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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#371

Post by grog454 »

sxg wrote: post #364
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…

Yes, it's absolutely very difficult to do rigorous statistical analysis. Genetics is oversimplified to non-physicians. It's cool that we can diagnose and predict the likelihood of getting Huntington's disease using our knowledge of genetics, but extremely few diseases are this simple. There are huge swaths of the human genome that we don't understand but are likely playing some important role in the regulation of oth…

Are you aware of any attempts to use machine learning in medical analysis and outcome prediction? I feel like this is one of the few applications where it could shine. I have no formal training in data science, but everything I've read so far seems to indicate that noisy and unreliable data is not an insurmountable problem.

All of this talk about how "hard" the statistical analysis is, is strange to me. Maybe "advanced" would be a better term? If you get a patient with a contradictory medical history that somehow also contradicts what they are telling you, simply adjust your expected chance of success appropriately (to zero perhaps). In that extreme case, if you get a good outcome, congrats you got lucky. If you don't, it should have 0 impact on how you are evaluated as a doctor.

Re: The Uselessness of Phenylephrine

#372

Post by AussieWog93 »

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…

>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.

I found the same thing for science in general. When I did my PhD and saw how the sausage was made, I was blown away by how obviously unscientific and irrational the entire process of science was.

Re: The Uselessness of Phenylephrine

#373

Post by HL33tibCe7 »

Reminds me of docusate, a very commonly prescribed “Laxative”. The problem? There’s seemingly barely any evidence that it actually works. And plenty to suggest it has no effect over that of a placebo. Yet there’s a culture of prescribing it, so on prescribed it goes.

Re: The Uselessness of Phenylephrine

#374

Post by Madmallard »

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’m feeling this way too hard. I have a condition where any food I consistently eat I become sensitized to and begin developing severe reactions that are alike anaphylaxis in nearly every way but not quite as severe. I have been hospitalized several times now with starvation issues. Yeah immune suppressants sorta worked but you can’t exactly stop a full on immune response so it just bought a little bir of time.

(1) mast cell testing - negative (2) ige testing - mostly negative but i also avoid things i react to (3) endoscopy - mostly negative but some inflammation (4) psychological - medications didnt do anything

(5) Non-allopathic stool testing from Genova Diagnostcs? astronomically high secretory IgA levels, high zonulin levels, disturbed gut flora populations and altered stool enzyme levels. -> point this out to doctors “sorry cant help ya there. _that’s unvalidated_”

Me - well fucking figure out something to try then!!!!

Dead end. I am so sick of evidence based medicine.

Re: The Uselessness of Phenylephrine

#375

Post by lcuff »

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.

In my mind it is not a good system, because if the surgeon is looking at a much-more-difficult than average circumstance, than he could reasonably expect a lower-than-average result, but a result that might be much better than average for a case so difficult.

As a separate observation, any time data is kept, turned into metrics that then become the basis for goals ("I want to have a better-than-average success rate, as a surgeon") then the system gets gamed.

I had a boss once propose to down-rate agile teams that didn't get done everything they took on in a sprint. He apparently didn't realize that teams would immediate game the system by taking on less actual work. They could up their 'point' estimates for each task, and always get the work done.

Re: The Uselessness of Phenylephrine

#376

Post by sterlind »

telchior wrote: post #242
beebmam wrote: post #227

Earlier quoted context omitted.

Ignoring them is unethical. Treating them with an unscientific treatment is unethical.

And the ethical alternative is, for chronic conditions, someone who suffers for their entire life and is not allowed to do anything about it? Look at every wastebasket diagnosis (yes, that's a real term) out there. There is no "ethical", approved treatment. In fact, there's not even an understanding of what the condition is. Instead, doctors work down a list of bad ideas with their patients: all the various medicatio…

I think you're being a little unfair to wastebasket diagnoses. you need something for insurance codes, for drug indications, for publishing research on. having a bucket of similar syndromes is a start for drilling down further. and often you can treat things supportively, even if you can't modify the disease itself.

doctors need to be up front with patients about wastebaskets though, and rule out other diagnoses. it's wrong to chalk someone's fits up to FND until you've ruled out epilepsy and other organic causes, for example. and even things like FND are probably "real", we just don't know enough about them yet.

Re: The Uselessness of Phenylephrine

#377

Post by sterlind »

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.

I think you can shop around in Canada, if you have private insurance. the universal healthcare system is just a baseline, to keep people from dying on the street after medical bankruptcy. many jobs offer supplementary health insurance as a benefit.

the US just uses ERs as an infinitely shittier but equally costly version.

Re: The Uselessness of Phenylephrine

#378

Post by joecool1029 »

mise_en_place wrote: post #84
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…

From what I've read, d-amphetamine[0] was the decongestant of choice for much of the 20th century. It's just that the counterculture weirdos were abusing it and that led to its restriction. Compared to pseudoephedrine its way more useful with minimal side effects like drinking a cup of coffee. [0] https://www.theatlantic.com/health/archive/2012/04/the-lost-...

I mentioned in my last comment that Sudafed had effects in treating my ADHD.

Ultimately I couldn't use it this way more than a few days a week or I'd get lower back pain. I've also tried steeping ephedra tea but did not notice any effects on concentration.

Later on when I was formally diagnosed and prescribed proper meds I was placed on Adderall first and had similar unwanted side effects after a time. Ultimately, I settled on Dexedrine and no more side effects (other than insomnia if I take it too late) and haven't felt a need to up the dose for years now. It does still have decongestant effects like the other two.

Considering I'm caffeine dependent and can't cycle off daily intake without crippling headaches, where I cycle Dexedrine off on the weekends/holidays without any withdrawal effects, I'd have to agree: So long as it's a therapeutic dose it's on-par or safer than coffee.

Re: The Uselessness of Phenylephrine

#379

Post by rscho »

grog454 wrote: post #371
sxg wrote: post #364

Earlier quoted context omitted.

Yes, it's absolutely very difficult to do rigorous statistical analysis. Genetics is oversimplified to non-physicians. It's cool that we can diagnose and predict the likelihood of getting Huntington's disease using our knowledge of genetics, but extremely few diseases are this simple. There are huge swaths of the human genome that we don't understand but are likely playing some important role in the regulation of oth…

Are you aware of any attempts to use machine learning in medical analysis and outcome prediction? I feel like this is one of the few applications where it could shine. I have no formal training in data science, but everything I've read so far seems to indicate that noisy and unreliable data is not an insurmountable problem. All of this talk about how "hard" the statistical analysis is, is strange to me. Maybe "advanc…

Statistics are not the problem. The data is. 'Big healthcare data' does not exist. Building what you are thinking of would require huge data gathering capabilities, that are very clearly out of reach.

Most big medical co do a lot of data science (Kaiser and others). Very efficient from a managerial pov. Totally useless, medically speaking.

Re: The Uselessness of Phenylephrine

#380

Post by zoba »

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…

Hopefully you never get something unrecognized by current medical knowledge. You visit progressively more esteemed experts: local, regional, national, global. Then you get to the top, and (in my experience) that’s it.

I thought for sure there was a “ok now we hand this off to the labs so we can learn” step… but, no. It was just a shrug and literally “come back in 8 months if you’re still having problems.”

I became my own lab and fixed my problem. I reported my findings to the doctors, and never heard back.

Pretty disappointing.

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