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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#461

Post by Fomite »

grog454 wrote: post #351
sxg wrote: post #345

Earlier quoted context omitted.

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…

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…

As someone who works on the methodological basis for a number of "Observed/Expected" healthcare metrics in the infection control and antibiotic stewardship space - just, this is pretty hard, even if you are trying to do a rigorous statistical analysis.

Re: The Uselessness of Phenylephrine

#462

Post by Fomite »

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 am.

In that I have several CDC funded projects using machine learning in medical analysis and outcome prediction.

Even on extremely well curated data sets this is a fairly hard problem.

Re: The Uselessness of Phenylephrine

#463

Post by driggs »

There's only one reason phenylephrine is used as a substitute in the OTC decongestant products: the general public can't pronounce or spell the word "pseudoephedrine" and they're intentionally being duped.

They walk into the grocery store, convenience store, or pharmacy after a sleepless night of breathing through their mouth, see the red package that says SUDAFED and a vaguely familiar-looking active ingredient, grab it, and plop their money on the counter.

PsEudoEPHedRINE

PhEnylEPHRINE

This is OTC medical fraud.

Re: The Uselessness of Phenylephrine

#464

Post by LorenPechtel »

scythe wrote: post #212
djrogers wrote: post #166

Earlier quoted context omitted.

> Underlying documents required to obtain ID cost money Err, no they don't. At least not with any of the IDs I've gotten in California for the past several years....

Yes, but you live in the People's Republic of California.

I'm next door in Nevada.

Scraping together the required documentation for proving her address was problematic. I set up the utilities, I'm the one that deals with them, they're just in my name. She doesn't like dealing with that sort of stuff and at the time most of it was done her English (she learned her first word of English at 43) would have added needless complexity.

Even the property records are problematic on that--we put our house into an estate-planning trust. The correct titling of the property has the trust and then both of our names--but the system only *displays* two lines. Thus it shows the trust and then my name, hers gets omitted.

Re: The Uselessness of Phenylephrine

#465

Post by Fomite »

wins32767 wrote: post #327
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…

Risk adjusted scoring is entirely viable in this age of data science, there is just no appetite for it. Doctors fight very hard against it because who actually wants to be held accountable for outcomes? Insurance companies really aren't the villains in the US healthcare system, they're going to make money no matter what because they pass cost increases on to their subscribers and are capped in how much profit they ca…

Risk adjusted scoring is done in some areas where we have the data for this (healthcare associated infections and antibiotic usage). And this is a place where hospitals and doctors actively do want it to work, because there are financial penalties associated with it.

It's still a fairly hard problem. I've had several very clever data scientists on teams who have gone "Oh, this is just an X problem..." and then 9 months later they're still trying to get a model to perform better than "Just take the average".

Re: The Uselessness of Phenylephrine

#466

Post by [deleted] »

tssva wrote: post #272
skyechurch wrote: post #224

Earlier quoted context omitted.

This is very silly, acetaminophen is very effective against pain, and for many people (e.g. me) is tolerated much better, especially at higher doses, than ibuprofen etc. There is already way to much panic about drugs/medicines, especially pain meds, especially especially for chronic conditions, without further hysterics about the 'threat' of useful and well tolerated chemicals. (Not a doctor, not offering medical adv…

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.

[deleted]

Re: The Uselessness of Phenylephrine

#467

Post by s0rce »

ipaddr wrote: post #414
s0rce wrote: post #392

Earlier quoted context omitted.

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 a…

I guess I don't see why your family doctor won't be open to referring you to another specialist. My experience was probably not normal in Canada since my parents are doctors.

Re: The Uselessness of Phenylephrine

#468

Post by ropable »

rscho wrote: post #300
csnover wrote: post #285

Earlier quoted context omitted.

The messaging in the US most commonly used to justify the lack of universal coverage and unreasonable cost of care is that we pay the most because we get the best treatments and best doctors and best outcomes, so I don’t think it’s fair to blame laymen for believing that. Also, it’s not just patients that think this way. (Or, at least, if the clinicians know, they aren’t saying much to their patients.) I’ve had docs…

> 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…

On the other hand: tracking clinical outcomes actually tells us if a treatment actually works - a net positive for the species, I'd have thought.

Re: The Uselessness of Phenylephrine

#469

Post by refurb »

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…

Well..yeah?

I mean it’s human biology we’re dealing with. Most medicine is “we think is the best approach” with varying levels of data from “best guess” to “a few anecdotes” to “suggestive data” to “robust, well designed clinical trials”.

If we only ever treated people with data from the last bucket most of the time your doctor would recommend “just wait and hope it gets better”

Re: The Uselessness of Phenylephrine

#470

Post by LorenPechtel »

InitialLastName wrote: post #271
thrwy_918 wrote: post #120

Earlier quoted context omitted.

>State non-motorist IDs should really cease to exist State non-motorist IDs are some of the only IDs available to non-citizens who live in the US and don't drive

Don't they presumably have a US alien ID (Green Card or otherwise) and/or a foreign passport? What other documents could they use to establish identity to be able to get a State ID?

My wife is foreign-born, but was in the US as a non-resident when our hearts turned proximity into much more. Since she was already here the whole application process took place in the US. It was just under two years from when we married until she had a green card. (And note that there is also a delay from being granted a green card to actually having one in one's possession.)

Foreign passport and non-driver's ID were her only options--and passports are a nuisance to carry around and a PITA if lost/stolen.

(And, yes, I think that just under two years bit was not by chance. They were definitely looking for signs of fraud and I'm sure they finally approved it just before the point where they would have had to issue a permanent one rather than a conditional one.)

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