441–450 of 613 posts
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'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'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…
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…
How is this "dangerously close to toxic"? Extra strength is 500mg. Adults should not take more than 3000mg in a day. Taking 7000 more more can lead to liver problems. https://medlineplus.gov/ency/article/002598.htm Common dosage forms and strengths: Suppository: 120 mg, 125 mg, 325 mg, 650 mg Chewable tablets: 80 mg Junior tablets: 160 mg Regular strength: 325 mg Extra strength: 500 mg Liquid: 160 mg/teaspoon (5 mill…
I just looked at a bottle of it here. Yes, 500mg. Adult dose: 2. That's 1,000mg. Every 6 hours to a maximum of 6 per day. That's 3,000mg/day. Danger at 7,000mg/day means a therapeutic ratio of less than three--nothing like that should be OTC and it's use should be carefully considered.
Phenylephrine is useless as an oral decongestant. It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist which in certain scenarios is desirable.
It is also indicated for treatment of priapism.
The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray, which has the added benefit of fewer systemic side effects compared with oral decongestants.
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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?
The codes we do have are mostly CPT4 and ICD-10 for billing purposes. Those are generally pretty accurate, but not detailed enough to reliably assess whether one surgeon is better than another at a particular procedure.
Earlier quoted context omitted.
"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.
Pseudoephedrine is a stimulant and not a particularly pleasant one at that. Here in Canada there's still cold medicines with it in them, and to be honest, when I see it, I avoid it. It may not be as good of a decongestant but phenylephrine won't keep me up at night. And when I'm sick with a cold what I really need is a good sleep.
I'm a physician- although I don't disagree with the spirit of the article the headline is exceptionally misleading. Phenylephrine is useless as an oral decongestant . It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist whic…
I'm a physician- although I don't disagree with the spirit of the article the headline is exceptionally misleading. Phenylephrine is useless as an oral decongestant . It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist whic…