The Uselessness of Phenylephrine • Hacker News Board

Re: The Uselessness of Phenylephrine

#571

Post by rprospero » Thu, Mar 31, 2022, 11:33 AM UTC

xyzzy21 wrote: post #509

travisathougies wrote: post #159

Earlier quoted context omitted.

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…

Indeed. My experience has been that 75%-90% of US doctors are borderline incompetent and that I can and do routine out-diagnose my own maladies better. Of course this also means I can lead them by the nose to get them to diagnose anything I please. Which is horrifying - they are Epic Fail if I can do that. Admittedly I was at one time planning to become a doctor myself so I ravenously consumed everything about biolog…

Honestly, the "lead the by the nose" situation is a large improvement from many of the doctors I've met, who will actively ignore any evidence that doesn't fit their favourite diagnosis. Classic example: my partner was impaled through the leg in a workplace accident and had to go to the ER. The doctor declared that the wound was, in fact, a diabetic sore and that my partner had faked the accident to cover it up. Since the "diabetes" had reached the point of developing sores, he was prescribing insulin. However, the insurance company, "as a formality", insisted that he measure her blood sugar. After TWENTY blood tests came back with a perfectly healthy blood sugar level, he stuck with the diabetes diagnosis and just prescribed a different drug for it.

A runner up was a co-worker who WAS diabetic after a pancreatic infection. He later went to the doctor to complain about some knee pain. The doctor looked at the symptoms (e.g. joint paint, diabetes, shortness of breath) and diagnosed asymptomatic obesity. The "asymptomatic" part comes from the fact that my co-worker was built like David Bowie. However, the doctor declared that the remaining symptoms pointed towards obesity and that losing forty pounds would clear up all his issues.

Re: The Uselessness of Phenylephrine

#572

Post by askvictor » Thu, Mar 31, 2022, 11:49 AM UTC

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.

Here's my theory: you know that pseudoephedrine works, so taking this thing that's supposed to be a replacement for it, and sounds pretty similar, will convince your brain that phenylephrine will also work. So yes, placebo, but with foreknowledge of the effectiveness of pseudoephedrine. I'm curious if there have been placebo-controlled studies on phenylephrine where the participants were told they were receiving pseudoephedrine

Re: The Uselessness of Phenylephrine

#573

Post by wastra » Thu, Mar 31, 2022, 11:50 AM UTC

Physician, anesthesiologist speaking. Intravenous phenylephrine widely used, effective. No good in stomach.

Doctors struggle to harness all the historic use and evidence for treatments, sometimes based on great evidence. Often evidence is the best that can be had given available resources.

Drug companies hiding data (derived from volunteers and patients) is wrong, and a problem. Selective publishing of only positive findings in medical journals is common. Careers depend on publications. But despite these pressures, most doctors think hard about these issues, and do their truthful best for the patient in front of them, given the imperfect knowledge available.

OTC labeling is deceptive at best. Placebo only works for a few things.

Re: The Uselessness of Phenylephrine

#574

Post by klodolph » Thu, Mar 31, 2022, 12:32 PM UTC

refurb wrote: post #410

klodolph wrote: post #338

Earlier quoted context omitted.

By comparison, the number of accidental firearm deaths is around 430 per year, and somewhere around 40% of US households have a firearm. So we can say that having acetaminophen in the house is roughly as dangerous as having a firearm in the house. Obviously this is not some kind of direct comparison between firearms and acetaminophen. I included the statistic in the first place because I thought it didn’t make sense…

I wouldn’t use accidental gun deaths when acetaminophen is often used in suicides. There are 25,000 of those with guns each year in the US. But yes, acetaminophen is a drug, can be dangerous and shouldn’t be treated as benign.

Do you have numbers for how often acetaminophen are used in suicides?

Re: The Uselessness of Phenylephrine

#575

Post by awhitby » Thu, Mar 31, 2022, 1:43 PM UTC

ambicapter wrote: post #426

gerdesj wrote: post #423

Earlier quoted context omitted.

"lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain)" That one is obvious: question too broad ... does not compute ... out of cheese error. Back pain is a massive, massive thing - it sometimes doesn't actually involve the back. Here's an anecdote: I (50ish y/o male) used to have episodes of quite crippling to very crippling "back pain". To cut a long story…

I wouldn't call the latter a "fix". More like avoiding the problem. Let's pretend for as second the actual problem was some sort of muscular tightness you've developed, wouldn't the preferable fix be to identify the tightness, do some exercises regularly that alleviate it, and conserve the original function of your body? Otherwise seems like you're just slowly abandoning capabilities that your body used to have.

"Slowly abandoning capabilities that your body used to have" is inevitable. Everyone will do this at a different rate and on a different time profile, but everyone will do it, and everyone will eventually reach capability = zero.

Re: The Uselessness of Phenylephrine

#576

Post by lazide » Thu, Mar 31, 2022, 1:57 PM UTC

henrikschroder wrote: post #538

commandar wrote: post #323

Earlier quoted context omitted.

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.

Also getting antibiotics for something gets rated pretty high, even if it did worse than nothing.

Re: The Uselessness of Phenylephrine

#577

Post by lazide » Thu, Mar 31, 2022, 2:01 PM UTC

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…

Yup, most of the data is junk, and even if the data isn’t junk - it usually doesn’t at all mean what you think it means.

Re: The Uselessness of Phenylephrine

#578

Post by wins32767 » Thu, Mar 31, 2022, 2:10 PM UTC

rscho wrote: post #334

wins32767 wrote: post #327

Earlier quoted context omitted.

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 currently absolutely not viable. You underestimate the messiness of the healthcare system by a huge margin. We don't even manage to record basic vital signs consistently, so believe me when I tell you that you can forget about any kind of nice statistical trick given the weakness of our data gathering processes. Plus it's not a matter of objectivity. Surgeons will subjectively assess that doi…

I literally was at a startup that could do this successfully, so I'm not underestimating the messiness.

Re: The Uselessness of Phenylephrine

#579

Post by thrwy_918 » Thu, Mar 31, 2022, 2:11 PM UTC

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?

>Don't they presumably have a US alien ID (Green Card or otherwise) and/or a foreign passport

There are millions of visa-holders who live in the US but don't have green cards. Carrying around a foreign passport for everyday identification is an absolutely terrible idea because of the risk of theft or loss. Losing a visa-containing foreign passport can necessitate getting an emergency travel document from your foreign-country consulate, traveling back to your home country, getting a new passport, getting an appointment at the US embassy in your home country, getting a new visa issued in your new passport, then finally traveling back to the US. The whole process could take weeks or months and cost thousands of dollars.

Re: The Uselessness of Phenylephrine

#580

Post by dionidium » Thu, Mar 31, 2022, 2:25 PM 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…

> This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution.

Maybe that's true at a population level, but I can take it. Just tell me the truth. If you can't treat me, then just say that. I don't want to be "ignored," but I'm not interested in being placated, either.

This, basically: https://www.youtube.com/watch?v=NyugCJ40IIw