just such an epidemic.
Central nervous system stimulants are very popular as drugs of misuse; new drug misusers are likely to be rapidly recruited, and stimulant use can be a substitute for, or be combined with, narcotic misuse. Furthermore, in the aftermath of a stimulant epidemic, th established demand may be easily transferred to opiates.
The dangers of cocaine were initially underestimated and this mistake should not be repeated. The early experiences with cocaine and the problems of stimulant misuse in the middle of this century provide a warning of the potential public health problems associated with the misuse of cocaine-type drugs. What is more, the present level of cocaine misuse signals a resurgence of stimulant misuse in epidemic proportions with all the associated dangers.
B. THE SPREAD OF COCAINE
After the isolation of cocaine from coca leaf, events began to occur at such a blinding pace that it’s difficult to elaborate them in chronological fashion. In April 1884, Sigmund Freud obtained cocaine from the Merck Company and took small amounts himself and felt a “sudden exhilaration and a feeling of ease.” He persuaded his bride-to-be to try and also doomed a friend to lifetime cocaine habituation by prescribing the drug to cure his morphine addiction.
Meanwhile across the Atlantic cocaine was being first used as an anesthetic in the first nerve block in 1884. Both Freud and this doctor became addicted to cocaine. Cocaine continued to find legitimate medicinal uses as time passed but possibly as a result of the enthusiasm of Freud and other well-intentioned researchers, cocaine left the scientific arena and captured the souls of the public in Europe and North America.
The new wonder drug caught the fancy of the public during the latter part of the 19th century and was hailed as a cure for asthma, cancer, conjunctivitis, dyspepsia, edema, nosebleed, broken bones, headache, hypochondria, itch, melancholy, nausea, nervous disorders, hemorrhoids, rheumatism, stomachache, and fainting spells, among others. It was also sold in many forms.
Commercial and street chemistry of coca derivatives
Coca leaf
acid/solvent extraction ® flavorings
(Plus multiple other compounds and residual plant flavor)
ecgonine alkaloids
ecgonine
cocaine (benzoylmethylecgonine)
benzolecgonine
cinnamylcocaine
alpha- and beta-truzilline
hydrolysis
ecgonine
(plus other hydrolysis products)
methanol/benzoic acid esterification
cocaine hydrochloride
base/solvent extraction
neutral free-base cocaine
C. COCA AND ITS COMPONENTS
Coca is the dried leaf of Erythroxylon coca and the commercial drug is derived from three plant varieties found in Bolivia, Peru, Java, and Colombia. Cocaine has been grown in botanical gardens and private collections throughout the world. Many countries have experimented with coca as a cultivated crop, including Indonesia, India, Sri Lanka, and Japan. Most coca is now grown in Peru and Bolivia.
Coca is a small, bushy tree with oval leaves, fragrant white flowers, and scarlet fruit. The plant may reach a height of 18 ft. at lower elevations but heights decrease to 6 ft. or so with increasing altitude. Leaves are harvested three times during the year and are processed by alternating drying and fermentation for three to four days before being collected. Cocaine is extracted from the leaves with dilute sulfuric acid and solvents.
D. COCAINE ON THE STREETS
Cocaine may be relatively pure or may by cut, or diluted, with a variety of harmless or toxic compounds once it enters into the channels of illicit commerce. Cocaine can also be injected and used as local anesthetics.
Nomenclature
snow
the pimp’s drug
the Cadillac of drugs
flake
gold dust
green gold
coke
speedball (heroin and cocaine)
blow
liquid lady (alcohol and cocaine)
toot
crack
Street measures
hit
snort
line
dose
Adulterants
local anesthetics: procaine, lidocaine, tetracaine, benzocaine
stimulants: amphetamine, caffeine, methylphenidate, ergotamine, aminophylline
hallucinogens: LSD, hashish, marijuana, PCP
opioids: codeine, heroin (speedball)
depressants: alcohol (liquid lady), methapyrilene
others: quinine, thiamine, thyarmine
Cocaine substitutes
sugars
caffeine
procaine
tobacco
lidocaine
caryanthine
E. ABSORPTION
As a topical anthesthetic in opthamological procedures, cocaine was used. It has been thought of as rapidly absorbing across the mucus membranes but they have found this not to be true. “Cocaine is relatively rapidly absorbed from almost any vascular surface, even skin and denuded or inflamed urinary muscosa, when used as a topical anesthetic.”(1) A high comes over the user within a minute or so of snorting. Furthermore, injection or smoking free-base cocaine increases the absorption rate 10-fold over snorting. It was amazing to find though that “free-base smoking induced more intense effects than did injection, even with less free-base inhaled than cocaine hydrochloride injected.”(1)
It has been thought that cocaine is not absorbed in the digestive tract, if at all very little. It is not absorbed until it reaches the duodenum because of the increase of alkaline that reacts with the pKa of the cocaine. Results show that ingested cocaine is in the range of 30% compared to 60% for the snorted drug. Therefore, orally can be effective if the user is willing to double the price for the effect. One problem associated with gastrointestinal absorption is the high mortality rate of smugglers who have swallowed packets of cocaine and they have ruptured which releases an overdose into the body.
1. Pharmacologic Mechanisms
Cocaine has the ability to show 3 main pharmacological effects. They are: (1) local anesthetic effect, (2) central nervous system stimulation, and (3) inhibition of neuronal uptake of catecholamines. The feeling of euphoria and an increase is alertness are the primary reasons people abuse this drug. The toxicity, however, come from the these effects mentioned above. Furthermore, “street” cocaine is usually not used alone and mixed with other toxic drugs or chemicals. This causes a mixed overdose that the user may not even be aware of.
2. Toxic Effects
The central nervous system is stimulated when cocaine is used. This is the primary cause of most users’ deaths because it results in seizures, hypothermia, ventricular fibrillation, or respiratory arrest. When someone overdoses on cocaine they are rarely treated in emergency centers, they are usually found dead.
Specific effects from a stimulated CNS are excitement, anxiety, severe agitation and overt paranoid psychosis.
The route of administration and a large degree of stimulant exposure appear to predispose some people to become habitual users. A rapid decline of cocaine results in spite of its continued presence in plasma. Users have commented that the satisfactory euphoria feeling they experienced the first time has not ever been captured again by other subsequent trials.
As mentioned before, seizures may occur. If there are multiple seizures, a risk of hypothermia and death is likely. It has been reported that intra cranial hemorrhage and stroke have occurred.
“Cardiovascular effects of cocaine include arrhythmia (both arrial and ventricular) , severe hypertension (including a case of aortic rupture), and both coronary and peripheral vasoconstriction. Myocardial infarction may result from coronary spasm, with or without pre-existing coronary artery disease. Cardiomuyopathy has been reported, as have several cases each of intestinal ischemia.”
Some of the pulmonary complications reported have been pulmonary edemas and respiratory arrest. A forced Valsalax maneuver during crack smoking have caused Pneumomediastinum and pneumothorax.
Metabolic complications also occur which result in hypothermia, rhabdomyolysis, renal failure, hepatotoxicity, and disseminated intra vascular coagulation.
Persistent rhinorrhea, epistaxis, anosmia, atrophy or nasal septum mucosa, and necrosis of the nasal septum are side effects of chronic intranasal cocaine use.
Similar to tobacco use, free-base smoking results in significant carbon monoxide-diffusing capacity reduction and can irritate the large and small airways.
Withdrawal from cocaine is a very painful process. There is a phase called the “crash” which can last from several hours to several days. Symptoms are depression, hyper somnolence, and hyperphagia. Up to four days afterward, an increase in rapid eye movement sleep will occur. The second phase consisted primarily of depression and decreased energy follows. Those who have abused cocaine may continue to have psychological craving for the drug up to ten years after their withdrawal process.
F. METABOLISM
Metabolism and elimination of the cocaine after absorption is done through several different routes. Cocaine is primarily metabolized through the esterases in the blood and liver. Depending upon the Ph of the urine, cocaine may be unchanged in small amounts ranging from 1 to 9%. Most urine screening looks for benzoylecogonine and not the cocaine itself. Benzolyecogonine is the major urinary elimination product-35 to 54% of the total dose from this drug. Cocaine may be found in the urine up to 8 hours after use. And benzolyecogonine will remain present for two days.
G. BIOLOGICAL EFFECTS
Cocaine in the past was used for local anesthesia. This drug has the ability to cause axon membranes to stabilize and can block the nerve impulses in the area of initiation and conduction. The sympathetic nervous system is very affected by cocaine. As the same as other sympathomimetic drugs, cocaine prevents the neuronal re uptake of epinephrine and norepineephrine after they are released. This result in a net increase in available neurotransmitters, which can add to the subsequent stimulatous effect. Also, cocaine may hasten the releasing of catecholamines which originate from achenergic nerve terminals.
H. CLINICAL EFFECTS
Human response to cocaine is predictable within certain limits. As with any drug, however, variables such as dosage, chronically of use, route of administration, and individual susceptibility must be considered. Most important when discussing catastrophic effects is the discrimination between the massive one-time overdose in an intravenous user or a body packer and the “wired” or “amped” chronic user on a “run,” or prolonged binge.
The effect upon the user’s central nervous system will generally follow the rostral-caudral progression, with a feeling of euphoric pleasure-the “rush”-being the earliest and most desirable effect. As doses increase, hyperactivity ensues and may be a visible sign to observers, as may the accompanying mydriasis. Pleasure gives way to negative sensations, particularly if the “set” and “setting” of the drug experience are adverse. Emotional ability and paranoia are signs of impending advanced toxicity, as are tactile hallucinations, such as “cocaine bugs,” visual hallucinations, such as “snow lights,” and other sensory hallucinations effects, terminating in overt cocaine psychosis with all its paranoid ideations and risk of physical harm to the user and those about him. Nausea, vertigo, and headache may precede later profound effects, as may tremors, tics, twitches, and jerks–”cocaine leaps”–associated with severe agitation.
Advanced stimulation may result in generalized hyperreflexia in the face of decreasing responsiveness, terminating in individual seizures and status epilepticus. Terminally, a depressive phase ensues, with loss of reflexes, coma, and loss of vital functions, ending in death.
Cardiovascular effects include a very early slowing the pulse, followed by an increase in the pulse and blood pressure. Pressures may rise sufficiently to cause intracranial hemorrhage or high-out-put congestive heart failure. Ventricular dysrhythmias may result form direct myocardial damage, evidenced anatomically by contraction ban necrosis, which promotes malignant reentry arrhythmias, eventual ventricular fibrillation, and cardiac arrest.
The picture of evolving malignant hyperthermia may be evidenced initially by a slight rise in body temperature with even a single snorted dose. The rise in core temperature is progressive through the stimulatory phases and is aggravated by seizure activity and progressive central effects.
The chronically “over-amped” individual is likely to present with restlessness, paranoia and hallucinations, hyperreflexia, and stereotyped movements, such as repetitive picking, lip-biting, and bruxism. The massive-overdose victim is more likely to present with advanced cardio respiratory distress and seizures.
Physical examinations of a chronic user may reveal lesions self-inflicted because of the urge to scrape out “cocaine bugs” crawling under the skin. Lesions may also be caused by the repetitive picking of the weird individual or may be the result of “coke burns” caused by cocaine injections.
