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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#311

Post by csnover »

rscho wrote: post #300
csnover wrote: post #285

Earlier quoted context omitted.

The messaging in the US most commonly used to justify the lack of universal coverage and unreasonable cost of care is that we pay the most because we get the best treatments and best doctors and best outcomes, so I don’t think it’s fair to blame laymen for believing that. Also, it’s not just patients that think this way. (Or, at least, if the clinicians know, they aren’t saying much to their patients.) I’ve had docs…

> When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in…

I could see that problem occurring if the metric was “what is the success rate of everything that Surgeon X does”. I can’t see that problem occurring for “Surgeon X performing Procedure Y has N% of patients reporting relief and M% of patients reporting complications after the surgery”. What am I missing here?

Edit: Follow-up question: notwithstanding the dysfunction of congress and the ability of companies to find loopholes, and assuming no universal health care to eliminate the role of insurers, surely a solution would be to prohibit the use of this information in the same way that ACA prohibits the use of pre-existing conditions to deny coverage?

Re: The Uselessness of Phenylephrine

#312

Post by slowmovintarget »

tssva wrote: post #272
skyechurch wrote: post #224

Earlier quoted context omitted.

This is very silly, acetaminophen is very effective against pain, and for many people (e.g. me) is tolerated much better, especially at higher doses, than ibuprofen etc. There is already way to much panic about drugs/medicines, especially pain meds, especially especially for chronic conditions, without further hysterics about the 'threat' of useful and well tolerated chemicals. (Not a doctor, not offering medical adv…

I find acetaminophen almost completely useless for pain. Ibuprofen is better but still not very effective. Naproxen sodium is the only OTC pain medicine which is effective for me.

After going nearly a year without taking painkillers of any kind (not an aspirin, ibuprofen, or acetaminophen dose), I took some Tylenol for a bad headache, and it worked far better than it had ever worked for me before.

Granted, I've had to learn to put up with a lot more constant low-level pain in my day-to-day life. But I think that's a reasonable trade off for choosing between cooking my kidneys (aspirin, ibuprofen) or blowing out my liver (acetaminophen).

I had a really weird 1-in-ten-million side-effect with Naproxen sodium. It caused hard insomnia (confirmed under a doctor's care, this was before it was OTC).

Re: The Uselessness of Phenylephrine

#313

Post by robotresearcher »

greedo wrote: post #295
ajross wrote: post #280

Earlier quoted context omitted.

> In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. Modern medical results would absolutely be viewed as a miracle to someone just a few decades back. Something like 90% of cancer cases are either cured or successfully suppressed (to the extent that the suf…

90% of cancer cases are cured or suppressed? I have to call BS. Cancer is the number two cause of death in the US.

UK data from 2010-2011:

"Half (50%) of people diagnosed with cancer in England and Wales survive their disease for ten years or more" [0]

Since lots of cancers and lots of deaths are in old people, 10 year survival is quite a high bar.

[0] https://www.cancerresearchuk.org/health-professional/cancer-...

Re: The Uselessness of Phenylephrine

#315

Post by Rebelgecko »

djrogers wrote: post #166
hammock wrote: post #81

Earlier quoted context omitted.

Many Americans have difficulty obtaining ID, because they cannot afford or cannot obtain the underlying documents that are a prerequisite to obtaining government-issued photo ID card. Underlying documents required to obtain ID cost money, a significant expense for lower-income Americans. The combined cost of document fees, travel expenses and waiting time are estimated to range from $75 to $175. The travel required i…

> Underlying documents required to obtain ID cost money Err, no they don't. At least not with any of the IDs I've gotten in California for the past several years....

The county in California where I was born charges $32 for a birth certificate. Most (all?) of the proof of address documents also require you to spend money. If you already have multiple utility bills in your name it's NBD, but if you live with someone it could be a pain in the ass.

Then a DL itself is another $40. A non-driving ID is like $30, although there's discounts depending on age and income.

Re: The Uselessness of Phenylephrine

#316

Post by salawat »

edmundsauto wrote: post #236
paulmd wrote: post #186

Earlier quoted context omitted.

> doesn't get you high. this is the big one. Phenyl-epinephrine doesn't work at all, it's consistently failed to outperform placebo, and the only reason it's on the market is because the FDA doesn't like pseudo-ephedrine (sudafed) because it can be used as a precursor for meth. Same reason they've required individual blister packs for sudafed (if only there was some illicit drug which gave you the focus and drive to…

What makes you say the FDA is actively adding poison to other drugs, are there first hand sources from them? This sounds like it could also be a case where they want to lower opiate consumption, and so adding some Tylenol increases pain relief without increasing opiate intake. I am not sure that’s wise policy, but if you don’t think Tylenol is all that bad (again, I’m not sufficiently informed to say this, but the FD…

Look up DXM.

You will never find it without either Gualfenisin or acetaminophen.

Does DXM need either of those to do what it does?

No.

Would it simplify dosing to be sold alone so that laymen didn't have to worry about potentially overdosing on three drugs at once instead of just one?

