Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The Uselessness of Phenylephrine

science.org

Post reply on HN
Print view View original

541–550 of 613 posts

Re: The Uselessness of Phenylephrine

#541

Post by hyperdimension »

mattkrause wrote: post #176
techsupporter wrote: post #44

Earlier quoted context omitted.

> 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…

> People may laugh at this Not to spoil the joke, but the paper by "O. Hai" and "I. B. Hakkenshit" is satire--I would be absolutely gobsmacked if anyone is actually doing this.

Right.

Here's a copy of the paper, if anyone is interested:

https://maggiemcneill.files.wordpress.com/2012/03/synthesizi...

Re: The Uselessness of Phenylephrine

#542

Post by wolverine876 »

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…

> grift

It's not grift, it's people with limited information and resources doing the best they can with their expertise. Should your doctor, lacking certain information, do nothing?

Every profession is the same: You rarely have the ideal of perfect information, enough time, enough resources. That's where human adaptability and expertise come into play: You find a way.

> I feel like my entire understanding of the medical system in the US was a lie.

How much is our responsibilities, especially as educated, informed persons?

Re: The Uselessness of Phenylephrine

#543

Post by wolverine876 »

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…

> The fallout from the over-criminalization of opioids, meth, etc is a big reason that you're observing these behaviors.

Didn't the massive opiod epidemic occur before they were criminalized?

Re: The Uselessness of Phenylephrine

#544

Post by refurb »

grog454 wrote: post #347
lcuff wrote: post #329

Earlier quoted context omitted.

In my mind it gets worse when the procedure is identified: A difficult shoulder surgery by an orthopedic surgeon gets refused because it might be result in a mediocre outcome and lower his 'success' rate. The patient can't get the surgery because no surgeon wants to 'risk' his success rate numbers.

Seems like a good system to me. If a doctor expects a lower than average success rate for performing some specific operation, he should let some other doctor do it anyway.

Agree if there is another doctor who feels they could have a better success . And this does happen, doctor will say "I don't feel comfortable doing this".

But there may be no other doctor.

Think of this way - if you're a doctor specializing in the treatment of septicemia, a lot of your patients will die. If you're really good, you'll likely get the hardest cases. So your "success rate" may be lower than another doctor who isn't as good but doesn't see such tough cases.

Re: The Uselessness of Phenylephrine

#545

Post by Kwantuum »

dataflow wrote: post #450
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…

What about when it does work for people as an oral decongestant though? Are you suggesting that's just randomness? Or perhaps the placebo effect? I guess I'm not entirely convinced it's really useless for that purpose, but I'm just a layman.

The original article doesn't just suggest it, it claims it outright, and links a study to back up that claim: https://www.annallergy.org/article/S1081-1206(10)60240-2/ful...

Re: The Uselessness of Phenylephrine

#546

Post by DannyBee »

joecool1029 wrote: post #396
astrange wrote: post #288

Earlier quoted context omitted.

Bit disappointing that everyone starts commenting about amphetamines on a post about Sudafed working the same way as Strattera, which isn't a stimulant. Though him telling people Strattera has no side effects hopefully didn't surprise anyone when they went on it, it feels (literally) like being kicked in the stomach and can make you quite nauseous.

I didn't like the safety profile on Strattera nor the inability to take it 'as needed'. Rare, but there were reports of liver injuries on it. My doctor seemed to be unimpressed in it when I asked about options on and said in her experience amphetamines almost always had the best efficacy in adult ADHD patients.

The safety profile of amphetamines are not anywhere near as good as Strattera, so if that's why you are avoiding it, you should reconsider. Vyvanse can cause heart issues, liver issues, and kidney issues (and rarely lung issues). If amphetamines didn't have serious side effects, we'd let everyone use them :)

I took amphetamines for 10 years, and Strattera for 15 years. Straterra was much more consistent in efficacy, and it never stopped working for me - almost all amphetamines stopped working after a few years, and i would have to change them.

Re: The Uselessness of Phenylephrine

#547

Post by riku_iki »

aerostable_slug wrote: post #319
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…

Surgeons would steer away from difficult, lower-percentage-outcome procedures which is precisely what you don't want. You want risk-takers who repeatedly tackle the surgeries and (ideally) get a more positive outcome percentage than a newbie.

Meaning they will not take over my risky surgery, and I will still be choosing among risk takers, but with clear stats in my hands.

Re: The Uselessness of Phenylephrine

#548

Post by archon810 »

perlgeek wrote: post #178
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…

My impression of the medical system (both here in Germany, and through reports from the US) is that it's very much like everything else: much is crap, much is mediocre, some good, and a very small, excellent sliver. This goes for doctors, drugs, surgeries, devices. If you want good results, you really have to take matters into your own hands, search for possible treatments yourself, evaluate several doctors until you…

Can you share what surgery advances these were specifically? I'm really curious.

Re: The Uselessness of Phenylephrine

#549

Post by Broken_Hippo »

hedora wrote: post #510
Broken_Hippo wrote: post #354

Earlier quoted context omitted.

You keep mentioning blister packs: I wish they were on all OTC drugs and many prescription drugs. On OTC drugs, I also support package size limits. These keep folks safer, lowering both accidental and intentional overdoses. I suspect that it taking longer to open and having a handy way to estimate what youve taken helps. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31616/ There is plenty of cough syrup without acetam…

Umm... As you get older, you'll simultaneously need more pills and lose your ability to easily open blister packs. A much better solution would be to have a robot pill dispenser that's hooked to the doctor's office, a pharmacy, and an alarm clock.

"Umm... As you get older, you'll simultaneously need more pills and lose your ability to easily open blister packs."

That isn't really a feature of old age. Some folks have some issues, sure, and sure - it is more likely when you are older, but by no means is it a given nor is it necessarily tied to old age. There are simple solutions for that, like ordering easy-to-open packaging from the pharmacist (here, they would literally put it in plastic bags). Some pharmacies already help folks organize medicines and I don't see where this would be a real issue.

I'll also state that most folks shouldn't need to buy a robot to take simple medicines plus it is going to add an expense that a lot of folks couldn't afford. It doesn't seem to be a huge issue in countries with blister packs that are fairly standard - again, pharmacies are generally helpful.

Re: The Uselessness of Phenylephrine

#550

Post by sam_bristow »

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 "substantially similar" thing for medical devices is a funny one. Especially when a company depends on that classification and then goes and tries to get a patent on part of their product.
Post reply on HN