In addition to nausea, vomiting, and diarrhea as a result of overamping, an interesting cas of pseudomemebranous colitis associated with cocaine addiction has recently been reported. It was thought to be due to a catecholamine-induced mucosal ischemia.
Various vascular complications of cocaine use in addiction to cerebrovascular accidents have now been reported, including renal infarction and rupture of an ascending aorta. Acute myocardial infarction was reported in 1985 in a 28-year-old woman without known previous heart disease, who had snorted 1.5 gm of cocaine over a five-hour period.
EFFECTS ON THE CIRCULATORY SYSTEM
There are basically three areas that I would like to cover within the effects of cocaine on the circulatory system: the cardiovascular, blood flow, and heart disease. These three areas are dominant parts of the the circulatory system which should be addressed.
Cardiovascular
First of all, the cardiovascular may take more hits from the use of cocaine than any other part of the system being discussed. There are three phases of body reaction when cocaine is used. The three phases are 1) initial stimulation, 2) progressing stimulation, and 3) depression (Higgins, 1989).
The first of these is the initial stimulation phase. During this phase, the blood pressure and pulse increase rapidly accompanied by premature ventricular contractions. In addition, the person may feel “hot” as if with a fever. A cold sweat may accompany the “fever.” Vasoconstriction may be followed by skin pallor.
During the second phase of progressing stimulation, the pulse and blood pressure increase at an alarming rate. The pulse not only skyrockets, but it gets weak, speedy and rather abnormal. Because of decreased cardiac output and hypotension, there is a high risk during this stage for a cerebral hemorrhage. (Higgins, 1989).
Phase
Effects
Initial stimulation
Variable pulse
Increased blood pressure
Premature ventricular contractions
Progressing stimulation
Cerebral hemorrhage
Decreased cardiac output
Hypotension
Ventricular fibrillation
Depression
Circulatory collapse
Cardiac arrest
Death
Depression is certainly the final stage usually resulting in death. However, before death overtakes the body, a few things happen. There is ventricular fibrillation, generalized cyanosis, and circulatory collapse. Naturally, cardiac arrest happens after the collapse of the circulatory system.
Perhaps one of the reasons for such a response to cocaine from the circulatory system is the overwhelming adrenaline-like stimulation that is administered by the drug. Symptoms show up in the cardiovascular system because of the “tachycardia and hypertension produced by this sympathetic stimulation. Initial management of cocaine-induced agitation includes ventilatory and circulatory support, physical restraint, and correction of hyperthermia.” (Higgins, 1989).
Two other cardiovascular responses to cocaine are cardiomyopathy and coronary vasospasm. The abuser may complain of chest pain or other nonspecific symptoms.
Blood Flow
Research has shown that even tiny amounts of cocaine can constrict the arteries and reduce the flow of blood to the heart. In addition, cocaine “inhibits nerve blood flow by effects on nerve prostaglandin metabolites.” (Kalichman, Sanicolas, Jorge, and Roux, 1994).
Cocaine exerts its reinforcing actions by clinging on to the dopamine transporter. (Pearlson, Jeffrey, Harris, Ross, Fischman, and Camargo, 1993). “Chronic cocaine abusers demonstrated decreased relative cerebral blood flow (CBF) in prefrontal cortex immediately after stopping use and increased global brain metabolism.” (Pearlson, et al., 1993).
In a study of eight abstinent cocaine users, the subjects reported significant increases in several self-ratings of drug effect. “Significant drug-induced blood flow decreases were seen in selected frontal and basal ganglia regions, and significant negative correlations existed between these decreases and self-report measures.” (Pearlson, et al., 1993).
This study shows more than “80% first-pass extraction with an estimated 90-second time window reflecting regional CBF changes. This is considerably shorter than the 40-minute uptake period for labeled 2-deoxyglucose in humans and corresponds more closely to the time of peak subjective effects, which for intravenous cocaine is 3-5 minutes.” (Pearlson, et al., 1993).
The researchers noted significant correlations between drug craving and frontal metabolic activity. In addition, it is noted that there are also significant correlations between “lesser cocaine-induced euphoriant effects (”rush” and “high”) and selected frontal and basal ganglia blood flow decreases. These data suggest that 48 mg of intravenous cocaine in humans produces regional decreases in CBF corresponding to sites enriched in dopaminergic terminals.” (Pearlson, et al., 1993).
Heart disease
Not only are a high fat diet, inactivity, high blood pressure and smoking contributing factors to heart disease, but now, cocaine abuse has been added to the list by doctors. In one study of individuals, average age 25, who had recently died from a variety of causes, researchers found the presence of “more atherosclerotic plaque in the aortas of those who had been cocaine users.” (McCarthy, 1991).
“Plaque buildup begins in most of us at this time of life,” explains Renu Virmani, M.D., chairperson of cardiovascular pathology at the Armed Forces Institute of Pathology in Washington, DC, who headed the study. “But in cocaine users, it appears to be much, much greater. It’s possible that by stopping cocaine use early enough, one could repair some of the damage, in the same way that stopping smoking can reverse problems.” Currently, about 20 million Americans say they have tried cocaine; about five million are chronic abusers. (McCarthy, 1991).
“The optimal medical regimen for the treatment of cocaine associated with myocardial ischemia has not been defined. While animal and human data demonstrate the risks of beta-adrenergic blockade, studies in the cardiac catheterization laboratory suggest a beneficial role of nitroglycerin. We performed a prospective multicenter observational study to evaluate the clinical safety and efficacy of nitroglycerin in the treatment of cocaine associated chest pain at six municipal hospital centers. Of 246 patients presenting with cocaine associated chest pain, 83 patients were treated with nitroglycerin at the discretion of the treating physician. Relief of chest pain and/or adverse hemodynamic outcome were the primary endpoints. Baseline comparisons of patients treated with nitroglycerin to those not treated with it found that the treated patients were at higher risk of ischemic heart disease.” (Hollander, Hoffman, Gennis, Fairweather, DiSano, Schumb, Feldman, Fish, Dyer, and Wax, 1994).
MYOCARDIAL ISCHEMIA
“Ischemia of the myocardium develops when the myocardial demand for oxygen-bearing coronary arterial blood exceeds the supply. In normal coronary arteries, ischemia can be induced by spasm. Cocaine use can lead to myocardial ischemia through these mechanisms.” (Bunn and Giannini, 1992).
“Cocaine potentiates the physiologic response to catecholamines. This action is produced by inhibition of the reuptake of norepinephrine into storage sites in adrenergic neurons, as well as by potentiation of tyramine-facilitated release of norepinephrine from these sites. The catecholamine response accelerates the pulse and elevates the blood pressure, increasing myocardial oxygen demand.” (Bunn and Giannini, 1992).
“Normally, increased myocardial oxygen demand results in dilation of the coronary arteries to allow more blood flow. However, cocaine has a direct vasoconstrictor effect on vascular smooth muscle.” (Bunn and Giannini, 1992).
“This effect is independent of alpha-adrenergic stimulation but is dependent on calcium. Thus, vasoconstriction occurs despite the increase in myocardial oxygen demand. If coronary artery disease is present, the problem is compounded by vasoconstriction can even occur in normal coronary arteries. This may overwhelm other auto-regulatory mechanisms that preserve coronary blood flow during exercise or during exposure to cold.” (Bunn and Giannini, 1992).
Chest pain, presumably due to myocardial ischemia, is a fairly frequent complaint in cocaine users and may precipitate a visit to the emergency department. While vasoconstriction may occur with small doses of cocaine, considerable variability exists among individuals; therefore, the occurrence of symptoms is unpredictable. Also, the “concomitant use of other drugs, such as alcohol, may enhance the cardiotoxic effects of cocaine.” (Bunn and Giannini, 1992).
“Holter monitor studies have demonstrated episodes of silent myocardial ischemia even during cocaine withdrawal, particularly during the first week of abstinence.” (Bunn and Giannini, 1992).
MYOCARDIAL INFARCTION
Since 1982, the medical literature has contained reports of patients with acute myocardial infarction temporally related to the use of cocaine. Cregler studied 36 such patients. The average age of these patients was 33 years, and 25 percent had no recognized risk factors for coronary artery disease. The infarcts in these patients were usually transmural, and they occured in first-time users as well as in chronic users. The mortality rate was 10 percent. (Bunn and Giannini, 1992).
“The pathophysiologic mechanisms for cocaine-induced myocardial infarction are usually multiple. These mechanisms include increased myocardial oxygen demand due to increased heart rate and blood pressure and coronary vasospasm induced by the direct effect of cocaine on vascular smooth muscle. In addition, cocaine’s effect on platelets causes increased thromboxane production and platelet aggregation, with a greater potential for intracoronary thrombosis.” (Bunn and Giannini, 1992).
“Finally, cocaine may induce procoagulant effects through transient depletion of protein C and antithrombin III.” (Bunn and Giannini, 1992).
Acute chest pain related to cocaine use is very similar to that produced by acute myocardial ischemia. “Although the degree of coronary artery narrowing is distinctly greater in the cocaine-addicted population than in comparable nonaddicted populations, the incidence of acute myocardial infarction is low.” Many young cocaine abusers, particularly in the black population, may have a normal-variant pattern of early repolarization on electrocardiograms. This pattern can simulate changes seen in acute myocardial injury and may cause difficulties in the emergency department. (Bunn and Giannini, 1992).
MYOCARDITIS AND CARDIOMYOPATHY
“Myocarditis and dilated cardiomyopathy are frequently found at autopsy in patients with a history of chronic cocaine use. In a series of 40 patients, the incidence of myocarditis was 20 percent. Foci of lymphocytes and/or eosinophils were seen on pathology specimens. The etiology of the myocarditis was unknown, but several mechanisms were postulated. Cocaine may have have a direct cytotoxic effect on cardiac myocytes. The presence of eosinophils in some biopsy specimens suggests the possibility of a hypersensitivity mechanism. Alternatively, sustained high levels of catecholamines may produce focal myocarditis. Chronic use of cocaine may lead to myocardial fibrosis.” (Bunn and Giannini, 1992).
“Reversible cardio myopathy also has been associated with cocaine intoxication. The acute dilated cardiomyopathy associated with cocaine intoxication runs a clinical course similar to that reported in patients with pheochromocytoma. In both situations, the depressed systolic function is probably attributable to the direct toxic effect of high levels of circulating catecholamines on myocytes. It is paradoxic that cocaine has a primary depressant effect on the myocardium and concurrently produces intense adrenergic stimulation.” (Bunn and Giannini, 1992).
Bunn, W.H. & Giannini, A.J. (1992). Cardiovascular complications of cocaine abuse.
American Family Physician, 46, 769-773.
Higgins, R. (1989). Cocaine abuse: what every emergency nurse should know.
Journal of Emergency Nursing, 15, 318-323.
Hollander, J.E., Hoffman, R.S., Gennis, P., Fairweather, P., DiSano, M.J., Schumb, D.A., Feldman, J.A., Fish, S.S., Dyer, S. & Wax, P. (1994). Nitroglycerin in the treatment of cocaine associated chest pain–clinical safety and efficacy. Journal of Toxicology, 32, 243-256.
Kalichman, M.W., Sanicolas, M.T., Jorge, M.C., & Roux, L. (1994). Effects of cocaine on blood flow and prostaglandin metabolites in rat sciatic nerve. American Journal of Physiology, 35, H2515-H2519.
McCarthy, L.F. (1991). Better body knowledge. Harper’s Bazaar, 124, 127-128.
Pearlson, G.D., Jeffrey, P.J., Harris, G.J., Ross, C.A., Fischman, M.W., & Camargo, E.E. (1993). Correlation of acute cocaine-induced changes in local cerebral blood flow with subjective effects.
American Journal of Psychiatry, 150, 495-497.Cocaine: History and Effects on the Circulatory and Reproductive Systems

