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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#451

Post by jacob019 »

dbbolton wrote: post #445

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…

He did mention it's usefulness for raising blood pressure and it's use in anesthesia.

Re: The Uselessness of Phenylephrine

#452

Post by KingMachiavelli »

techsupporter wrote: post #44
p_l wrote: post #13

The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.

> 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…

A divers license or state issue ID (much easier to get if you get it before you surrender/expire you DL) is just a defacto standard in the US.

The people who check IDs for medications and alcohol are trained to check DL cards, not passports. It's not surprising that using an ID different from 99.9% of other people causes issues. Although my friend who was a student from Germany never had any issues...

Re: The Uselessness of Phenylephrine

#453

Post by LorenPechtel »

Madmallard wrote: post #374
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) m…

At least I don't go down the anaphylaxis route. Unless the picture changes I won't have starvation issues, malnutrition is definitely an issue. I'm sure it's going to end up having to go with immune suppression (and I have every reason to suspect that's only going to be a temporary solution) but so far I've been able to avoid that.

Never tried the psych stuff. One doctor suggested it but it felt very much like they were pretending it had off-label relevance--but he ignored my saying capsules, not tablets. Sorry, you're not thinking about it and I'm not taking psych stuff without the doctors considering it carefully. And tablets that can't be cold-turkeied are a hard no for me. (I'm going to go sensitive to the tablet binder at some point. If I go sensitive to a capsule I can at least break it open.)

Nobody's suggested the stool testing, is that something new? I'm pretty sure gut flora play a role but I don't have details. (E-mail in my profile.)

Re: The Uselessness of Phenylephrine

#454

Post by chefandy »

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…

Yeah: https://www.nature.com/articles/d41586-019-03228-6

I’m reluctantly pessimistic about humanity’s near-term capability to appropriately weight input from technology as imperfect but inscrutable as current ml.

Re: The Uselessness of Phenylephrine

#455

Post by tingletech »

dbbolton wrote: post #445

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…

> The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray

humm, so, crush and and snort it?

Re: The Uselessness of Phenylephrine

#456

Post by nkozyra »

Cannabat wrote: post #339
genewitch wrote: post #177

Earlier quoted context omitted.

afaik coca cola is the only entity in the US allowed to import actual coca leaves, so, technically?

I’m not sure if it is still legal, but importing “coca tea” - that is, tea bags filled with shredded coca leaves - was legal at some point and a few enterprising folks imported a few kilos of it and processed it into the drug.

It's still legal to buy decocanized coca leaves but I think the odds of getting anything worthwhile out of it would be slim and probably more expensive than a plane ticket to Peru.

Re: The Uselessness of Phenylephrine

#457

Post by LorenPechtel »

techsupporter wrote: post #44
p_l wrote: post #13

The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.

> 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…

Yeah, many years ago my wife had a fair problem at a bank because the teller didn't like being presented with a passport. "Just bring your driver's license!" Hey, you've already seen and rejected her non-driver's ID (at the time the non-driver IDs didn't have expiration dates and the bank wouldn't take any ID without an expiration date) and here you can't have both a driver's license and a non-driver's ID. It took getting a manager involved.

Now, had this happened a few years earlier before she was naturalized.... While her passport did have the standard English labels it was mostly written in bird tracks.

Re: The Uselessness of Phenylephrine

#458

Post by LorenPechtel »

hammock wrote: post #81
ericbarrett wrote: post #55

Earlier quoted context omitted.

Why not get a non-motorist ID card? Every US state has these; here's Washington's: https://www.dol.wa.gov/driverslicense/gettingidcard.html

Many Americans have difficulty obtaining ID, because they cannot afford or cannot obtain the underlying documents that are a prerequisite to obtaining government-issued photo ID card. Underlying documents required to obtain ID cost money, a significant expense for lower-income Americans. The combined cost of document fees, travel expenses and waiting time are estimated to range from $75 to $175. The travel required i…

It can be quite a headache.

I ran into a guy online that couldn't obtain an ID, period. The only form of ID he had was a driver's license. His doctor pulled it (legitimately, but needlessly--there was no question he was incapable of driving) leaving him with nothing. Where he lives that left one option--get a birth certificate. The application must be signed--something he's no longer capable of doing. The only other route would be to show up in person at the right office--multiple states away, a trip that would be medically ill-advised.

Note that he's educated and not poor, this is purely a problem of the system not handling the oddball cases. That state needs to be clobbered with a clue-by-4, if you pull a driver's license you should issue the person a non-driver's ID!

We have also run into a problem. When my wife was naturalized a hyphen got inserted in her name on her naturalization certificate, it wasn't noticed at the time. Almost everything is in her name as intended but social security saw the hyphen and would not relent. Even after we legally changed her name to rid it of the hyphen they were digging in their heels on changing the records. At this point we *think* the Real ID stuff is going to work, but the virus interfered. For the occasional place that won't accept her expired ID we use her passport card. (She doesn't drive, there's no issue of driving on an expired license.)

Re: The Uselessness of Phenylephrine

#459

Post by Fomite »

commandar wrote: post #323
rscho wrote: post #300

Earlier quoted context omitted.

> When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in…

To some degree, there's an even more toxic element of this already in play with the amount of weight the wider US medical system puts behind patient satisfaction surveys. Many times, things that a patient wants and would make a patient happy are medically contraindicated and lead to worse outcomes, yet there's immense pressure on clinicians to maintain patient satisfaction metrics. I'm not disagreeing with you at all…

This is even true when we're not talking about patient satisfaction. There's definitely conflicts for things like infection control, where what we should probably should be measuring (process measures) conflict with what patient advocacy groups care about and are pushing for (deaths).

Re: The Uselessness of Phenylephrine

#460

Post by Fomite »

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…

This is also known as confounding by indication, and is something the pharmacoepidemiology field contents with a lot.

And it shows up all the time in things like the Consumer Reports hospital rankings and the like, where hospitals with particularly uncomplicated patient populations come off looking like they're the best hospitals.

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