I used to be on a chemo drug and had to take folic acid every day to stop it from doing bad things to me. I had awful ulcers in my mouth from the chemo drug and had been taking the folic acid in the morning. Through forgetfulness I ended up shifting the folic acid to the afternoon and the ulcers went away and never came back.
How many side effects people just accept because no one thought to tweak the schedule
Administering immunotherapy in the morning seems to matter. Why?
131–140 of 200 posts
Re: Administering immunotherapy in the morning seems to matter. Why?
#132Earlier quoted context omitted.
> And shameful (for them.) 1. A single positive outcome with N=1 should generally not be the basis for making a medical recommendation. 2. It takes a mountain of research work to go from that to a study that you can draw meaningful conclusions from. 3. The hospital is not in the business of doing research, it's in the business of treating patients.
Given the scheduling was clearly not based on a medical recommendation in the first place given they were prepared to change it, then even a single datapoint suggesting it might have an impact should be reason to do at least minimal investigation into whether #3 might be better served by altering the schedule. Since they clearly could alter the schedule, offering a limited number of later slots and comparing results…
There's a difference between a doctor entertaining a medically-irrelevant suggestion from a patient (or patient's family), vs. assuming that the subsequent improvement was related to it, and then making that decision for some other patients (or suggesting it to them). The former is being accommodating, the latter is making treatment changes without good reason.
Improvement or no change aren't the only two possible outcomes for a patient. They could also get worse. What's worse, often neither improvement nor decline are obviously related to the treatment, or treatment changes.
Maybe it's the circadian rhythm thing. Maybe it's some delayed effects of something unrelated about the patient, that just coincided with your intervention. Maybe it's just a response to a change - any change. Or maybe it's just completely random. The point is, you don't know. You might feel like you do, or maybe it really looks obvious - but from N=1 you don't actually know, not enough to potentially bet other people's health on it.
Because maybe you do go ahead, and make a schedule change to another few patients - and few days later, suddenly and for no apparent reason, one of them goes into critical condition and dies soon after. Good luck convincing the grieving family, your colleagues, the board - and your own conscience - that the schedule change could not have possibly caused this. You won't, because you don't actually know.
Re: Administering immunotherapy in the morning seems to matter. Why?
#133My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…
As a younger person what are the best habits to get into to maintain optimal long term immune health?
Re: Administering immunotherapy in the morning seems to matter. Why?
#134Earlier quoted context omitted.
I don’t disagree but the guy below you wants to grow human shells and try head transplants.
Transplant a few heads and suddenly you never get invited to another Christmas party
Re: Administering immunotherapy in the morning seems to matter. Why?
#135Re: Administering immunotherapy in the morning seems to matter. Why?
#136Earlier quoted context omitted.
It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.
The razor to use to determine whether something is actually evidenced based under uncertainty is whether you would follow the same policy if it was your own child. There are many things that are simply uncertain and “untrue until proven otherwise” isn’t an exclusively optimal policy.
What? This makes no sense. How do you explain anti-vaxxer parents with this perspective? Parents may feel they know best, but feeling and fact have nothing to do with each other.
Re: Administering immunotherapy in the morning seems to matter. Why?
#137Earlier quoted context omitted.
It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.
> It’s not shameful, it’s how evidence based medicine works. Yeah, but I'll bet nothing happened as an outcome of this. No study, no communication to anyone else. That information probably just withered on the vine. I did a molecular bio undergrad and had classes with a bunch of pre-med students. They had zero interest in the science, just getting A's. They did care about appearance and money, driving cool cars, and…
Also medicine is an evidence-based practice because fundamentally our knowledge is woefully incomplete. Doctors are basically applied statisticians, the chemistry and biochemistry people are the researchers.
Re: Administering immunotherapy in the morning seems to matter. Why?
#138Earlier quoted context omitted.
Given the scheduling was clearly not based on a medical recommendation in the first place given they were prepared to change it, then even a single datapoint suggesting it might have an impact should be reason to do at least minimal investigation into whether #3 might be better served by altering the schedule. Since they clearly could alter the schedule, offering a limited number of later slots and comparing results…
> Since they clearly could alter the schedule, offering a limited number of later slots and comparing results would seem like the prudent response. There's a difference between a doctor entertaining a medically-irrelevant suggestion from a patient (or patient's family), vs. assuming that the subsequent improvement was related to it, and then making that decision for some other patients (or suggesting it to them). The…
They could already have made it worse with prior scheduling decisions, without having any idea.
Intentionally choosing to ignore a possibly harmful effect of the current lack of scheduling rules seems to me as blatantly unethical or worse as taking reasonable steps within what is already permitted to try to address a possible negative effect.
If concerned about making the schedule change for them: Provide the option. Add appropriate warnings if you like.
But also consider that any grieving families that finds out after the fact that there might be a known benefit to changing the scheduling would be equally hard to convince that you've not acted unethically and done harm.
Re: Administering immunotherapy in the morning seems to matter. Why?
#139Earlier quoted context omitted.
> It’s not shameful, it’s how evidence based medicine works. Yeah, but I'll bet nothing happened as an outcome of this. No study, no communication to anyone else. That information probably just withered on the vine. I did a molecular bio undergrad and had classes with a bunch of pre-med students. They had zero interest in the science, just getting A's. They did care about appearance and money, driving cool cars, and…
"Evidence-based" is a really problematic term when it is used to protect bureaucracies and medical managerialism, rather than actually interact with scientific processes in an ethical way. Their anecdote is actually a good example of why evidence-based logic is not the end-all.
Re: Administering immunotherapy in the morning seems to matter. Why?
#140Earlier quoted context omitted.
How many side effects people just accept because no one thought to tweak the schedule
And to think about how often such things are figured out individually, but go unnoticed, because there's basically 0 chance for the average person to get anyone to do a study on it.
Most people also fast at night (sleeping) and are less physically active etc etc.