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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#341

Post by paxys »

ipaddr wrote: post #318
perlgeek wrote: post #178

Earlier quoted context omitted.

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.

You can find the best medical care in the world in the US if you have the means to pay for it. I don't think people will agree though that it is the indicator for the best healthcare system.

Re: The Uselessness of Phenylephrine

#342

Post by drdeca »

CamperBob2 wrote: post #303
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…

What makes you say the FDA is actively adding poison to other drugs, are there first hand sources from them? "Not everyone thought it was a good idea to make alcohol deadly, when making it illegal hadn’t stopped drinkers, and New Jersey Senator Edward I. Edwards called it “legalized murder.” However, the Anti-Saloon League persisted, arguing that legal alcohol had killed many more in its day than denatured alcohol wo…

This makes me wonder if it would have been possible to, instead of using something that causes significant harms to health, instead something which just causes a rather unpleasant experience.

But, I guess one important thing is whether such an additive is compatible with the altered substance still being usable for the purpose for which it is being made available.

Now, presumably something as simple as “dissolve large amounts of capsaicin in it” wouldn’t work (I’m not even sure if capsaicin can be dissolved in alcohol), but, what about something along those lines? Or something that just causes headaches, or vomiting?

Re: The Uselessness of Phenylephrine

#343

Post by ashtonkem »

Zak wrote: post #17

I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.

The restrictions the state places on us largely function as a one way ratchet, alas. There is a lot about American drug policy that is wildly unpopular, and yet here we are.

A huge portion of the issue is that we’re largely ruled by people who don’t need to deal with any of the inconveniences they cause; if any senator or rep has a runny nose I’m sure they can get an aide to sort it out for them. The rest of us are not so lucky.

Re: The Uselessness of Phenylephrine

#344

Post by Spooky23 »

travisathougies wrote: post #159
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…

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. 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. In reality, there are a plethora of conditions, some…

We have miracle cures for many things, but medicine is worse than ever.

I grew up with ER doctors. There are dozens of things that would have killed you on 1990 that you’ll walk away from today.

But in the slow transition from a professional discipline to a sort of IT help desk for health delivery, billing comes first, and even that sucks.

Re: The Uselessness of Phenylephrine

#345

Post by sxg »

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…

I'm guessing you haven't heard of Goodhart's Law? (https://en.wikipedia.org/wiki/Goodhart%27s_law) Under your proposal, surgeons will be incentivized to selectively operate on easier patients and minimize their complication rates while not performing surgery on very sick patients who may also need the same surgery.

Different surgeons in different areas treat different kinds of patients. It's hard to accurately measure anything in a meaningful way that should influence decision making. To use your example, surgeon Z may also perform procedure Y but has (N-5)% of patients reporting relief and (M+5)% of patients reporting post-op complications. However, surgeon Z works at a community hospital and treats a poorer patient population with more co-morbidities. Can you really say if surgeon X is better than surgeon Z?

Re: The Uselessness of Phenylephrine

#346

Post by dd36 »

csnover wrote: post #285
travisathougies wrote: post #159

Earlier quoted context omitted.

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. 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. In reality, there are a plethora of conditions, some…

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…

Every doctor is the best.

Re: The Uselessness of Phenylephrine

#347

Post by grog454 »

lcuff wrote: post #329
csnover wrote: post #311

Earlier quoted context omitted.

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.

Seems like a good system to me. If a doctor expects a lower than average success rate for performing some specific operation, he should let some other doctor do it anyway.

Re: The Uselessness of Phenylephrine

#349

Post by Raineer »

travisathougies wrote: post #159
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…

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. 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. In reality, there are a plethora of conditions, some…

"This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution."

Citation needed.

Re: The Uselessness of Phenylephrine

#350

Post by emmelaich »

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…

I had a condition recently, now resolved. During that time I had many consultations with specialists and did quite a bit of research myself.

It's astonishing. 80pc or more of shelf products in a pharmacy will do nothing and many will make things worse.

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