Jennifer Pearce
Kim Caldwell
Jason Scarabin
Todd Chelius

Running Head: COCAINE

Brigham Young University, English 315
March 28, 1995
I. HISTORY
Integral to the development of the healing arts has been man’s use of plants and other natural products to ease his lot in life- whether for shelter, food, alleviation of suffering, or recreation in the form of mind alteration. “Primitive” cultures have often been the true discoverers of particular compounds, while “modern” society exploits the peculiar attributes of certain plants for beneficial or perverse ends or both. Such has been the lot of the coca plant, the “divine plant of the Incas”.
A. THE ROOTS
“The Divine Plant” of the Incas was originally written by Dr. W. Golden Mortimer in 1901 and reprinted in 1974. Dr. Mortimer, a New York physician, devoted years to this text. It is written in the romantic style of his time and he outlines the origins of the use of the coca plant in South America:
During the early age, when this nature’s garden was unknown to the rest of the world, the Incas, who were then the dominant people of this portion of the continent, regarded this shrub as “the divine plant,” so all important and complete in itself, that it was termed simply khoka, meaning the tree, beyond which all other designation was unnecessary. This plant, which has been described known as Coca, has appealed alike to the archaeologist, the botanist, the historian, and traveler as well as to the physician. Its history is united with the antiquity of centuries, while its traditions link it with a sacredness of the past, the beginning of which is lost in the remoteness of time. So intimately entwined is the story of Coca with these early associations - with religious rites, with superstitious reverence, with false assertions and modern doubts - that to unravel it is like to the disentanglement of a tropical vine in the primitive jungles of its native home.
Coca’s use in the spiritual, political, and everyday life of the Incan Indians was well established and seemingly very structured. For centuries, the Incas had made a habit of inserting leaves from the coca plant between teeth and gums with “lime” -usually wood ashes or burnt crushed shells. In South and Central America, chewing of the leaf of the coca plant dates back to very ancient times. News of this plant and its properties was brought back to Europe by the early explorers and references to coca can be found in European medical texts dating from the 17th century. However, it was not until the 19th century that scientific and chemist, Dr. Albert Neimann, isolated cocaine in the pure alkaloid form from leaves brought to Europe. During the following twenty years or so, cocaine was used extensively by the medical profession as a stimulant, a local anesthetic, and as a “cure” for morphine dependence.
This era of unrestrained medical enthusiasm was short-lived, however, and by the end of the 19th century it had become very clear that the dangers of dependence developing with this drug had been greatly underestimated. There were many reports from both Europe and North America of physicians and nurses who had become dependent and of cases of cocaine dependence, associated with its use in treatment.
In the early part of the 20th century it also became clear that as a result of the uncontrolled availability of this drug it was being used, in certain circles, as a “recreational” drug. The extent of this recreational use, at that time, is difficult to ascertain, but it was certainly extensive enough to arouse concern and to stimulate calls for legislative control- the fact that cocaine is a drug with potential for misuse had become very firmly established.
The middle decades of the 20th century might be viewed as a rather quiescent period as far as cocaine is concerned- coca leaves continued to be chewed in the geographical areas traditionally associated with their use and there was a continuing low-level problem of cocaine misuse in the developed world. This period, however, saw an almost explosive increase in the misuse of synthetic stimulants (amphetamine and phenmetrazine) in many countries. The experiences of the countries where these “epidemics” of misuse occurred gave ample confirmation of the threat to public health posed by any type of central nervous system stimulant. Today it is the use of cocaine that threatens to erupt into just such an epidemic.
Central nervous system stimulants are very popular as drugs of misuse; new drug misusers are likely to be rapidly recruited, and stimulant use can be a substitute for, or be combined with, narcotic misuse. Furthermore, in the aftermath of a stimulant epidemic, th established demand may be easily transferred to opiates.
The dangers of cocaine were initially underestimated and this mistake should not be repeated. The early experiences with cocaine and the problems of stimulant misuse in the middle of this century provide a warning of the potential public health problems associated with the misuse of cocaine-type drugs. What is more, the present level of cocaine misuse signals a resurgence of stimulant misuse in epidemic proportions with all the associated dangers.
B. THE SPREAD OF COCAINE
After the isolation of cocaine from coca leaf, events began to occur at such a blinding pace that it’s difficult to elaborate them in chronological fashion. In April 1884, Sigmund Freud obtained cocaine from the Merck Company and took small amounts himself and felt a “sudden exhilaration and a feeling of ease.” He persuaded his bride-to-be to try and also doomed a friend to lifetime cocaine habituation by prescribing the drug to cure his morphine addiction.
Meanwhile across the Atlantic cocaine was being first used as an anesthetic in the first nerve block in 1884. Both Freud and this doctor became addicted to cocaine. Cocaine continued to find legitimate medicinal uses as time passed but possibly as a result of the enthusiasm of Freud and other well-intentioned researchers, cocaine left the scientific arena and captured the souls of the public in Europe and North America.
The new wonder drug caught the fancy of the public during the latter part of the 19th century and was hailed as a cure for asthma, cancer, conjunctivitis, dyspepsia, edema, nosebleed, broken bones, headache, hypochondria, itch, melancholy, nausea, nervous disorders, hemorrhoids, rheumatism, stomachache, and fainting spells, among others. It was also sold in many forms.
Commercial and street chemistry of coca derivatives
Coca leaf
acid/solvent extraction ® flavorings
(Plus multiple other compounds and residual plant flavor)
ecgonine alkaloids
ecgonine
cocaine (benzoylmethylecgonine)
benzolecgonine
cinnamylcocaine
alpha- and beta-truzilline
hydrolysis
ecgonine
(plus other hydrolysis products)
methanol/benzoic acid esterification
cocaine hydrochloride
base/solvent extraction
neutral free-base cocaine
C. COCA AND ITS COMPONENTS
Coca is the dried leaf of Erythroxylon coca and the commercial drug is derived from three plant varieties found in Bolivia, Peru, Java, and Colombia. Cocaine has been grown in botanical gardens and private collections throughout the world. Many countries have experimented with coca as a cultivated crop, including Indonesia, India, Sri Lanka, and Japan. Most coca is now grown in Peru and Bolivia.
Coca is a small, bushy tree with oval leaves, fragrant white flowers, and scarlet fruit. The plant may reach a height of 18 ft. at lower elevations but heights decrease to 6 ft. or so with increasing altitude. Leaves are harvested three times during the year and are processed by alternating drying and fermentation for three to four days before being collected. Cocaine is extracted from the leaves with dilute sulfuric acid and solvents.
D. COCAINE ON THE STREETS
Cocaine may be relatively pure or may by cut, or diluted, with a variety of harmless or toxic compounds once it enters into the channels of illicit commerce. Cocaine can also be injected and used as local anesthetics.
Nomenclature
snow
the pimp’s drug
the Cadillac of drugs
flake
gold dust
green gold
coke
speedball (heroin and cocaine)
blow
liquid lady (alcohol and cocaine)
toot
crack
Street measures
hit
snort
line
dose
Adulterants
local anesthetics: procaine, lidocaine, tetracaine, benzocaine
stimulants: amphetamine, caffeine, methylphenidate, ergotamine, aminophylline
hallucinogens: LSD, hashish, marijuana, PCP
opioids: codeine, heroin (speedball)
depressants: alcohol (liquid lady), methapyrilene
others: quinine, thiamine, thyarmine
Cocaine substitutes
sugars
caffeine
procaine
tobacco
lidocaine
caryanthine
E. ABSORPTION
As a topical anthesthetic in opthamological procedures, cocaine was used. It has been thought of as rapidly absorbing across the mucus membranes but they have found this not to be true. “Cocaine is relatively rapidly absorbed from almost any vascular surface, even skin and denuded or inflamed urinary muscosa, when used as a topical anesthetic.”(1) A high comes over the user within a minute or so of snorting. Furthermore, injection or smoking free-base cocaine increases the absorption rate 10-fold over snorting. It was amazing to find though that “free-base smoking induced more intense effects than did injection, even with less free-base inhaled than cocaine hydrochloride injected.”(1)
It has been thought that cocaine is not absorbed in the digestive tract, if at all very little. It is not absorbed until it reaches the duodenum because of the increase of alkaline that reacts with the pKa of the cocaine. Results show that ingested cocaine is in the range of 30% compared to 60% for the snorted drug. Therefore, orally can be effective if the user is willing to double the price for the effect. One problem associated with gastrointestinal absorption is the high mortality rate of smugglers who have swallowed packets of cocaine and they have ruptured which releases an overdose into the body.
1. Pharmacologic Mechanisms
