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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#551

Post by ycombinete »

fluoridation wrote: post #418
slowmovintarget wrote: post #312

Earlier quoted context omitted.

After going nearly a year without taking painkillers of any kind (not an aspirin, ibuprofen, or acetaminophen dose), I took some Tylenol for a bad headache, and it worked far better than it had ever worked for me before. Granted, I've had to learn to put up with a lot more constant low-level pain in my day-to-day life. But I think that's a reasonable trade off for choosing between cooking my kidneys (aspirin, ibuprof…

>After going nearly a year without taking painkillers I find this pretty shocking. Is this how people normally take painkillers, would you say? Speaking for myself, I normally go for years without taking anything.

Many migraine sufferers will take pain killers multiple times in a month

Re: The Uselessness of Phenylephrine

#552

Post by grangerg »

refurb wrote: post #287
caymanjim wrote: post #162

Earlier quoted context omitted.

> OTC medicines that by current standards would not be made OTC Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it's been informally grandfathered in, makes an absolute fortune for pharmaceutical compa…

I doubt it. Ibuprofen and other NSAISDs were approved not that long ago, cause plenty of GI bleeds, have nephrotoxicity when used chronically and increase the risk of cardiovascular events. And they’re OTC. Acetaminophen is actually very safe considering the number of serious events and the facts it’s in hundreds of different OTC combinations.

Any sources on that bit about chronic ibuprofen usage? I'm aware of the GI issues (stomach lining actually), and not the others. I'm a long chronic user (daily for years now), and appear to have a reliable mitigation for the GI problems, so I'd love to know more about the other stuff you mentioned.

Re: The Uselessness of Phenylephrine

#553

Post by Nitramp »

Over here in Germany, when you ask for a decongestant, you usually get Xylometazolin as a spray. As I understand, that's both more effective and has fewer side effects (due to being local). You can also get pseudoephedrine, but I don't think it's as commonly used as these nasal sprays.

Is that not an option in the US?

Re: The Uselessness of Phenylephrine

#554

Post by clort »

sxg wrote: post #405
grog454 wrote: post #371

Earlier quoted context omitted.

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…

Before you can even do the statistical analysis you suggest, you need large amounts of high quality data—which we don't have. One place where the US (and the world?) gets data privacy right is in healthcare, but unfortunately that also means it's nearly impossible to create the data sets we need to do the statistical analysis you want. Institutions face severe penalties for wrongfully sharing patient data, so most op…

Re data privacy, as of last summer in the UK we had to opt out of data sharing of our NHS records with third parties. I am conflicted about this because as you suggested, large amounts of data could be beneficial for things like statistical analysis and machine learning to help medical research. On the other hand, what we know about human nature seems to indicate that there will already be sociopaths slavering over this data in order to enrich themselves at the expense of everybody else.

https://inews.co.uk/opinion/nhs-data-shared-third-parties-we...

Anyway, its out there now.. so watch this space, I guess!

Re: The Uselessness of Phenylephrine

#555

Post by perlgeek »

archon810 wrote: post #548
perlgeek wrote: post #178

Earlier quoted context omitted.

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.

One was a minimally-invasive surgery that removes old pace maker cables attached to the heart. The alternative would have been to cut up the sternum for a regular open heart surgery. Which is both more taxing on the circulatory system, and takes about half a year to fully heal again.

The other was a "tissue engineered" heart valve. They take a human donor valve, and over the course of a few weeks remove the human cells in some kind of soap bath, only the collagen matrix remains. This reduces rejection to basically zero, and allows the patient to live without immune suppressants for the rest of their lives.

Alternatives would be a regular human valve (+ immune suppressants indefinitely), animal valves (same problem) or artificial valve (typically don't last for longer than 10 years, and always has increased risk of persistent settlement with bacteria, so need to take antibiotics for every minor thing).

(sorry, medical English is really hard for me, hope this makes sense; if not, feel free to ask).

Re: The Uselessness of Phenylephrine

#556

Post by TheSpiceIsLife »

Nitramp wrote: post #553

Over here in Germany, when you ask for a decongestant, you usually get Xylometazolin as a spray. As I understand, that's both more effective and has fewer side effects (due to being local). You can also get pseudoephedrine, but I don't think it's as commonly used as these nasal sprays. Is that not an option in the US?

Have you ever tried taking twice the recommended daily dose of xylometazolin in one go?

Quite stimulating!

Re: The Uselessness of Phenylephrine

#557

Post by NoPie »

happyopossum wrote: post #172
NoPie wrote: post #73

Earlier quoted context omitted.

This. Derek has missed that spray is rather effective. Also other agents, such as oxymetazoline is used. They all have a rebound effect, so their use should be limited to 7 days at most. Also, this is mostly for comfort. There is no really reason to go back to pseudo-effedrive and risk side-effect (high-blood pressure etc.). Also people value their comfort a lot, they are not so good with assessing risks. Apparently…

> Also, this is mostly for comfort. Spoken like someone who has never had severe nasal congestion. A week or two of not being able to sleep, taste, or speak with your normal voice would change your view of the importance of good decongestants.

I totally understand. That is two weeks of discomfort but not medically dangerous to your life. Whereas high blood pressure especially for people who already have elevated blood pressure and don't know it, can damaged your heart with long-term effects on your heart and possibly shorten your life by some non-trivial amount.

Re: The Uselessness of Phenylephrine

#558

Post by billfruit »

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…

Wouldn't that be rectifiable by also tracking the statistics of cases which a practitioner reneges or refuses.

Then somebody with high success rate and high refusal rate stands out as a red flag.

Re: The Uselessness of Phenylephrine

#559

Post by refurb »

grangerg wrote: post #552
refurb wrote: post #287

Earlier quoted context omitted.

I doubt it. Ibuprofen and other NSAISDs were approved not that long ago, cause plenty of GI bleeds, have nephrotoxicity when used chronically and increase the risk of cardiovascular events. And they’re OTC. Acetaminophen is actually very safe considering the number of serious events and the facts it’s in hundreds of different OTC combinations.

Any sources on that bit about chronic ibuprofen usage? I'm aware of the GI issues (stomach lining actually), and not the others. I'm a long chronic user (daily for years now), and appear to have a reliable mitigation for the GI problems, so I'd love to know more about the other stuff you mentioned.

I think Google would help with the nephrotoxicity topic, but with regards to cardiovascular risk, the FDA has been doing a ton of work on it since the early 2000's when Vioxx and Bextra were pulled off the market. The other NSAIDs like ibuprofen, naproxen were kept on the market due to a lower, but not non-existent, risk.

I take NSAID for pain, but personally I'm not too concerned as it's only a ~10-50% increase in relative risk. If I was at a higher risk for stroke or heart attack, or took them very frequently (say daily for arthritis) I'd probably look for alternatives, but there are lots of others things to worry about.

This is the latest FDA update I could find, there may be more information out there:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-d...

Re: The Uselessness of Phenylephrine

#560

Post by kelnos »

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…

> 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.

Isn't that already the case, even without formal tracking of outcomes?

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