Yes.

However, from the war on drugs perspective, that makes it "easier to abuse" to achieve it's hallucinogenic side effect. Bundled with acetaminophen or gualfenisin however, you'd have to be a chemist intimately familiar with how to seperate the other two components to distill DXM in any amount with abuse potential, and the naive non-chemist trying to get high will either end up puking their guts out (Gualfenisin OD) or burning out their liver (Tylenol OD, which is exacerbated by alcohol consumption as well).

The Tylenol one is particularly problematic, because acetaminophen is also commonly prescribed with other common multi-drug formulations that people may not realize are additive.

When you take the route of adding a substance that does harm to discourage a pattern of behavior, you are poisoning. Poisoning being the act of artificially and with intent increasing the toxicity of an imbibed substance to disincent some pattern of behavior.

This is actually based on a natural pattern of behavior by the way. There is a mushroom that is generally completely harmless... Until you drink alcohol. Metabolizing the mushroom depletes the supply of the same enzymes that detoxify alcohol (and Tylenol).

https://en.m.wikipedia.org/wiki/Coprinopsis_atramentaria

So to be clear... If you call this mushroom poisonous, and it targets the same enzyme that alcohol does, then adding something like tylenol to something that doesn't need it to do it's job, you are poisoning.

It just happens to be handwaved because in the establishment's mind, those damn druggies aren't worth caring about anyway.

Not a partaker of DXM, but very concerned with the ethical implications, and the adverse contribution to trust in public health measures that this practice entails.

Re: The Uselessness of Phenylephrine

#317

Post by ashtonkem »

Rediscover wrote: post #165
techsupporter wrote: post #44

Earlier quoted context omitted.

> With explanation in abstract that its easier to buy meth than pseudoephedrine. People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong. Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID. This has resulted in several situations where we've been t…

Gotta chime in on this. Seattle (in general a great place) has some pretty horrible things re: purchasing alcohol. Idiot/mis-placed store/bar-workers who only want a state ID. My U.S. passport=NO. My U.N. passport=NO. Freakin' weird. Edit: I worked at Boeing for eight years, very often in a sec/reserved area. My passport was good there. Buying booze down the street from [Boeing] plant 2, no.

Not entirely unique to Seattle, in my experience.

Seared into my head is my experience of trying to buy alcohol in Boston back in 2009, when I was in town for a wedding. I had just turned 21 so buying alcohol was still novel and exciting. I had multiple bars and liquor stores refuse my valid Illinois license, forcing me to hand alcohol to my father to purchase, and find shady bars that wouldn’t card me. It was extremely frustrating to have to rely on such tactics despite being legally allowed to purchase alcohol.

Re: The Uselessness of Phenylephrine

#318

Post by ipaddr »

perlgeek wrote: post #178
dataangel wrote: post #146

I've recently had to deal with the medical profession a lot more than in the past and I'm finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, surgeries that are extremely common but have never had quality randomized trials, official sounding diagnoses that on inspection are actually defined as "we have no idea", lack of consensus about how to treat some of the most co…

My impression of the medical system (both here in Germany, and through reports from the US) is that it's very much like everything else: much is crap, much is mediocre, some good, and a very small, excellent sliver. This goes for doctors, drugs, surgeries, devices. If you want good results, you really have to take matters into your own hands, search for possible treatments yourself, evaluate several doctors until you…

This is the reason why the US system is better than Canada. In Canada you can't shop around and need referrals for specialists.

Re: The Uselessness of Phenylephrine

#319

Post by aerostable_slug »

csnover wrote: post #311
rscho wrote: post #300

Earlier quoted context omitted.

> When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in…

I could see that problem occurring if the metric was “what is the success rate of everything that Surgeon X does”. I can’t see that problem occurring for “Surgeon X performing Procedure Y has N% of patients reporting relief and M% of patients reporting complications after the surgery”. What am I missing here? Edit: Follow-up question: notwithstanding the dysfunction of congress and the ability of companies to find lo…

Surgeons would steer away from difficult, lower-percentage-outcome procedures which is precisely what you don't want.

You want risk-takers who repeatedly tackle the surgeries and (ideally) get a more positive outcome percentage than a newbie.

Re: The Uselessness of Phenylephrine

#320

Post by rscho »

csnover wrote: post #311
rscho wrote: post #300

Earlier quoted context omitted.

> When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in…

I could see that problem occurring if the metric was “what is the success rate of everything that Surgeon X does”. I can’t see that problem occurring for “Surgeon X performing Procedure Y has N% of patients reporting relief and M% of patients reporting complications after the surgery”. What am I missing here? Edit: Follow-up question: notwithstanding the dysfunction of congress and the ability of companies to find lo…

Surgeons will concentrate on easy procedures and will basically all have an almost identical track record of quasi perfection. So there will be nobody left to perform procedure Y, where Y has an intrinsically high rate of failure. Same thing for difficult patients. No one will touch Mr X who's got a complex problem.
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