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Administering immunotherapy in the morning seems to matter. Why?

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Re: Administering immunotherapy in the morning seems to matter. Why?

#191

Post by tialaramex »

pbhjpbhj wrote: post #34
tialaramex wrote: post #27

Earlier quoted context omitted.

For the drug I take every day (Levothyroxine), research found that evening was worse, but the explanation was poor compliance - people forget to do it more often compared to the morning. Same reason the contraceptive pill is less effective than you'd expect in real populations, compliance is poor. If you're the sort of person who can actually take it on time, every day, without fail, it's extremely effective, if you…

What annoys me here is that these things are hidden - if the patient knows that compliance is better (ie their chance of staying with the medicine and so of getting better) does it really reduce said compliance?

What's hidden? Compliance means you directly benefit from the intended functionality. Like anything else in life you can insist on more documentation but most people don't care.

Re: Administering immunotherapy in the morning seems to matter. Why?

#192

Post by vlovich123 »

owenthejumper wrote: post #182
vlovich123 wrote: post #153

Earlier quoted context omitted.

I think once again - when the process becomes the metric it’s insane. What time things are being administered is already random and not regulated or organized. “What if it hurts” isn’t relevant for something like this because the reasoning is that the baseline is that “when” doesn’t matter, you’re still giving the same dosage. “What if it clearly helps?” What if. Then you publish a paper or give a talk at a conferenc…

You are approaching things from software development perspective of "what's the worst that can happen? I rollback". In the topic discussed, you cannot rollback. While you might have a reasonable suspicion that changing the time will improve some outcomes in most, you cannot be sure that it won't greatly reduce positive outcomes in many. The IRB is often in place not to stop positive outcomes, but to reduce negative o…

No I'm not. I'm pointing out the time of administration literally is already under the discretion of the hospital. There's literally no recommendation one way or the other and hospitals administer randomly based on what's convenient for staffing (i.e. not a medical decision). A) there's nothing dangerous about taking something your doing randomly anyway and systematizing it. B) there's no plausible way this is even remotely dangerous.

> The IRB is often in place not to stop positive outcomes, but to reduce negative ones.

Research can literally be IRB exempt if it provides minimal or no risk to patients which is literally what this is. Even if you put this in the "minimal risk" category which would be extreme that's still minimal IRB oversight and approval takes ~1-3 weeks.

You're imagining IRB is something it's not even intended to be and then saying it's a reasonable bottleneck in general because of real problems it prevents and thus justified for this specific experiment (where it wouldn't be relevant).

This is top to bottom a failure to follow up - doctor's are overworked & fail to follow up on potential research results because they act more like mechanics.

Re: Administering immunotherapy in the morning seems to matter. Why?

#193

Post by maherbeg »

levocardia wrote: post #91
trhway wrote: post #52

Earlier quoted context omitted.

>some other variable that incidentally varies by time of day. glucose level? low in the morning, and cancer likes glucose (among other effects of low glucose a cancer site would probably have lower local acidity, and the high local acidity is one of the tools used by cancer to protect and spread itself) .

AM/PM glucose differences are probably going to be swamped by mundane stuff like who has a snack before treatment vs. who doesn't. Are you not supposed to eat before immunotherapy? If so, maybe (non)compliance with that requirement is what's underneath.

People are more insulin sensitive in the morning too which could correlate with this.

Re: Administering immunotherapy in the morning seems to matter. Why?

#194

Post by jcims »

JamesSwift wrote: post #166
ch4s3 wrote: post #163

Earlier quoted context omitted.

There's limited time and a finite supply of doctors and researchers. They can't study everything that's promising all at once, and good ideas fall through the cracks all of the time.

I think this clears a bar of things that are useful and simple to study. Theres basically no effort involved. If it ends up beneficial we just update job postings from 'daytime infusion tech' to 'nighttime infusion tech'. Instant improvement in outcomes. I doubt you even need to clear this in any way to get the study greenlit.

Agreed. Scheduling is patient discretion anyway. It's the lowest bar possible as far as I can tell.

Re: Administering immunotherapy in the morning seems to matter. Why?

#195

Post by tomcam »

tough wrote: post #134
tomcam wrote: post #95

Earlier quoted context omitted.

Transplant a few heads and suddenly you never get invited to another Christmas party

2017 https://nationalpost.com/health/worlds-first-human-head-tran...

I maybe wouldn’t put this on my LinkedIn

Re: Administering immunotherapy in the morning seems to matter. Why?

#197

Post by dang »

calf wrote: post #196
uselesswords wrote: post #187

Earlier quoted context omitted.

[flagged]

[flagged]

You crossed repeatedly into personal attack in this thread. That's not ok and not allowed here.

If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

Re: Administering immunotherapy in the morning seems to matter. Why?

#198

Post by dang »

uselesswords wrote: post #187
calf wrote: post #183

Earlier quoted context omitted.

[flagged]

[flagged]

It's great that you're in medical school and very aware, but that doesn't make it ok to break the site guidelines, which you unfortunately did repeatedly in this thread.

If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

Re: Administering immunotherapy in the morning seems to matter. Why?

#199

Post by uselesswords »

dang wrote: post #198
uselesswords wrote: post #187

Earlier quoted context omitted.

[flagged]

It's great that you're in medical school and very aware, but that doesn't make it ok to break the site guidelines, which you unfortunately did repeatedly in this thread. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

Sorry, I was definitely snarky in my comments and if I could edit my comments to remove the snark and change the tone I would.

However, your "It's great that you're in medical school and very aware" is very patronizing and pointedly dismissive. Its a superficially polite acknowledgment that feels sarcastic rather than genuinely complimentary. I don't really mind, and I acknowledge the point you're trying to make. But if your goal is to curate a curious discussion and avoid snark you should model it too.

Re: Administering immunotherapy in the morning seems to matter. Why?

#200

Post by dang »

uselesswords wrote: post #199
dang wrote: post #198

Earlier quoted context omitted.

It's great that you're in medical school and very aware, but that doesn't make it ok to break the site guidelines, which you unfortunately did repeatedly in this thread. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

Sorry, I was definitely snarky in my comments and if I could edit my comments to remove the snark and change the tone I would. However, your "It's great that you're in medical school and very aware" is very patronizing and pointedly dismissive. Its a superficially polite acknowledgment that feels sarcastic rather than genuinely complimentary. I don't really mind, and I acknowledge the point you're trying to make. But…

Sorry! You are right.

It's all too easy to fall into, and we do it too. In such cases it's good when people point it out, and I'm happy to take my own medicine.

The fix is to be more mindful of how easily this happens and edit one's comments to err on the side of unsnark. That's what I will do. If you're willing to do that as well, then HN will be better off in both cases.

(I do think it's great that you're in medical school and willing to share some of what you know on HN, but I shouldn't have singled out the "very aware" bit - that was me being passive-aggressive.)

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