Cocaine has the ability to show 3 main pharmacological effects. They are: (1) local anesthetic effect, (2) central nervous system stimulation, and (3) inhibition of neuronal uptake of catecholamines. The feeling of euphoria and an increase is alertness are the primary reasons people abuse this drug. The toxicity, however, come from the these effects mentioned above. Furthermore, “street” cocaine is usually not used alone and mixed with other toxic drugs or chemicals. This causes a mixed overdose that the user may not even be aware of.
2. Toxic Effects
The central nervous system is stimulated when cocaine is used. This is the primary cause of most users’ deaths because it results in seizures, hypothermia, ventricular fibrillation, or respiratory arrest. When someone overdoses on cocaine they are rarely treated in emergency centers, they are usually found dead.
Specific effects from a stimulated CNS are excitement, anxiety, severe agitation and overt paranoid psychosis.
The route of administration and a large degree of stimulant exposure appear to predispose some people to become habitual users. A rapid decline of cocaine results in spite of its continued presence in plasma. Users have commented that the satisfactory euphoria feeling they experienced the first time has not ever been captured again by other subsequent trials.
As mentioned before, seizures may occur. If there are multiple seizures, a risk of hypothermia and death is likely. It has been reported that intra cranial hemorrhage and stroke have occurred.
“Cardiovascular effects of cocaine include arrhythmia (both arrial and ventricular) , severe hypertension (including a case of aortic rupture), and both coronary and peripheral vasoconstriction. Myocardial infarction may result from coronary spasm, with or without pre-existing coronary artery disease. Cardiomuyopathy has been reported, as have several cases each of intestinal ischemia.”
Some of the pulmonary complications reported have been pulmonary edemas and respiratory arrest. A forced Valsalax maneuver during crack smoking have caused Pneumomediastinum and pneumothorax.
Metabolic complications also occur which result in hypothermia, rhabdomyolysis, renal failure, hepatotoxicity, and disseminated intra vascular coagulation.
Persistent rhinorrhea, epistaxis, anosmia, atrophy or nasal septum mucosa, and necrosis of the nasal septum are side effects of chronic intranasal cocaine use.
Similar to tobacco use, free-base smoking results in significant carbon monoxide-diffusing capacity reduction and can irritate the large and small airways.
Withdrawal from cocaine is a very painful process. There is a phase called the “crash” which can last from several hours to several days. Symptoms are depression, hyper somnolence, and hyperphagia. Up to four days afterward, an increase in rapid eye movement sleep will occur. The second phase consisted primarily of depression and decreased energy follows. Those who have abused cocaine may continue to have psychological craving for the drug up to ten years after their withdrawal process.
F. METABOLISM
Metabolism and elimination of the cocaine after absorption is done through several different routes. Cocaine is primarily metabolized through the esterases in the blood and liver. Depending upon the Ph of the urine, cocaine may be unchanged in small amounts ranging from 1 to 9%. Most urine screening looks for benzoylecogonine and not the cocaine itself. Benzolyecogonine is the major urinary elimination product-35 to 54% of the total dose from this drug. Cocaine may be found in the urine up to 8 hours after use. And benzolyecogonine will remain present for two days.
G. BIOLOGICAL EFFECTS
Cocaine in the past was used for local anesthesia. This drug has the ability to cause axon membranes to stabilize and can block the nerve impulses in the area of initiation and conduction. The sympathetic nervous system is very affected by cocaine. As the same as other sympathomimetic drugs, cocaine prevents the neuronal re uptake of epinephrine and norepineephrine after they are released. This result in a net increase in available neurotransmitters, which can add to the subsequent stimulatous effect. Also, cocaine may hasten the releasing of catecholamines which originate from achenergic nerve terminals.
H. CLINICAL EFFECTS
Human response to cocaine is predictable within certain limits. As with any drug, however, variables such as dosage, chronically of use, route of administration, and individual susceptibility must be considered. Most important when discussing catastrophic effects is the discrimination between the massive one-time overdose in an intravenous user or a body packer and the “wired” or “amped” chronic user on a “run,” or prolonged binge.
The effect upon the user’s central nervous system will generally follow the rostral-caudral progression, with a feeling of euphoric pleasure-the “rush”-being the earliest and most desirable effect. As doses increase, hyperactivity ensues and may be a visible sign to observers, as may the accompanying mydriasis. Pleasure gives way to negative sensations, particularly if the “set” and “setting” of the drug experience are adverse. Emotional ability and paranoia are signs of impending advanced toxicity, as are tactile hallucinations, such as “cocaine bugs,” visual hallucinations, such as “snow lights,” and other sensory hallucinations effects, terminating in overt cocaine psychosis with all its paranoid ideations and risk of physical harm to the user and those about him. Nausea, vertigo, and headache may precede later profound effects, as may tremors, tics, twitches, and jerks–”cocaine leaps”–associated with severe agitation.
Advanced stimulation may result in generalized hyperreflexia in the face of decreasing responsiveness, terminating in individual seizures and status epilepticus. Terminally, a depressive phase ensues, with loss of reflexes, coma, and loss of vital functions, ending in death.
Cardiovascular effects include a very early slowing the pulse, followed by an increase in the pulse and blood pressure. Pressures may rise sufficiently to cause intracranial hemorrhage or high-out-put congestive heart failure. Ventricular dysrhythmias may result form direct myocardial damage, evidenced anatomically by contraction ban necrosis, which promotes malignant reentry arrhythmias, eventual ventricular fibrillation, and cardiac arrest.
The picture of evolving malignant hyperthermia may be evidenced initially by a slight rise in body temperature with even a single snorted dose. The rise in core temperature is progressive through the stimulatory phases and is aggravated by seizure activity and progressive central effects.
The chronically “over-amped” individual is likely to present with restlessness, paranoia and hallucinations, hyperreflexia, and stereotyped movements, such as repetitive picking, lip-biting, and bruxism. The massive-overdose victim is more likely to present with advanced cardio respiratory distress and seizures.
Physical examinations of a chronic user may reveal lesions self-inflicted because of the urge to scrape out “cocaine bugs” crawling under the skin. Lesions may also be caused by the repetitive picking of the weird individual or may be the result of “coke burns” caused by cocaine injections.
In addition to nausea, vomiting, and diarrhea as a result of overamping, an interesting cas of pseudomemebranous colitis associated with cocaine addiction has recently been reported. It was thought to be due to a catecholamine-induced mucosal ischemia.
Various vascular complications of cocaine use in addiction to cerebrovascular accidents have now been reported, including renal infarction and rupture of an ascending aorta. Acute myocardial infarction was reported in 1985 in a 28-year-old woman without known previous heart disease, who had snorted 1.5 gm of cocaine over a five-hour period.
EFFECTS ON THE CIRCULATORY SYSTEM
There are basically three areas that I would like to cover within the effects of cocaine on the circulatory system: the cardiovascular, blood flow, and heart disease. These three areas are dominant parts of the the circulatory system which should be addressed.
Cardiovascular
First of all, the cardiovascular may take more hits from the use of cocaine than any other part of the system being discussed. There are three phases of body reaction when cocaine is used. The three phases are 1) initial stimulation, 2) progressing stimulation, and 3) depression (Higgins, 1989).
The first of these is the initial stimulation phase. During this phase, the blood pressure and pulse increase rapidly accompanied by premature ventricular contractions. In addition, the person may feel “hot” as if with a fever. A cold sweat may accompany the “fever.” Vasoconstriction may be followed by skin pallor.
During the second phase of progressing stimulation, the pulse and blood pressure increase at an alarming rate. The pulse not only skyrockets, but it gets weak, speedy and rather abnormal. Because of decreased cardiac output and hypotension, there is a high risk during this stage for a cerebral hemorrhage. (Higgins, 1989).
Phase
Effects
Initial stimulation
Variable pulse
Increased blood pressure
Premature ventricular contractions
Progressing stimulation
Cerebral hemorrhage
Decreased cardiac output
Hypotension
Ventricular fibrillation
Depression
Circulatory collapse
Cardiac arrest
Death
Depression is certainly the final stage usually resulting in death. However, before death overtakes the body, a few things happen. There is ventricular fibrillation, generalized cyanosis, and circulatory collapse. Naturally, cardiac arrest happens after the collapse of the circulatory system.
Perhaps one of the reasons for such a response to cocaine from the circulatory system is the overwhelming adrenaline-like stimulation that is administered by the drug. Symptoms show up in the cardiovascular system because of the “tachycardia and hypertension produced by this sympathetic stimulation. Initial management of cocaine-induced agitation includes ventilatory and circulatory support, physical restraint, and correction of hyperthermia.” (Higgins, 1989).
