The Uselessness of Phenylephrine • Hacker News Board

Re: The Uselessness of Phenylephrine

#321

Post by aaaronic » Wed, Mar 30, 2022, 9:31 PM UTC

samtho wrote: post #298

edmundsauto wrote: post #236

Earlier quoted context omitted.

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…

Why can you go to the store and buy rubbing alcohol to drink? It’s primary ingredient is just ethanol. The FDA literally mandates that the ethanol is not able to be safely consumed and is cut with poison that is not easily separated from ethanol. Similarly, cutting opioids with Tylenol is not actually intended to be a deterrent to someone who gets their hands on the pills rather it deters people involved with illicit…

Rubbing alcohol where I am is isopropyl alcohol (which is highly toxic -- your body metabolizes it into acetone), not ethanol. A kid in my high school class ended up getting his stomach pumped when drinking it to try to get drunk.

Re: The Uselessness of Phenylephrine

#322

Post by [deleted] » Wed, Mar 30, 2022, 9:31 PM UTC

refurb wrote: post #293

klodolph wrote: post #219

Earlier quoted context omitted.

Not accidental, but very tragic. It's the #1 cause for calls to poison control, and accounts for 26,000 hospitalizations every year, and 500 deaths. Dying from an acetaminophen overdose is not a good way to go out, you spend a couple days in the hospital suffering as your organs fail and your loved ones watch. Other OTC drugs are much safer. I don't allow acetaminophen in the house. Pseoudoephedrine? Yes. Acetaminoph…

500 deaths (many intentional attempts at suicide) in a country of 350M where arguably every household has acetaminophen present is incredibly low .

[deleted]

Re: The Uselessness of Phenylephrine

#323

Post by commandar » Wed, Mar 30, 2022, 9:32 PM UTC

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…

To some degree, there's an even more toxic element of this already in play with the amount of weight the wider US medical system puts behind patient satisfaction surveys.

Many times, things that a patient wants and would make a patient happy are medically contraindicated and lead to worse outcomes, yet there's immense pressure on clinicians to maintain patient satisfaction metrics.

I'm not disagreeing with you at all; more suggesting that we're currently relying on metrics that are even more perilous than actual clinical outcomes.

Re: The Uselessness of Phenylephrine

#324

Post by sbierwagen » Wed, Mar 30, 2022, 9:32 PM UTC

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.

When I lived in downtown Seattle in 2010 I had no problems using a passport to buy alcohol. (Unfortunately, routinely carrying around my passport resulted in me losing it, and replacing a lost passport is a giant pain in the ass)

Re: The Uselessness of Phenylephrine

#325

Post by lostcolony » Wed, Mar 30, 2022, 9:32 PM UTC

tshaddox wrote: post #201

hammock wrote: post #57

Earlier quoted context omitted.

NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip). NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune syst…

DXM doesn’t actually suppress cough either, right?

Sort of! There isn't consistent evidence that -any- antitussive is more effective than placebo. A majority of studies show a statistically significant result for DXM, but not all, and they aren't fully replicable which definitely calls it into question. But that's true of every purported cough suppressant, and there's understandable reasons for that; coughing is a voluntary response to irritation, so there's definitely a lot going to determine whether you cough or not on beyond a purely autonomous system response. Plus there's not really much clarity in how to measure improvement (reduction in frequency may not actually be a reduction in irritation; reduction in severity is hard to measure. Etc).

So, really, for a given incident, try it, see if it helps. If it does, great, if it doesn't, stop taking it.

Re: The Uselessness of Phenylephrine

#326

Post by netizen-936824 » Wed, Mar 30, 2022, 9:33 PM UTC

rootusrootus wrote: post #306

edmundsauto wrote: post #236

Earlier quoted context omitted.

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…

I also wonder where the idea that the FDA 'denatures' hydrocodone with acetaminophen comes from. AFAICT, if you overdose on vicodin it's more likely the hydrocodone will kill you before the acetaminophen.

This is entirely false.

You can overdose from ~4 grams of APAP which you can ingest by taking 6 7.5/750 hydrocodone/APAP tablets

That's not nearly enough hydrocodone to kill you

Re: The Uselessness of Phenylephrine

#327

Post by wins32767 » Wed, Mar 30, 2022, 9:33 PM UTC

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…

Risk adjusted scoring is entirely viable in this age of data science, there is just no appetite for it. Doctors fight very hard against it because who actually wants to be held accountable for outcomes?

Insurance companies really aren't the villains in the US healthcare system, they're going to make money no matter what because they pass cost increases on to their subscribers and are capped in how much profit they can make via regulation.

Re: The Uselessness of Phenylephrine

#328

Post by freedomben » Wed, Mar 30, 2022, 9:33 PM UTC

samtho wrote: post #301

skyechurch wrote: post #268

Earlier quoted context omitted.

This also is silly, illegal drug users constantly take their dosages mixed with much worse things than Tylenol with no noticeable dissuasion effect that I am aware of. Acetaminophen is mixed with oxycodone etc bc it increases the pain relieving effect of the opiate drug (which for many people (e.g. me), are of limited effectiveness relative to the side effects/"buzz"), and because, unlike NSAIDs, it doesn't thin your…

I don’t think anyone reasonable is actively arguing to delist Tylenol as OTC, rather we shouldn’t be so restrictive on these medications that can actually really help people. In addition we should be giving people resources for discontinuing use when they no longer need it. Also, we need to really research the NSAIDS after surgery thing, afaik, there has been nothing super rigorous on it and is only going off of the…

Yes absolutely. I don't want to see Tylenol go away. I want more options, not less. I think as long as companies are being honest about the product they are selling, even if it's ineffective I think it should be available.

Re: The Uselessness of Phenylephrine

#329

Post by lcuff » Wed, Mar 30, 2022, 9:33 PM UTC

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…

In my mind it gets worse when the procedure is identified: A difficult shoulder surgery by an orthopedic surgeon gets refused because it might be result in a mediocre outcome and lower his 'success' rate. The patient can't get the surgery because no surgeon wants to 'risk' his success rate numbers.

Re: The Uselessness of Phenylephrine

#330

Post by chimeracoder » Wed, Mar 30, 2022, 9:34 PM UTC

eurasiantiger wrote: post #310

greedo wrote: post #295

Earlier quoted context omitted.

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

That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions.

> That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions.

I get that this explanation fits with a common preconception of the US, but it doesn't bear out in reality. The US has a higher survival rate for all common types of cancer than all other developed countries, and this has been consistently the case for the last three decades.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...