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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#531

Post by jasonhansel »

ray__ wrote: post #304
munificent wrote: post #196

Earlier quoted context omitted.

It's not inconsistent to treat different things differently and different drugs are radically different in their individual health and societal effects. I live in Seattle where marijuana is legal. Alcohol and marijuana are widely consumed and I rarely see any large-scale problems from it. Obviously, there are many people who can't handle either of those, but their failure to handle it well seems to not impinge on oth…

The fallout from the over-criminalization of opioids, meth, etc is a big reason that you're observing these behaviors. Stigmatizing drug use perpetuates the punitive approach to this problem. If the law treated addiction and the abuse of hard drugs with compassion rather than the draconian approach that we have in place currently you'd be seeing a lot less of this stuff. This post could have easily been written about…

> This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better.

It's worth remembering that Prohibition was, in fact, quite successful: https://www.vox.com/the-highlight/2019/6/5/18518005/prohibit...

To quote that article:

> Across the Hudson River, in Manhattan, the number of patients treated in Bellevue Hospital’s alcohol wards dropped from fifteen thousand a year before Prohibition to under six thousand in 1924. Nationally, cirrhosis deaths fell by more than a third between 1916 and 1929. In Detroit, arrests for drunkenness declined 90 percent during Prohibition’s first year. Domestic violence complaints fell by half.

Of course, one can still find Prohibition objectionable, or think that the costs outweighed the benefits. But there is strong evidence that Prohibition succeeded in reducing some of the negative impacts of alcohol use.

Re: The Uselessness of Phenylephrine

#532

Post by refurb »

headsoup wrote: post #530
refurb wrote: post #501

Earlier quoted context omitted.

But if the alternative to a 15% response rate is “no treatment” then you are getting the gold standard. In many other countries those medicines aren’t even considered or paid for.

Only if Gold Standard means "not quite as bad as the other options," which I'm not sure is a definition that'd stick.

But that's true in general.

What's another way to describe the "best doctor in the country"?

"Marginally better than the next best option".

Re: The Uselessness of Phenylephrine

#533

Post by ionicgiraffe »

hedora wrote: post #497
ipaddr wrote: post #416

Earlier quoted context omitted.

That involves flying to the US in many cases

And flying out of the US in most cases.

Indeed, I have just realized that the main problem of the US healthcare system is that their inhabitants cannot even imagine that anything better even exists.

Healthcare is much more than being operated or receiving some treatment for a rare condition, both things that are very much researched and done outside the US both privately and with public money. Healthcare is also about allowing people with health problems to live with dignity and allow then to function in society. To care for the weak and not only to restore productivity of a broken cog. Healthcare is about a strong first line of care that prevent conditions to get worse and irreparable. Many countries with a thousand or less of US's GDP can teach a lesson or two on that. In any case, most countries are slowly copying many aspects of US healthcare, I guess it must be indeed be better, or perhaps more profitable.

Re: The Uselessness of Phenylephrine

#534

Post by TylerE »

rootusrootus wrote: post #518
netizen-936824 wrote: post #326

Earlier quoted context omitted.

This is entirely false. You can overdose from ~4 grams of APAP which you can ingest by taking 6 7.5/750 hydrocodone/APAP tablets That's not nearly enough hydrocodone to kill you

That seems low -- 4 grams is the max daily dose for OTC acetaminophen. According to this [1] the minimum single dose toxicity for APAP is more like 7.5 to 12 grams. Finding a value for a lethal hydrocodone dose is more difficult, but I did see 90 mg mentioned. For the dose of Vicodin you specified, 90mg of hydrocodone would correspond to 9 grams of APAP. So it's a race that it looks like either one could win. [1] htt…

The difference is you can build a tolerance to opioids, so the LD of hydrocodone in an addict (or even just someone using for an extended period medically) will be FAR higher than in an opiod-naive person.

Opioids kill via respiratory depression, not by destroying your organs.

Re: The Uselessness of Phenylephrine

#535

Post by FeepingCreature »

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…

Goodhart's law means you need to gather more data, not less. The more and diverse metrics you have, the more Goodhart pressure you can take.

Re: The Uselessness of Phenylephrine

#537

Post by MichaelBurge »

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…

Have one person do nothing but estimate the difficulty of a case(and be tracked and judged for the quality of their estimates), and the surgeon be tracked and judged on the relative performance given the difficulty.

Then you could make a career out of doing well on difficult cases, or out of doing better-than-average on easy cases, and either would be viable.

Re: The Uselessness of Phenylephrine

#538

Post by henrikschroder »

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…

In patient satisfaction surveys, treatments like invasive surgery usually ranks very low, while treatments like massage rank very highly. One probably saved your life, the other just felt nice, and yet the second one is rated higher.

It's complete insanity to even being comparing treatments that are so different.

Re: The Uselessness of Phenylephrine

#539

Post by jrockway »

tingletech wrote: post #455
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?

You can buy it in nasal spray form already. I would skip it and use oxymetazoline, though. (Do be aware of "rebound congestion" with any of these decongestant sprays. If you're always stopped up, ask your doctor about the steroid sprays. They're over the counter as well, but I feel bad recommending steroids to random people on the Internet.)

Re: The Uselessness of Phenylephrine

#540

Post by refurb »

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…

It's also a bad idea because the best surgeons often take on the most difficult cases you can't necessarily compare doctor to doctor without knowing the types of patients they treat.
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