Two other cardiovascular responses to cocaine are cardiomyopathy and coronary vasospasm. The abuser may complain of chest pain or other nonspecific symptoms.
Blood Flow
Research has shown that even tiny amounts of cocaine can constrict the arteries and reduce the flow of blood to the heart. In addition, cocaine “inhibits nerve blood flow by effects on nerve prostaglandin metabolites.” (Kalichman, Sanicolas, Jorge, and Roux, 1994).
Cocaine exerts its reinforcing actions by clinging on to the dopamine transporter. (Pearlson, Jeffrey, Harris, Ross, Fischman, and Camargo, 1993). “Chronic cocaine abusers demonstrated decreased relative cerebral blood flow (CBF) in prefrontal cortex immediately after stopping use and increased global brain metabolism.” (Pearlson, et al., 1993).
In a study of eight abstinent cocaine users, the subjects reported significant increases in several self-ratings of drug effect. “Significant drug-induced blood flow decreases were seen in selected frontal and basal ganglia regions, and significant negative correlations existed between these decreases and self-report measures.” (Pearlson, et al., 1993).
This study shows more than “80% first-pass extraction with an estimated 90-second time window reflecting regional CBF changes. This is considerably shorter than the 40-minute uptake period for labeled 2-deoxyglucose in humans and corresponds more closely to the time of peak subjective effects, which for intravenous cocaine is 3-5 minutes.” (Pearlson, et al., 1993).
The researchers noted significant correlations between drug craving and frontal metabolic activity. In addition, it is noted that there are also significant correlations between “lesser cocaine-induced euphoriant effects (”rush” and “high”) and selected frontal and basal ganglia blood flow decreases. These data suggest that 48 mg of intravenous cocaine in humans produces regional decreases in CBF corresponding to sites enriched in dopaminergic terminals.” (Pearlson, et al., 1993).
Heart disease
Not only are a high fat diet, inactivity, high blood pressure and smoking contributing factors to heart disease, but now, cocaine abuse has been added to the list by doctors. In one study of individuals, average age 25, who had recently died from a variety of causes, researchers found the presence of “more atherosclerotic plaque in the aortas of those who had been cocaine users.” (McCarthy, 1991).
“Plaque buildup begins in most of us at this time of life,” explains Renu Virmani, M.D., chairperson of cardiovascular pathology at the Armed Forces Institute of Pathology in Washington, DC, who headed the study. “But in cocaine users, it appears to be much, much greater. It’s possible that by stopping cocaine use early enough, one could repair some of the damage, in the same way that stopping smoking can reverse problems.” Currently, about 20 million Americans say they have tried cocaine; about five million are chronic abusers. (McCarthy, 1991).
“The optimal medical regimen for the treatment of cocaine associated with myocardial ischemia has not been defined. While animal and human data demonstrate the risks of beta-adrenergic blockade, studies in the cardiac catheterization laboratory suggest a beneficial role of nitroglycerin. We performed a prospective multicenter observational study to evaluate the clinical safety and efficacy of nitroglycerin in the treatment of cocaine associated chest pain at six municipal hospital centers. Of 246 patients presenting with cocaine associated chest pain, 83 patients were treated with nitroglycerin at the discretion of the treating physician. Relief of chest pain and/or adverse hemodynamic outcome were the primary endpoints. Baseline comparisons of patients treated with nitroglycerin to those not treated with it found that the treated patients were at higher risk of ischemic heart disease.” (Hollander, Hoffman, Gennis, Fairweather, DiSano, Schumb, Feldman, Fish, Dyer, and Wax, 1994).
MYOCARDIAL ISCHEMIA
“Ischemia of the myocardium develops when the myocardial demand for oxygen-bearing coronary arterial blood exceeds the supply. In normal coronary arteries, ischemia can be induced by spasm. Cocaine use can lead to myocardial ischemia through these mechanisms.” (Bunn and Giannini, 1992).
“Cocaine potentiates the physiologic response to catecholamines. This action is produced by inhibition of the reuptake of norepinephrine into storage sites in adrenergic neurons, as well as by potentiation of tyramine-facilitated release of norepinephrine from these sites. The catecholamine response accelerates the pulse and elevates the blood pressure, increasing myocardial oxygen demand.” (Bunn and Giannini, 1992).
“Normally, increased myocardial oxygen demand results in dilation of the coronary arteries to allow more blood flow. However, cocaine has a direct vasoconstrictor effect on vascular smooth muscle.” (Bunn and Giannini, 1992).
“This effect is independent of alpha-adrenergic stimulation but is dependent on calcium. Thus, vasoconstriction occurs despite the increase in myocardial oxygen demand. If coronary artery disease is present, the problem is compounded by vasoconstriction can even occur in normal coronary arteries. This may overwhelm other auto-regulatory mechanisms that preserve coronary blood flow during exercise or during exposure to cold.” (Bunn and Giannini, 1992).
Chest pain, presumably due to myocardial ischemia, is a fairly frequent complaint in cocaine users and may precipitate a visit to the emergency department. While vasoconstriction may occur with small doses of cocaine, considerable variability exists among individuals; therefore, the occurrence of symptoms is unpredictable. Also, the “concomitant use of other drugs, such as alcohol, may enhance the cardiotoxic effects of cocaine.” (Bunn and Giannini, 1992).
“Holter monitor studies have demonstrated episodes of silent myocardial ischemia even during cocaine withdrawal, particularly during the first week of abstinence.” (Bunn and Giannini, 1992).
MYOCARDIAL INFARCTION
Since 1982, the medical literature has contained reports of patients with acute myocardial infarction temporally related to the use of cocaine. Cregler studied 36 such patients. The average age of these patients was 33 years, and 25 percent had no recognized risk factors for coronary artery disease. The infarcts in these patients were usually transmural, and they occured in first-time users as well as in chronic users. The mortality rate was 10 percent. (Bunn and Giannini, 1992).
“The pathophysiologic mechanisms for cocaine-induced myocardial infarction are usually multiple. These mechanisms include increased myocardial oxygen demand due to increased heart rate and blood pressure and coronary vasospasm induced by the direct effect of cocaine on vascular smooth muscle. In addition, cocaine’s effect on platelets causes increased thromboxane production and platelet aggregation, with a greater potential for intracoronary thrombosis.” (Bunn and Giannini, 1992).
“Finally, cocaine may induce procoagulant effects through transient depletion of protein C and antithrombin III.” (Bunn and Giannini, 1992).
Acute chest pain related to cocaine use is very similar to that produced by acute myocardial ischemia. “Although the degree of coronary artery narrowing is distinctly greater in the cocaine-addicted population than in comparable nonaddicted populations, the incidence of acute myocardial infarction is low.” Many young cocaine abusers, particularly in the black population, may have a normal-variant pattern of early repolarization on electrocardiograms. This pattern can simulate changes seen in acute myocardial injury and may cause difficulties in the emergency department. (Bunn and Giannini, 1992).
MYOCARDITIS AND CARDIOMYOPATHY
“Myocarditis and dilated cardiomyopathy are frequently found at autopsy in patients with a history of chronic cocaine use. In a series of 40 patients, the incidence of myocarditis was 20 percent. Foci of lymphocytes and/or eosinophils were seen on pathology specimens. The etiology of the myocarditis was unknown, but several mechanisms were postulated. Cocaine may have have a direct cytotoxic effect on cardiac myocytes. The presence of eosinophils in some biopsy specimens suggests the possibility of a hypersensitivity mechanism. Alternatively, sustained high levels of catecholamines may produce focal myocarditis. Chronic use of cocaine may lead to myocardial fibrosis.” (Bunn and Giannini, 1992).
“Reversible cardio myopathy also has been associated with cocaine intoxication. The acute dilated cardiomyopathy associated with cocaine intoxication runs a clinical course similar to that reported in patients with pheochromocytoma. In both situations, the depressed systolic function is probably attributable to the direct toxic effect of high levels of circulating catecholamines on myocytes. It is paradoxic that cocaine has a primary depressant effect on the myocardium and concurrently produces intense adrenergic stimulation.” (Bunn and Giannini, 1992).
Bunn, W.H. & Giannini, A.J. (1992). Cardiovascular complications of cocaine abuse.
American Family Physician, 46, 769-773.
Higgins, R. (1989). Cocaine abuse: what every emergency nurse should know.
Journal of Emergency Nursing, 15, 318-323.
Hollander, J.E., Hoffman, R.S., Gennis, P., Fairweather, P., DiSano, M.J., Schumb, D.A., Feldman, J.A., Fish, S.S., Dyer, S. & Wax, P. (1994). Nitroglycerin in the treatment of cocaine associated chest pain–clinical safety and efficacy. Journal of Toxicology, 32, 243-256.
Kalichman, M.W., Sanicolas, M.T., Jorge, M.C., & Roux, L. (1994). Effects of cocaine on blood flow and prostaglandin metabolites in rat sciatic nerve. American Journal of Physiology, 35, H2515-H2519.
McCarthy, L.F. (1991). Better body knowledge. Harper’s Bazaar, 124, 127-128.
Pearlson, G.D., Jeffrey, P.J., Harris, G.J., Ross, C.A., Fischman, M.W., & Camargo, E.E. (1993). Correlation of acute cocaine-induced changes in local cerebral blood flow with subjective effects.
American Journal of Psychiatry, 150, 495-497.

