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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#391

Post by rscho »

asmithmd1 wrote: post #382
rscho wrote: post #361

Earlier quoted context omitted.

They almost universally don't know their own rate. I don't know my own rates of complications. But, if I want you to go away because you seem to be the kind of guy that will come back to bite me, I'll gladly tell you I have a huge rate of complication.

For a colonoscopy I asked about the risk of a perforated bowel. Their first response was, “that is meaningless, if it happens to you the rate is 100%.” I said if the chances are 50:50, then I am not doing it. They said it has happened twice in their career and based on my lack of risk factors, it would not happen to me. For my daughters tonsillectomy, the doctor was very happy to share how her stats for post surgery…

I have 10+ years of clinical experience in academic hospitals, and have worked in Boston at Brigham and Women's. From this experience, I can tell you 2 things:

1. Being a lecturer at Harvard does not correlate with being a skillful clinician

2. Your view of the clinical system is very skewed, and will bring you more risks than benefits.

Re: The Uselessness of Phenylephrine

#392

Post by s0rce »

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.

Why can't you shop around? You aren't forced to go to a specific doctor. It certainly might be challenging but that's also the case in the USA.

Re: The Uselessness of Phenylephrine

#393

Post by asmithmd1 »

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…

> I feel like this is one of the few applications where it could shine.

Read “The Alignment Problem”, a very good just above pop sci level book about machine learning. They have one example where ML determined seniors with COPD were at reduced risk from pneumonia, and obviously non-sensical result. Patients with COPD wound up in the hospital at a lower rate than average because doctors know they need careful attention right away.

Re: The Uselessness of Phenylephrine

#394

Post by mardifoufs »

drdeca wrote: post #342
CamperBob2 wrote: post #303

Earlier quoted context omitted.

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 larg…

They already add a bittering agent to ethanol when it's sold as a disinfectant. It's not toxic, just very unpleasant

Re: The Uselessness of Phenylephrine

#395

Post by throwaway48375 »

salawat wrote: post #316
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…

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 w…

https://www.amazon.com/dp/B005E74U3W/

https://www.amazon.com/dp/B09LKLNKZ7/

Re: The Uselessness of Phenylephrine

#396

Post by joecool1029 »

astrange wrote: post #288
joecool1029 wrote: post #150

Phenylephrine does have one use that the author missed: It's used in ophthalmology to dilate the pupils before eye exams. On the topic of other use case medications, I used to take Sudafed (the real pseudoephedrine kind) during allergy season for a few weeks each year and noticed my productivity skyrocketed during that time, when I normally had issues context switching. Eventually I narrowed it down to taking Sudafed…

Bit disappointing that everyone starts commenting about amphetamines on a post about Sudafed working the same way as Strattera, which isn't a stimulant. Though him telling people Strattera has no side effects hopefully didn't surprise anyone when they went on it, it feels (literally) like being kicked in the stomach and can make you quite nauseous.

I didn't like the safety profile on Strattera nor the inability to take it 'as needed'. Rare, but there were reports of liver injuries on it. My doctor seemed to be unimpressed in it when I asked about options on and said in her experience amphetamines almost always had the best efficacy in adult ADHD patients.

Re: The Uselessness of Phenylephrine

#397

Post by ionicgiraffe »

paxys wrote: post #341
ipaddr wrote: post #318

Earlier quoted context omitted.

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 .

I would even say that any person of any country with enough financial resources could afford and get the best treatment in whatever country of the world would happen to be offered.

Re: The Uselessness of Phenylephrine

#398

Post by p_l »

mattkrause wrote: post #176
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…

> People may laugh at this Not to spoil the joke, but the paper by "O. Hai" and "I. B. Hakkenshit" is satire--I would be absolutely gobsmacked if anyone is actually doing this.

The process described is true, but the authors are anonymous - and rightly snarky

Re: The Uselessness of Phenylephrine

#399

Post by nsxwolf »

lostcolony wrote: post #128
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…

Multiple clarifications - Antihistamines do not directly dry up your runny nose/post nasal drip. Rather, they reduce the histamine response, which is helpful when something is caused by allergies. It's usually not that helpful with an actual cold (but allergic rhinitis is often mistaken for a cold). Sudafed is what the parent was referring to with Pseudophedrine; a decongestant. This works by shrinking blood vessels,…

Do any of these compounds actually do what they say? I have always found all cold medicines to be entirely worthless. Supposedly a study found guaifenesin to be no better than a placebo:

http://rc.rcjournal.com/content/59/5/788

Re: The Uselessness of Phenylephrine

#400

Post by asmithmd1 »

rscho wrote: post #391
asmithmd1 wrote: post #382

Earlier quoted context omitted.

For a colonoscopy I asked about the risk of a perforated bowel. Their first response was, “that is meaningless, if it happens to you the rate is 100%.” I said if the chances are 50:50, then I am not doing it. They said it has happened twice in their career and based on my lack of risk factors, it would not happen to me. For my daughters tonsillectomy, the doctor was very happy to share how her stats for post surgery…

I have 10+ years of clinical experience in academic hospitals, and have worked in Boston at Brigham and Women's. From this experience, I can tell you 2 things: 1. Being a lecturer at Harvard does not correlate with being a skillful clinician 2. Your view of the clinical system is very skewed, and will bring you more risks than benefits.

Completely agree with point 1. There are many researchers in the area who like to also practice, that lead me to ask the # of surgeries question.

My bias is towards surgery at a good regional hospital (Newton-Wellesley for example) with a surgeon who teaches downtown and does lots of surgeries.

What is my skew that that is bringing me more risk? I used to think all doctors were about the same. Now I realize that is about as true as all baseball players are the same. There are hall of famers as well as some who could be sent down to the minors. The trick is figuring out who is who, because other docs won’t say.

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