The Uselessness of Phenylephrine • Hacker News Board

Re: The Uselessness of Phenylephrine

#351

Post by grog454 » Wed, Mar 30, 2022, 9:49 PM UTC

sxg wrote: post #345

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…

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 meas…

Is it really too "hard" to perform rigorous statical analysis? Why can't you factor in patient genetics + background + circumstances to come up with some expected chance of success for each procedure (in fact, isn't that why doctors have such detailed patient histories?). Isn't it the doctor's job to estimate and inform the patient of the expected outcomes?

Doctor's historical success rate exceeds expected success rate on average => Good (or lucky) doctor.

Re: The Uselessness of Phenylephrine

#352

Post by rscho » Wed, Mar 30, 2022, 9:49 PM UTC

grog454 wrote: post #347

lcuff wrote: post #329

Earlier quoted context omitted.

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.

Other doctors? And where will you find those? No one will ever touch you, except if you pay more. Pay more for worse outcomes, really.

Re: The Uselessness of Phenylephrine

#353

Post by fpgaminer » Wed, Mar 30, 2022, 9:50 PM UTC

hammock wrote: post #57

munificent wrote: post #43

My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold. I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo. Only a couple years…

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…

NyQuil also contains alcohol and pseudo (in some formulations).

My pet theory is that NyQuil's biggest effect is simply to make you mildly "faded" so all your symptoms are more tolerable. DXM, the antihistamine, the pseudo, and the alcohol are all drugs that would definitely do that if taken in larger doses. While NyQuil doesn't have those larger doses, the combination of all of them may amplify the otherwise weaker effects into a general buzz/haze that helps you go about your day/night.

Re: The Uselessness of Phenylephrine

#354

Post by Broken_Hippo » Wed, Mar 30, 2022, 9:50 PM UTC

paulmd wrote: post #186

caymanjim wrote: post #162

Earlier quoted context omitted.

> OTC medicines that by current standards would not be made OTC Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it's been informally grandfathered in, makes an absolute fortune for pharmaceutical compa…

> 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…

You keep mentioning blister packs: I wish they were on all OTC drugs and many prescription drugs. On OTC drugs, I also support package size limits. These keep folks safer, lowering both accidental and intentional overdoses. I suspect that it taking longer to open and having a handy way to estimate what youve taken helps.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31616/

There is plenty of cough syrup without acetaminophen sold in the US, by the way. People like all-in-one products, though, hence there being many with it in it. I'm gonna need some evidence for the "FDA actively uses it as a poison", though. I'm not so convinced a lot of folks think about side effects of tylenol but instead, see it as rather safe.

And it really doesn't matter if a few folks will find ways around an intervention. An improvement doesn't need to be perfect to be implemented nonetheless - because, it is an improvement and as such, better than before.

Re: The Uselessness of Phenylephrine

#355

Post by jacobmartin » Wed, Mar 30, 2022, 9:52 PM UTC

60secz wrote: post #282

The herb ephedra (Ma Huang/Mormon Tea) contains appreciable amounts of ephedrine and is prepared as a tea in Chinese medicine as a remedy for asthma and cold congestion. It can easily be purchased online and the ephedrine ban does not apply to it. https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...

Any idea how pure or clean these online sources are?

Re: The Uselessness of Phenylephrine

#356

Post by asmithmd1 » Wed, Mar 30, 2022, 9:52 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…

There are some things that are helpful that they will answer that have steered me away from a surgeon: How many of these surgeries do you do per year? An answer of 50 or above is good. What is YOUR rate of ? Keep pushing until they tell you their rate, not the overall rate.

Re: The Uselessness of Phenylephrine

#357

Post by meepmorp » Wed, Mar 30, 2022, 9:52 PM UTC

60secz wrote: post #282

The herb ephedra (Ma Huang/Mormon Tea) contains appreciable amounts of ephedrine and is prepared as a tea in Chinese medicine as a remedy for asthma and cold congestion. It can easily be purchased online and the ephedrine ban does not apply to it. https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...

NB: ephedrine and pseudoephedrine are related (they're stereoisomers), but are different drugs with somewhat different pharmacokinetics.

Re: The Uselessness of Phenylephrine

#358

Post by rscho » Wed, Mar 30, 2022, 9:53 PM UTC

grog454 wrote: post #351

sxg wrote: post #345

Earlier quoted context omitted.

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 meas…

Is it really too "hard" to perform rigorous statical analysis? Why can't you factor in patient genetics + background + circumstances to come up with some expected chance of success for each procedure (in fact, isn't that why doctors have such detailed patient histories?). Isn't it the doctor's job to estimate and inform the patient of the expected outcomes? Doctor's historical success rate exceeds expected success ra…

The number of factors you'd have to consider to achieve that is huge enough that it makes it completely unrealistic, both practically and financially speaking. In fact, I'm 100% convinced that it's currently impossible to build such a system, given the extent of medical knowledge.

Re: The Uselessness of Phenylephrine

#359

Post by consumer451 » Wed, Mar 30, 2022, 9:54 PM UTC

caymanjim wrote: post #162

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…

> OTC medicines that by current standards would not be made OTC Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it's been informally grandfathered in, makes an absolute fortune for pharmaceutical compa…

Here are some interesting related HN posts regarding Acetaminophen:

https://hn.algolia.com/?dateEnd=1648670057&dateRange=custom&...

Re: The Uselessness of Phenylephrine

#360

Post by grog454 » Wed, Mar 30, 2022, 9:56 PM UTC

rscho wrote: post #358

grog454 wrote: post #351

Earlier quoted context omitted.

Is it really too "hard" to perform rigorous statical analysis? Why can't you factor in patient genetics + background + circumstances to come up with some expected chance of success for each procedure (in fact, isn't that why doctors have such detailed patient histories?). Isn't it the doctor's job to estimate and inform the patient of the expected outcomes? Doctor's historical success rate exceeds expected success ra…

The number of factors you'd have to consider to achieve that is huge enough that it makes it completely unrealistic, both practically and financially speaking. In fact, I'm 100% convinced that it's currently impossible to build such a system, given the extent of medical knowledge.

I'm skeptical. I concede it's probably a hard problem but there is an entire field dedicated to hard statistical problems called data science. What is the point of having detailed patient histories and data if it can't be used to inform decisions?