Jason Scarabin
Communications 459
March 7, 1995

Mid-Term Questions

1. Who’s job is it to run or manage the production? The Production Manager.
2. The Production Manager is the executive head of which department? The production department, and all other departments, art, camera, sound, editorial and music.
3. Name 4 steps in the production process: The idea, the evaluation, the development, production finance, pre-production, budgeting and scheduling, casting and crewing, etc.
4. What are the two elements in the development of an idea? The raising of the finance and the actual developing of the project.
5. The script is the blueprint by which a production is guided.
6. There is a tendency for inexperienced film writers to present shooting scripts which detail every shot. Is this a waste of effort? Yes.
7. The documentary is a different type of production and, in its classic form, is intended literally to be a document of what happened in front of the camera.
8. Which is the cheapest form of documentary programme? Talking-head documentary.
9. While the draft budget is being produced, or checked, the producer will be trying to place key contracts.
10. While the production office is finalizing the contracts and budget, the art department should be progressing towards set construction, if it is required, and the location manager towards confirming locations where these are required.
11. Before a shoot can begin, what are the two main questions needed to be answered? How long will it take to produce the film? How much will the production cost?
12. Another way of tabulating the scrip information is by each individual place and this produces the location document.
13. What does the author of your text say about the “only time a production is being productive? When film is going through the camera.”
14. One of the methods used by some production managers to help in the organization of the cross-plot is the strip board or production board.
15. As a general rule, a production manager can never provide too much information.
16. Because different productions have different needs it must be realized that every schedule should be tailor-made for the particular film.
17. If the whole production is not completed in one shoot it is of benefit to attach at this stage a(n) outline schedule for the rest of the shoot.
18. Once the schedulehas been drafted the budget can be checked against its demands although it must be remembered that it is the budget which usually has the controlling or final say on the shape of a schedule.
19. In relation to cost, what is one of the key documents in any project? The budget.
20. The individual parts of the budget form are divided into sections which are usually categorized by letters and, where necessary, split into numbered subsections.
21. What is the first factor that has an effect on the budget? The agreement under which the film is being produced.
22. What are attached to the rates in relation to the processing of stock or the hire of equipment? Terms and conditions.
23. What is a cash flow forecast? A business produces a forecast of how the money in the business is to be earned and spent.
24. The cash flow forecast gives the producer, the accountant and the production office a tool by which the actual cost of the production can be measured.
25. The problems of casting, crewing, equipment hire, location finding, insurances, terms of engagement and relations with the unions will all vary from film to film.
26. Whose business is it to crew a film? The production manager.
27. What does the term Film Producers’ Indemnity mean? It is the generic term used today for the insurances summarized in the first six items on the list in the feature budget form.
28. Give an example of when a union clearance would be necessary: In the case of the production going overseas.
29. Describe briefly what a progress report is: It is a record of the comings and goings of anyone and everyone involved in the film.
30. During the filming of any production permission has to be obtained by the film company for the use of the images recorded by it. What is form is needed to take care of this? The Release Form.
31. What is the beginning of the editing process? The filmed material must be organized into script order.
32. Music recording is the responsibility of the music director in conjunction with the production manager.
33. At what point is the delivery date specified? It is specified in the original contract and there will almost certainly be penalties if the date is not met.
34. What may cost more than the actual producing of a film? Publicity.
35. In the text a film is referred to as “the last travelling circus.” Who would be considered “the ring master?” The production manager.
36. One of the ways a producer may work to guarantee a profit is to sell the film as it is being made.

To: Michele Cardall
From: Jason Scarabin
Date: February 28, 1995
Subject: Lan-Silver Platter Class

I attended the Lan-Silver Platter class. It was given by Diana Butler on Monday, February 27 at 4 p.m. It took place in HBLL 2445.
Diana took us through the Lan-Silver Platter databases. She explained how the system worked which is quite simple. She understood that most were already familiar with the system. She taught us about “truncation” which is a term I didn’t know before the class. It helps you to cover many different related subjects by placing an asterisk behind the so-called “root word.”
Strengths:
*a quick and easy way to find information on any topic and it’s related topics.
*more variety as far as databases.
Weaknesses:
*there should be a block/semester one credit course offered for this.
*if class has to be taught, it should be more organized and entertaining/fun!

To: Michele Cardall
From: Jason Scarabin
Date: February 16, 1995
Subject: Library Mini-Class
Re: Report

I attended the Library Mini-Class for Communication’s majors. It was given by Russ Clement on Wednesday, February 8 at 4 p.m. It took place in HBLL 2445.
Russ talked about Gateway, etc. for about 20 minutes and excused us. He seemed to realize that most of the people in the class were already familiar with the system. He did take us through a little tour in Gateway. We looked up a few different topics such as children, television and violence.
Strengths:
*very helpful to someone who has never used the computers in the library.
*assists students in digging for research.

Weaknesses:
*shouldn’t be required for people who already know how to use the system.
*if class has to be taught, it should be more organized and entertaining/fun!

Jason Scarabin
Communications 360
Anchor Critique
January 18, 1995
This particular critique is of KUTV’s co-anchor, Phil Riesen. Phil was taking the place of Terry Wood on the ten o’clock news on Tuesday, January 17, 1995.
Although not a regular, Phil exemplified credibility by being dressed in a very conservative grey sports coat. His hair is trickled with grey which seems to add credibility. He has an honest looking face. He is an older gentleman.
He certainly built good audience rapport by mentioning that the station had received dozens of calls from concerned family members of Japan-serving missionaries. He assured the audience that the church had confirmed that all missionaries were safely accounted for.
Phil’s posture was upright and proper throughout the show. His eyes stayed on the camera, the desk or the anchor at all times.
His head movement was very impressive as well. When he introduced the Kobe earthquake, the camera was on a two-shot of him and Michelle. He said, as he was looking at Michelle, “That’s right, in Kobe, Japan,” then turned his head to the camera as it pushed to a single of him, “rescuers are…” Also, coming out of a break, Phil’s head was turned towards Michelle, then after a moment, he turned into the camera and said, “There were some new developments in the O.J. Simpson…” It seemed very natural throughout the show as he turned his head.
I must be quite critical of Phil with his ad lib/interaction category. First of all, he ad libbed twice during the whole show saying, “about 8 inches of flurries in my driveway,” and “I can put my shovel away.” There was very little interaction between him and his co-workers. It seemed as if there was friction there.
Now I must compliment Phil on conversational ideal. He seemed to hit the golden mean for most of the show. His language flowed very nicely. His inflections were very appropriate for each story. One great example is when he said, “a new drug to fight alcoholism is offering some renewed hope.” He emphasized all the right words in a way that interested viewers. However, I must mention that he veered from the golden mean just a touch when he was talking about Professor David Cowles. He said, which was fine, “David Cowles has now been upgraded to–pause–serious condition,” but the way he said “flesh-eating bacteria” to open the story just seemed a little too radical and over-emphasized.

Jason L. Scarabin
Local TV News Viewing; Audiences
Communications 391–Dr. Kay Egan
September 28, 1994

My first impressions of Television ratings including local are that they are quite absurd. The ratings come from where and from whom. I have never believed that an accurate account of viewers could be obtained in a reasonable and non-intruding way. Personally, I am still quite ill-informed about how this system works. Companies such as A. C. Nielsen and Arbitron have been foreign words to me for most of my life. In doing some research into this topic, I have discovered some answers yet still remain a bit confused as to how accurate these ratings are and why stations and advertisers rely so heavily on them.
In response to the first article I read, I learned that Arbitron did not have a very significant role in the ratings race. The article explains how Nielsen would not necessarily monopolize the business now that Arbitron is no longer a competitor. Arbitron mostly capitalized on the big markets where stations bought both services. Arbitron’s President Stephen B. Morris said, “It wasn’t economical anymore for them to carry both services. We obviously didn’t do a good enough job of differentiating ourselves.”
Despite all of this, Arbitron has complete domination of the local radio ratings business and plans to develop new ideas for measuring radio and broadcast and cable TV. (Advertising Age, pg. 23).
My opinion of this article is that there is fierce competition in this ratings business. Also, I have learned just how big this business is. It was mentioned that Arbitron’s local TV ratings business generated $70 million in revenues.
The second article I read dealt with local TV stations having corrections policies or not. It seems that the stations are put in a sticky situation because the more they are correcting themselves from their mistakes, the more their credibility may decrease. I must say that I agree with the fact that TV News should have corrections policies because people want accuracy in the news. However, I also realize that because of the need for urgency in “getting the story out” can be extremely crucial as well. This is certainly a dilemma facing the local TV News industry.
Without the corrections policies in place, viewers would tend to think that stations are hiding mistakes. But with the policies in place, they may get the impression that the station is no longer a very credible source and may discontinue watching that station.
In this article all news departments reported that errors are acknowledged and corrected on the air. However, sixty-percent said they do not have a formal correction policy and only twelve-percent had written policies. The stations who felt that airing corrections was beneficial cited things such as credibility, truthfulness, integrity, and even avoiding lawsuits. Some of these stations also cited disadvantages such as “weakens credibility, draws attention to mistakes, and causes confusion for viewers.”
It is also worth mentioning that there were two kinds of errors, objective and subjective. The study found that stations were more likely to correct an objective mistake such as the wrong date and time as opposed to a subjective one like misquoting someone. (Journalism Quarterly, Vol. 69, No. 1, pgs. 166-172).
My opinion certainly agrees with the conclusion of the article which says that it is professionally responsible to report errors. The bottom line is that these reported errors will build credibility because people want accurate and factual news.
In the third article I read, I learned that local TV News should be given more credit than it has been given in the past. In fact the article says that local news gets a slightly larger audience than its network counterpart.
The article reports on research done based on two themes which are: “1)that local TV News is passive, borrowing its news agenda (the ‘what’) from local newspapers–and relying on police scanners for a daily parade of disaster and crime stories, 2)local television news gatekeeping decisions (the ‘why’) are dominated by the visual imperative to show the viewer something of intrinsic interest.” (Journalism Quarterly, Vol. 66, No. 4, pg.857).
This information really surprised me. I had never thought that a local television station would get its information from the newspapers. It had always occurred to me that it was quite the opposite case; that is, newspapers get their information from the television stations. In the article, it states that rarely does a local television news originate news; “they are parasites.” (ibid, pg.858).
The article also suggests that local television news seems to be veering away from the traditional approach of “proximity, timeliness or consequence.” They seem to be worried more with showing something visually that will captivate the audience and they don’t care how they get that something. As a result, they will receive higher ratings. (ibid, pg.858).
Despite this news from the article, I discovered that a research dilemma had been reached. How can they properly analyze content and make a judgment as to whether or not a news station is reporting sensationalism or not? For example, is the election of an anti-American president in South Africa good or bad news? Good because democracy prevailed or bad because he/she is anti-American?
Research was done to resolve this dilemma. Five-Hundred forty-three stories were selected to be analyzed from thirty-four newscasts. The researcher noted the topic, the spontaneity of the topic, rejected stories and why they were rejected, etc. (ibid, pg.859).
The researcher found the contrary to popular belief about daily newspapers being a dominant source for stories. He/She found that “newspapers were the primary source of only seven of the one-hundred thirty-two news stories analyzed.” (ibid, pg.860).
The conclusion was made that local news stations are not as parasitic or sensationalistic as aforementioned. Local newscasts are very “capable of rare bursts of enterprise reporting.” Oftimes they will take apart an existing news story and take a completely different approach to that same story that another news source may have approached. Surprisingly, the study found that twenty-one percent of the topics fell into the general political category while twenty percent fell into the violent crime category. (ibid, pg.861).
The article concludes also that one must realize that within a given market there are only so many stories to be told. So, the challenge is not only to find a new story, but more importantly, to find an existing story and approach and tell it in a unique way.
I really learned from the information in this article. Before reading the article I thought local TV news was reasonably credible, but I didn’t know why. In addition, I didn’t realize that there were preconceived ideas that TV newscasts were parasitic or super-sensationalistic.
From the three articles I read, I would suggest to our client that credibility is the what his operation should seek and maintain. Ratings seem to be what every operation is trying to obtain. I strongly feel that there is a fine line between obtaining ratings and maintaining integrity. I know it is possible for both to be accomplished. However, it must be done with extreme caution and tact.
BIBLIOGRAPHY PAGE
Advertising Age, Arbitron Exits Ratings Race, Scott Donaton, Oct.1993

