The Uselessness of Phenylephrine • Hacker News Board

Re: The Uselessness of Phenylephrine

#471

Post by tlb » Thu, Mar 31, 2022, 1:20 AM UTC

ropable wrote: post #468

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…

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.

Doing RCTs of a treatment tells you if it works. Without random assignment (or some clever experimental design) tracking outcomes really doesn't tell you anything.

Re: The Uselessness of Phenylephrine

#472

Post by throwaway684936 » Thu, Mar 31, 2022, 1:21 AM UTC

jimbob45 wrote: post #180

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…

>the complete lack of enforcement of what goes in supplements I agree with everything you said except for this. If resources are finite to approve and regulate drugs, 3rd-party supplements are the first thing I want tossed before any other more critical medication.

Mislabeled supplements can be very dangerous and some people require supplements due to diet choice or health issues such as pernicious anemia.

Re: The Uselessness of Phenylephrine

#473

Post by LorenPechtel » Thu, Mar 31, 2022, 1:22 AM UTC

reincarnate0x14 wrote: post #66

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.

It would be interesting to see if there were any reliable stats on how many, if any, people were caught by the ID check laws trying to manufacture from pseudoephedrine, because even at the height of the meth panic that engendered the laws something like 95% of pseudoephedrine outside of a handful of high-risk areas was very obviously not being used for any illegal purposes.

I doubt it caught people. That wasn't the purpose. Rather, it deterred them from buying up a bunch of it and thus got rid of the meth labs. And I think that's a good thing--while I am solidly on the side of drug legalization I don't want amateurs making hazmat sites all over the place.

Re: The Uselessness of Phenylephrine

#474

Post by gwerbret » Thu, Mar 31, 2022, 1:22 AM UTC

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'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

This comment reflects a common, but mistaken, believe that OTC = "essentially medicine, but safe enough to not need a prescription". In most cases, nothing could be further from the truth .

OTCs of course do include useful medications such as acetaminophen (eg Tylenol), ibuprofen (eg Advil), Aspirin, and so on. However, OTCs also include miscellaneous and assorted nonsense, such as the heroic quantities of vitamin C that many companies like to sell as somehow beneficial, and the assorted concoctions that fall under the banner of "natural health products".

In the United States, a product can pass as an OTC "medication" if it passes under the generally regarded as safe (GRAS) exemption. This basically involves sending documents to the FDA that suggest the product should be safe in humans, without necessarily having to prove it's an effective treatment for anything. Couple that with the fact that manufacturers do lie about how well they tested the safety of their products (many are fly-by-night operations with little to lose), and you end up with the situation described in the article.

You can probably blame the pharmaceutical companies for some of this confusion, as it is their wont to mix actual medications with miscellaneous nonsense in the pursuit of profit.

Re: The Uselessness of Phenylephrine

#475

Post by tuatoru » Thu, Mar 31, 2022, 1:22 AM UTC

the__alchemist wrote: post #439

opportune wrote: post #389

Earlier quoted context omitted.

The problem with empowering people medically is that 10% of people will benefit from it but 90% of people will get info from Facebook and infomercials and fall victim to quacks. Hence everything being gated behind credentials and prescriptions (along with some good old regulatory capture). I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of m…

> I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of medicine/public health is so effective we barely think about it. Of course we are going to notice and pay more attention to the things medicine sucks at treating, because they’re real problems that inflict a lot of pain due to the lack of treatment. > But medicine is very good at treating…

Hip replacements? Cataract surgery? Disfigurements (cosmetic surgery)? - just off the top of my head. My own mother had "cosmetic" surgeries to re-set her toes which had been deformed by decades of fashionable shoes, and to remove varicose veins which are painful. Occasionally one reads about someone's hearing, sight, or power of speech being restored also.

Maybe only a few things, but still affecting millions, if not tens of millions of people.

I also think that medicine is a victim of its own success, in two ways.

One, how many funerals of people in their thirties to fifties does the average person go to, these days, compared to say the 1920s? It's hard to see things that don't happen.

Two, success breeds hubris which breeds a sense of being right whatever the evidence may say.

Re: The Uselessness of Phenylephrine

#476

Post by tlb » Thu, Mar 31, 2022, 1:22 AM UTC

csnover wrote: post #311

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…

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…

Doctors that work on older patients or worse cases will have worse numbers. Usually that effect far outweighs the skill difference between doctors.

Re: The Uselessness of Phenylephrine

#477

Post by tharkun__ » Thu, Mar 31, 2022, 1:23 AM UTC

stuckonempty wrote: post #419

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…

> 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!

I think your analogy is a bit off here.

Your first sentence would be the equivalent of the inventor of patient history data keeping calling patient history keeping a garbage tool. Which is actually something that would be totally OK to do and say if suffixed with "and unfortunately so far nobody has come up with a better tool and it's not for lack of trying".

I'm assuming you didn't mean "you medical doctors" in the sense it's easy to read in. In any case, what you are doing here is telling one doctor that he is bad at the medical history writing and reading job when in fact he is the one telling you how he is able to spot other doctor's mistakes and trying to correct them. This is like telling one developer that he's bad at his job, that "you developers are the ones writing bad code and hold the decision making power for how it's done" when that developer is actually someone that tries to make things better both through his own maintainably written code (medical histories) and helping others in code reviews to make their code better and not let bad code get into Prod (finding errors in existing medical histories and trying to correct them).

That can be very discouraging, being thrown in with the bad apples. And even good apples can have a bad day or misunderstand something. But I guess you are perfect and have never produced a bug in your life.

Re: The Uselessness of Phenylephrine

#478

Post by throwaway684936 » Thu, Mar 31, 2022, 1:31 AM UTC

driggs wrote: post #463

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, gra…

Not quite the same thing, but it's odd the way they attached 8-chlorotheophylline to diphenhydramine, renamed it "dimenhydrinate" and marketed as "non-drowsy nausea medication" (Dramamine). The added molecule is totally ineffective at combating the drowsiness. It's all-but-technically an identical product to diphenhydramine.

Re: The Uselessness of Phenylephrine

#479

Post by the_d3f4ult » Thu, Mar 31, 2022, 1:35 AM UTC

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…

Everyone and their mother is working on ML applications in medicine.

Re: The Uselessness of Phenylephrine

#480

Post by tuatoru » Thu, Mar 31, 2022, 1:35 AM UTC

travisathougies wrote: post #159

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…

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some…

> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever.

The thing is, application of the germ theory of disease and Harvey's theory of circulation of the blood by action of the heart (and consequent developed understanding of the role of the blood, and of blood types) did produce miracles. Reliably safe milk and meat. Penicillin. Reliably useful blood transfusions. The tetanus vaccine. The polio vaccine.

The great polio epidemic was only four-ish generations ago. In my childhood I knew one or two people in iron lungs, having contracted polio before the vaccine. The vaccine was miraculous to every parent at the time.

The evidence has been culturally transmitted through the generations.