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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#411

Post by telchior »

sterlind wrote: post #376
telchior wrote: post #242

Earlier quoted context omitted.

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'…

I'm criticizing the parent's comment that it's not ethical to treat people with "unscientific" treatments. This is in the context of an article criticizing phenylephrine, which differs from really, deeply unscientific stuff like, say, acupuncture or homeopathic remedies, in that it has studies going both ways but the balance (according to meta-analyses) is that it's useless as a decongestant, and is thus unscientific to have on the shelves.

How does that relate to wastebasket syndromes? At least for the one I have (a migraine variant) -- every single accepted treatment falls in the same basket. Some evidence, but not enough that it's really a good idea to use it. Unless, that is, the syndrome is ruining your life.

And behind this argument that yet more things should be taken off the shelves and regulated, I'll note that the US has one of the most restrictive, patient-unfriendly regulatory atmospheres in the world. It's goddamned ridiculous, pardon my French, that the "solution" to phenylephrine not being a good decongestant would be to regulate it so that it can't be sold without a prescription. Doubly so, in a country with a healthcare industry that's so thoroughly corrupt and dysfunctional that a vast swathe of patients can't afford to even go to a doctor to get whatever tenuous recommendation they may have. (Phenylephrine, by the way, has a number of uses other than decongestion.)

... that was a rant. But this system is truly screwed up, that fact has affected my life quite negatively, and it's annoying that the knee-jerk reaction so many people have is to keep playing along with this completely broken ethical system.

Re: The Uselessness of Phenylephrine

#412

Post by sparker72678 »

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…

The ethanol with methanol additive ("Denatured Alcohol") is a tax issue as well. Government wants to tax consumed ethanol.

Re: The Uselessness of Phenylephrine

#413

Post by bredren »

jrnichols wrote: post #25
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.

Difficult. Dianne Feinstein was the figure behind the changes, as part of her war on drugs. She wanted pseudoephedrine made prescription only too. https://www.drugcaucus.senate.gov/press-releases/feinstein-g... ironically, OR and MS, the states listed in that report, are so far the only 2 that are starting to roll back the restrictions. Our elected officials seem adverse to admitting something doesn't work well and r…

Wow, I did not know Oregon had repealed that already. Apparently, this past June: https://www.chpa.org/news/2021/06/oregon-repeal-unnecessary-...

IIRC, early attempts to repeal failed stalled. (I presumed due to some pharm lobby)

I wonder if Covid and focus on flu like symptoms led to it getting “fast tracked.”

Looks like pseudoephedrine OTC products became available for sale January 1st 2022. https://www.statesmanjournal.com/story/news/politics/2022/01...

I made the drive from Portland to Vancouver, WA multiple times over the years (usually while sick) to resupply with something that worked.

Glad that is done with.

Re: The Uselessness of Phenylephrine

#414

Post by ipaddr »

s0rce wrote: post #392
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.

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.

You have a family doctor who you are signed up with. You can't signup with another without losing your family doctor. You can't just go see any doctor. They have to decide to take you. Then if you are lucky you get a referral for a year later. You do have places you can walk in but there ability to refer is much lower.

In the USA you literally shop around. They advertise. You can literally look for the best surgeon and ask around.

Re: The Uselessness of Phenylephrine

#415

Post by ipaddr »

sterlind wrote: post #377
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.

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.

You can't book an appointment directly with a specialist.

You can't even shop around for a family doctor. You have to sell them accepting you as a patient. With that power inbalance you better follow what they suggest and avoid questioning too much or you won't have a doctor.

Re: The Uselessness of Phenylephrine

#416

Post by ipaddr »

ionicgiraffe wrote: post #397
paxys wrote: post #341

Earlier quoted context omitted.

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.

That involves flying to the US in many cases

Re: The Uselessness of Phenylephrine

#417

Post by [deleted] »

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,…

[deleted]

Re: The Uselessness of Phenylephrine

#418

Post by fluoridation »

slowmovintarget wrote: post #312
tssva wrote: post #272

Earlier quoted context omitted.

I find acetaminophen almost completely useless for pain. Ibuprofen is better but still not very effective. Naproxen sodium is the only OTC pain medicine which is effective for me.

After going nearly a year without taking painkillers of any kind (not an aspirin, ibuprofen, or acetaminophen dose), I took some Tylenol for a bad headache, and it worked far better than it had ever worked for me before. Granted, I've had to learn to put up with a lot more constant low-level pain in my day-to-day life. But I think that's a reasonable trade off for choosing between cooking my kidneys (aspirin, ibuprof…

>After going nearly a year without taking painkillers

I find this pretty shocking. Is this how people normally take painkillers, would you say? Speaking for myself, I normally go for years without taking anything.

Re: The Uselessness of Phenylephrine

#419

Post by stuckonempty »

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…

> patient histories are often garbage

This is a little like programmers calling the programming language they invented and write in every day garbage. Separate from patient-reported histories, you medical doctors are the ones documenting these histories and hold the decision making power for how it’s done!

Re: The Uselessness of Phenylephrine

#420

Post by BurningFrog »

rscho wrote: post #365
grog454 wrote: post #360

Earlier quoted context omitted.

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?

If data science was that efficient on healthcare records, we'd know it by now and everyone would do it. There is no 'big healthcare data'. We gather mostly noise, and records are full of blatant mistakes. Medicine is still more art than science today, and records mostly give you a 'feeling' for the patient's condition in light of your MD education, with a little hard data sprinkled on top.

My impression is that data science on healthcare records is mostly illegal due to HIPAA and other regulations.
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