Journalism Quarterly, Corrections Policies in Local Television News: A Survey, Michael E. Cremedas, Vol. 69, No. 1 (Spring 1992), pgs.166-172.

Journalism Quarterly, Mr. Gates Goes Electronic: The What and Why Questions in Local TV News, Mark D. Harmon, Vol. 66, No. 4, pgs. 857-863.

Taking this survey for Fox Television News in Salt Lake City has been a very educational experience. I had never done telephone surveys before this. Interestingly enough there were some surprising as well as expected results.
From class discussion, we have discovered that Fox’s main focus is on Stowell Group III. This group is a massive group and apparently very critical in Fox’s decision-making. This group is family oriented which indicates a conservative nature. Most of the women in this group tend to be homemakers. Members of the group have at least a high school education. The average age of the group is thirty-nine years, while the income averages $35,000. The entire group makes up a whopping thirty-five percent of the total population.
Because of the importance of thi/*rticular group, I would suggest to Fox that they take these statistics and re-evaluate them. Perhaps a different approach could be taken in targeting this audience.
First of all, I would like to report the result of how marital status relates to importance of anchors/reporters. Of the five-hundred ninety-nine people who answered these questions, seventy-five percent of them were married. Of those /*ied people, a whopping seventy-seven percent said that anchors/reporters were more important, even more important, or very important.
Of the twenty-five percent singles, over seventy-five percent of the them said that anchors/reporters were more important, even more important, or very important.

Now I would like to report on the results of how marital status relates to how they rate KSTU-Fox. Four-Hundred forty-six people answered this question. Of that number, seventy-seven percent were married. Now of that married group here is how they rated KSTU: Twelve-percent said they are “way below average;” Thirteen-percent said they are “below average;” A big forty-percent said that they are “average;” An admirable twenty-six percent said that Fox was “above average;” and finally, nine-percent said that they were “way above average.”
Now let’s compare these statistics to the singles group: A tiny three-percent said that Fox was “way below average;” A significant twenty-one percent said they were “below average;” a very big thirty-six percent said they were “average.” Twenty-eight percent said that they were “above average;” and twelve-percent of the singles said that Fox was “way above average.”
It interesting to note that in comparison, forty-percent of the singles rate KSTU at least above average while a close thirty-five percent of the marrieds rate KSTU at least above average.
In relation to the targeting of Stowell Group III, I believe Fox should take a second look at these statistics that seemingly have no significance at all. One could argue that more marrieds were interviewed so it skews the data, but the bottom line is that there are lots of marrieds out there in Utah who must me considered and not discounted for their significance. I strongly recommend to Fox that marrieds certainly make up a large part of their target audience. I know that Rupert Murdock seems to have a certain philosophy that is uncompromising. However, I think Mr. Murdock should realize that the Utah Market is slightly different than any other markets. Perhaps Utah could be referred to as “drastically” different than most other markets of its size.
My girlfriend is a committed viewer of “90210,” “Melrose Place,” and “Models, Inc.” She suggests that in order for Fox to get her to watch the news, it should be sandwiched in between “90210,” and “Models, Inc.,” at 8 p.m. Now that may seem a bit awkward putting it right in the middle of primetime, but if Fox is so “hip,” what’s the problem? Their news at 8 p.m. could become the “hip” thing to watch that night and other nights.
Concerning the format of Fox News, I must commend the “localness” of the news. I really like the literal “in-depth” news approach.
To those at KSTU-Fox, I commend your excellent effort in a very tough, and extremely traditional market. I feel that time will change your image–even in Utah. I wish you much success. In the meantime, I’ll stay tuned for the improvements yet to come.

Jason L. Scarabin
Economics 110-003
Dr. Dwight M. Blood
Book Report
11 November 1992

NEW IDEAS FROM DEAD ECONOMISTS

To be perfectly honest, I did not enjoy what I did read of the book. It was very difficult to concentrate on what I was reading. The most important insight I gained from reading the book was the simple economic fact that it all boils down to people’s self-interest. Self-interest, in my opinion, runs the economy.

Secondly, I must admit I jumped around in the book and read only 65 to 70 percent of it.

Throughout recent human history, there have been many economists express different philosophies describing human behavior concerning choice. The most prominent economists are Adam Smith, Karl Marx, Maynard Keynes, and the monetarists. Although these men have opposing views on economic theory, their ideas shape the economic systems of various nations and governments today.
The first and great economist was Adam Smith. Smith looked for cause-and-effect relationships between people and the economy. He felt that man is continually trying to better himself and his surroundings by trying to improve his standard of living. One way in which man tries to improve his surroundings is through trading his possessions with someone else, or bartering. Since man is born with the instinct to seek for better things, Smith believed that the government should not interfere with mans’ quest. People will act out of self-interest and obtain what they desire.
In his book, “The Wealth of Nations”, Smith trusts an “invisible hand” which guides the decisions that people will make. It is this invisible hand that creates social harmony, and allows the free market system to run smoothly. For instance, Smith says that people will produce things which are in demand. No one will produce something that nobody will buy, or something that will be economically disadvantageous.
One way of multiplying the wealth of nations is through the division of labor. By dividing the production of a good into many separate and individual jobs to be completed by a skilled worker greatly expands output. This is accomplished through saving time in switching from one task to the next, and through greater skill obtained through experience. The wealth of nations could also be expanded through specialization of towns and countries. If trade routes were to open up, it would be possible for increased trade, and for countries to buy products at a lower cost than for them to produce it themselves. But on the down side of divided labor, Smith warns that specialization could create boredom, and a decrease in creativity. He thought that man might lose his spirit and intellect. He felt that public education could remedy this side effect of specialization.
The roles of government were defined by Smith to be: “first, providing for national defense; second, administering justice through a court system; third, maintaining public institutions and resources such as roads, canals, bridges, educational systems, and the dignity of the sovereign.” In Smith’s economic theory, the government had no position to set laws or regulations. He believed that the free market would be guided by an invisible hand, and that man should act according to his fellow man’s needs and desires. He felt that labor would spark economic growth–not government intervention.
Karl Marx, a socialist economist, believed that society was a product of constant struggle and conflict. He felt that one day, the working class capitalists would rise up and overthrow their leaders. He claimed that capitalism would crumble while socialism thrived. The workers in a capitalist society were exploited by their employers, receiving only enough salary to live on, while their wealthy employers live extravagantly off of the profit that the workers should receive. The working class will eventually revolt, and regain their humanity that they have lost through repression. They will take control of the economy and unite together forming a dictatorship. Under this dictatorship, “property rights would be abolished, heavy, graduated taxes would be imposed, a national bank would be established, and free public education would be provided.” Under this new form of economic government, imagination and entrepreneurship will die along with wealth, because wealth depends upon imagination and entrepreneurship.
While Smith and Marx display two different methods of extreme government intervention (either for or against) in economics, the next two economists prefer a more middle of the line type policy. Maynard Keynes felt that income was the determining factor to how much a consumer spends. As income increases, so does spending. Households are also the key factor of demand. Keynes believed that depression occurs when total demand for goods and services is less than total income. How much a household spends determines the quantity demanded in an economy. In order for a healthy economy to exist, “households must consume and businesses must invest enough that sales of goods equal the amount produced.” But since people save their money, business must make up for the loss of the money supply, and increase investments. If this condition is not met, then output will exceed sales, inventories will stack up, and the unemployment level will increase; thus creating a recession. The cause of the recession is clearly the fact that people save their money instead of spending it.
If people keep on saving their money, then the economy will continue to suffer. This suffering will continue to pile upon itself, creating what Keynes calls a multiplier. A multiplier exists due to the change in spending by one person creating a spiral leading to a national trend in spending. The government’s duty is to intervene and increase their spending to balance out the multiplier. Keynes feels that the best way to pull out of a recession is to create deficits.
The other group of economists who believe in a government regulated/free market system are the monetarists. The monetarists parallel Keynes’ economic theories to that of a car. The national economy represents the car. The accelerator is described by increasing government spending and lowering taxes while the decelerator is describer through decreasing government spending and raising taxes. The monetarists do believe that the national economy is controlled through an accelerator and a decelerator, but that the accelerator represents higher money supply and the decelerator represents lower money supply. The driver of the monetarists vehicle is the Federal Reserve Board, and not Congress who drives the Keynesian vehicle. Monetarists believe that the money supply is what should be manipulated in government intervention. The Federal Reserve Board can manipulate the money supply in the following ways: 1)By allowing more banks to lend a greater amount of money; 2)By putting the money into the hands of the households and into the money supply; 3)By lending funds to banks, and then raising the interest rate on these loans which discourages banks to lend the money, thus enlarging the money supply; and 4)By selling and buying government securities. Since bills held by the Federal Reserve are not considered part of the money supply, they buy the bonds, giving the seller a check, placing money into the money supply.
Monetarists also believed the velocity (the number of times that money changes hands) equals the nominal value of goods and services purchased by consumers, and that velocity is constant. They also believed that the amount of goods and services that con be produced is fixed in the short run leading to the fact that the amount by which the Fed increases the money supply is directly proportional to the percent rise in prices.
The views and theories presented by each of these economists differs by great degree. Each economist defined the roles of the consumer and the government to be different. Smith believed that the market is controlled by self-interest, and involves no government intervention. Marx believed in complete government control of the market place, leaving the consumer with little say. Keynes and the monetarists both believed in government regulation of the market place, but differed in how and why the government should spend money. Each economist had their own ideas, and governments through out the world have taken heed to their words in deciding upon their own form of economic policy. No one is quite sure who is right and who is wrong.

