Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The Uselessness of Phenylephrine

science.org

Post reply on HN
Print view View original

421–430 of 613 posts

Re: The Uselessness of Phenylephrine

#421

Post by randallsquared »

vkou wrote: post #110
reincarnate0x14 wrote: post #48

Earlier quoted context omitted.

It really is amazing how someone manages to be on the wrong side of seemingly everything, and yet is locked into office past the point of senility.

This means that either your calibration mechanism for 'wrong side' is flawed, or the system is rigged in a way that it consistently produces bad outcomes. Speaking for myself, am shocked and outraged that red senators and other congresscritters are consistently on the wrong side of seemingly everything, yet they keep getting elected. Of course, my political calibration mechanisms are quite in tune.

> the system is rigged in a way that it consistently produces bad outcomes.

The system doesn't have to be rigged to produce bad outcomes. Most outcomes are bad, so only a system which is nearly perfect has any hope of producing good outcomes.

Re: The Uselessness of Phenylephrine

#422

Post by [deleted] »

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…

[deleted]

Re: The Uselessness of Phenylephrine

#423

Post by gerdesj »

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…

"lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain)"

That one is obvious: question too broad ... does not compute ... out of cheese error.

Back pain is a massive, massive thing - it sometimes doesn't actually involve the back. Here's an anecdote:

I (50ish y/o male) used to have episodes of quite crippling to very crippling "back pain". To cut a long story short, I found at least two causes (can't remember the medical term - indicator?) and sorted them. One was putting my wallet in my back pocket - sounds innocuous but it puts pressure on the buttock involved and skews your posture slightly. The other was seemingly ridiculous: When turning over in bed, I used to flick myself over by performing a sort of torsion twist about my spine. That's fine when you are 10 but not 30, 40, 50 etc.

Nowadays I simply avoid silly lifting postures and all is generally good. It took about four or five years to recover from past habits.

Re: The Uselessness of Phenylephrine

#424

Post by LorenPechtel »

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…

Yup. As a patient I've found a bunch of bogus allergies in my records once that I was able to get fixed, but I know there's other stuff I've tried but the doc wasn't interested in listening. He felt he had "proved" I was mistaken/faking when he didn't listen in the first place. How am I supposed to identify the evil item in a challenge when it isn't even present? (I had said "ham". The challenge was with pork. I didn't say pork--whatever the actual evil item it was something that got added in the process of turning pork into ham.) How do you get a mistake like that out of your records?

Re: The Uselessness of Phenylephrine

#425

Post by omgwtfbyobbq »

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'…

It really depends on how wastebasket diagnoses are used. I've seen doctors lean on them without telling the patient, and the patient turned out to have some other valid diagnosis. It's an awful situation and significantly erodes relationships.

Even someone's fits might not be an FND after ruling everything else out. There are atypical presentations of organic diseases we don't have tests for. It's fine to use wastebasket codes as long as the patient understands, but I've also seen doctors lean on certain things really early in notes (eg FNDs) without much consideration, and it's a little much to me.

Re: The Uselessness of Phenylephrine

#426

Post by ambicapter »

gerdesj wrote: post #423
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…

"lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain)" That one is obvious: question too broad ... does not compute ... out of cheese error. Back pain is a massive, massive thing - it sometimes doesn't actually involve the back. Here's an anecdote: I (50ish y/o male) used to have episodes of quite crippling to very crippling "back pain". To cut a long story…

I wouldn't call the latter a "fix". More like avoiding the problem. Let's pretend for as second the actual problem was some sort of muscular tightness you've developed, wouldn't the preferable fix be to identify the tightness, do some exercises regularly that alleviate it, and conserve the original function of your body? Otherwise seems like you're just slowly abandoning capabilities that your body used to have.

Re: The Uselessness of Phenylephrine

#427

Post by lostcolony »

nsxwolf wrote: post #399
lostcolony wrote: post #128

Earlier quoted context omitted.

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

So the treatment of symptoms, in general, leads to some really inconsistent results, as it's really hard to measure them. Some studies have definitely found guaifenesin to not be helpful (others have), but the way all of them measure it is...questionable. Ultimately, what a user wants is a subjective experience of "I feel better", but what is being tested for is stuff like "what concentration of inhailed capsaicin leads to them coughing".

So generally my take is "hey, this is what it's been found effective for, and it's generally regarded as safe to take. Is it going to help here, for you, in this situation? Who knows! Give it a whirl if you got the money and want to try".

Re: The Uselessness of Phenylephrine

#428

Post by astrange »

erosenbe0 wrote: post #401
astrange wrote: post #249

Earlier quoted context omitted.

Dexedrine is a normal ADHD medicine so this has been studied and it seems fine. eg https://journals.sagepub.com/doi/10.1177/1087054719896857

This is really good news but hardly a comprehensive meta analysis over thousands of infants.

Well, it's not the only study, it's just an example. I think it was already generally considered safe but doctors were worried it might be passed on through breastfeeding.

Re: The Uselessness of Phenylephrine

#430

Post by astrange »

joecool1029 wrote: post #396
astrange wrote: post #288

Earlier quoted context omitted.

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.

It works well for me. Just Vyvanse wasn't 24/7 (unless you enjoy never sleeping) and the comedown is really bad for me. I did have to suggest it myself because my doctor preferred guanfacine for a secondary medicine, but it has a lot of side effects itself - and whenever anyone else asked my medicines they thought I said "guaifenesin".
Post reply on HN