OBEDIENCE, SACRIFICE & SERVICE Talk given by Jason L. Scarabin at Brigham Young University, Provo, Utah 27 September 1992 (originally inspired on December 31, 1989, Syracuse, NY)

Much to the dismay of Jeff Putnam and maybe others, my message will not be one filled with deep doctrine, but rather one of simplicity, and perhaps, repetition. I gave a remarkably similar talk three semesters ago to this very ward.

"Build a better world," said God.
And I answered,
"How? The world is such a vast place,
and so complicated now,
I’m small and useless;
there’s nothing I can do."
But God, in all His wisdom said,
"Just build a better you!"

Brothers and Sisters, I am going to suggest three ways in which we can build better "you’s" and better "me’s". They are OBEDIENCE, SACRIFICE, and SERVICE. Take note that all three of these require unselfishness. We must put the wants and needs of others above our own.

OBEDIENCE

Let me share with you a dream I had while on my mission: I was a missionary who was visiting a high school somewhere in the United States. As I walked down the halls of this high school, I noticed that students were arguing, fighting, backbiting, and some were even destroying school property. A voice came to me and said, "As long as people are acting this way, you won’t touch them." As the dream progressed–or should I say digressed–students became more and more violent and more and more disobedient. The voice came again, "As long as people are acting this way, you won’t touch them." By the end of the dream, the campus had turned into a battlefield. Students were armed with guns and knives. They were killing one another. I tried to talk to them but no one would listen to me nor recognize my presence. Then the voice said a final time, "As long as people are acting this way, you won’t touch them." These students had become so cold-blooded and hard-hearted by disobedience that they would not listen to the message I carried. Likewise, our disobedience can drive away the Spirit of the Lord. When we are obedient, we leave ourselves open for the Holy Ghost to strengthen us. In my dream, I could not help but think of the Lord’s words to the Nephites, "Inasmuch as ye shall keep my commandments, ye shall prosper in the land," but "Inasmuch as ye shall not keep my commandments, ye shall be cut off from my presence." Bruce R. McConkie stated, "Obedience is the first Law of Heaven, the cornerstone upon which all righteousness and progression rest. It consists in compliance with divine law, in conformity to the mind and will of deity, in complete subjection to God and His commands." Paul H. Dunn has said, "No one has the right to do wrong, just the opportunity to do wrong." In the summer of 1991, I had the opportunity to portray the prophet Nephi in the Hill Cumorah Pageant. This was one of the most incredible spiritual growth periods for me. Each night I prayed to Heavenly Father concerning my performance. I would ask Him to help me to portray this great prophet in a manner that would be pleasing to Him and the audience–as well as Nephi himself. One night in particular, I added something to my prayer: "Heavenly Father, if it would not be too much trouble–and if he is not too busy right now–would you mind if Nephi were here with me tonight?Well, the most incredible thing happened that night. As soon as the spotlight was put on me, it was though I had stepped back and just watched Nephi play his part. I could actually feel him right there with me. It was a powerful experience! I also had a dream while at the pageant: I was working on an offshore drilling platform in the Gulf of Mexico when an intense hurricane came upon us without warning. I was thrown off of the platform into the rough waters. I tried to swim–with no success. Eventually, I felt my life at stake. I finally lost strength to stay atop the rough seas and I began to sink. My eyes were open. I could see that I was leaving this precious world behind me. Then, suddenly I felt the strong arms of someone scoop me up. I looked at His face and into His eyes. It was the Savior Jesus Christ. He said to me, "Jason, I have come to take you home." I truly know that these experiences happened as a direct result of my obedience to the commandments and the pageant rules. Let us pledge to God and to ourselves that we will be obedient to God’s laws as well as man’s righteous laws. Let us receive the Lord’s blessing he promises us in D&C 82:10, which says, "I, the Lord, am bound when ye do what I say; but when ye do not what I say, ye have no promise."

SACRIFICE

Here is a story many of you may have heard dozens of times. However, listen carefully to the words of this beautiful illustration of sacrifice: ["The Bridge" (attached)] Mormon Doctrine states, "Sacrifice is the crowning test of the gospel. Men are tried and tested in this mortal probation to see if they will put first in their lives the things of the kingdom of God. To gain eternal life, they must be willing if called upon, to sacrifice all things for the gospel." I spent two months this summer in Australia, Indonesia, Singapore, and Hong Kong. Most of the time was spent in Indonesia–a third world country with many humbling attractions. I learned much while there, but there is one particular story I would like to share with you to teach the principle of sacrifice. The man’s name I cannot recall, but these are his circumstances: He has two jobs. He is a "becuk" driver by day. A becuk is a three-wheeled motorcycle taxi. He is a security guard by night. He is home only three to four hours per twenty-four hour period all week except Sundays. On Sundays, he magnifies his church calling of branch president beyond the call of duty. He has six children and a beautiful wife. One thing that amazes me is that he does all of this for the equivalent of $20 US per month. Now, most of us would think that this man would be a very uptight yet depressed man. Wrong! I cannot say I have heard of a happier family. This man is always happy and would give anyone the shirt off of his back. To me, this is a classic example of the kind of sacrifice the Lord requires of each of us.

SERVICE

Gospel service means dedication to oneself to righteousness to the extent that a person accepts the gospel, obeys its laws, and works in the church organization. King Benjamin put it this way as recorded in Mosiah 2:17. "And Behold, I tell you these things that ye may learn wisdom; that ye may learn that when ye are in the service of your fellow beings ye are only in the service of your God." When I think of service, I think of my parents. Here is a poem I wrote to my mother: ["I Love You, Mother" (not attached)] I believe one of the greatest ways we can serve God and our fellowmen is to share the gospel. Sharing the gospel with our brothers and sisters is not merely an option, but a commandment from the Lord: "Behold, I sent you out to testify and warn the people, and it becometh every man who hath been warned to warn his neighbor." (D&C 88:81). The best way to share the gospel is to live it! It is not tough. While working at a nightclub this summer, I met a girl who saw that there was something different about me. After telling her she should not be in a place like that, I told her about my beliefs and gave her a copy of the Book of Mormon. She watched every church video at our home. Shortly thereafter, our family went overseas. Upon our return, we discovered that Tammy had been baptized four weeks earlier and had already spoken in three different wards. Well, my dear brothers and sisters, I hope that we will stand tall in this difficult world in which we live. Sometimes we may feel we are alone. Charles Sumner has said, "I honor any man who, in the conscious discharge of his duty, dares to stand alone." So when we feel aloneness–as opposed to loneliness–remember that there is power in this if we are choosing the right. However, we are not alone! We are a part of the royal army of God and have legions of angels beside us. Jesus is the Christ. He is our Savior. He is our Redeemer. He is our Friend. He loves us. Let us love Him! Joseph Smith was and is a true prophet of the Living God. The Church of Jesus Christ of Latter-day Saints is the only Church on earth with the keys and authority to lead us unto salvation. It is God’s church! Remember that people matter most! The best way to measure where we are on the pathway back to our eternal home is how we treat other people. Remember King Benjamin’s words: "…I cannot tell you all the things whereby ye may commit sin; for there are divers ways and means, even so many that I cannot number them. But this much I can tell you, that if ye do not watch yourselves, and your thoughts, and your words, and your deeds, and observe the commandments of God, and continue in the faith of what ye have heard concerning the coming of our Lord, even unto the end of your lives, ye must perish. And now, O man, remember, and perish not." (Mosiah 4:29-30). I love each of you. I hope and pray that we will all work on building ourselves to build a better world by obedience, sacrifice, and service.

"Build a better world," said God.
And I answered,
"How? The world is such a vast place,
and so complicated now,
I’m small and useless;
there’s nothing I can do."
But God, in all His wisdom said,
"Just build a better you!"

I say these things in the name of Jesus Christ. Amen.