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

401–410 of 613 posts

Re: The Uselessness of Phenylephrine

#401

Post by erosenbe0 »

astrange wrote: post #249
erosenbe0 wrote: post #213

Earlier quoted context omitted.

That's dangerous to think it's the same as coffee. You can have a daily coffee when pregnant but we don't know about a daily dl-amphetamine. Not even close to the same side-effect profile. Coffee doesn't dilate your eyes, for starters. It's just not the same as a dopaminergic

Dexedrine is a normal ADHD medicine so this has been studied and it seems fine. eg https://journals.sagepub.com/doi/10.1177/1087054719896857

This is really good news but hardly a comprehensive meta analysis over thousands of infants.

Re: The Uselessness of Phenylephrine

#402

Post by stuckonempty »

rscho wrote: post #365
grog454 wrote: post #360

Earlier quoted context omitted.

I'm skeptical. I concede it's probably a hard problem but there is an entire field dedicated to hard statistical problems called data science. What is the point of having detailed patient histories and data if it can't be used to inform decisions?

If data science was that efficient on healthcare records, we'd know it by now and everyone would do it. There is no 'big healthcare data'. We gather mostly noise, and records are full of blatant mistakes. Medicine is still more art than science today, and records mostly give you a 'feeling' for the patient's condition in light of your MD education, with a little hard data sprinkled on top.

This is a fallacy. At any point in history you can say “if X field was so good, we’d have Y by now”. In 1925 you could’ve said, “if biology’s understanding of bacteria is so good, we’d have antibiotics by now”. Within 5 years, they did.

There is certainly noise in healthcare data especially when patient-reported, but is it noise to say that a patient having X procedure later does or doesn’t have serious complications? Analyzes of medical care and their consequences can be evaluated and it’s not noise

And big healthcare data has lagged, partially because privacy concerns trump sharing. There are companies selling anonymized medical records for basically every American now though. Big data is coming

Re: The Uselessness of Phenylephrine

#404

Post by lcuff »

grog454 wrote: post #384
lcuff wrote: post #375

Earlier quoted context omitted.

In my mind it is not a good system, because if the surgeon is looking at a much-more-difficult than average circumstance, than he could reasonably expect a lower-than-average result, but a result that might be much better than average for a case so difficult. As a separate observation, any time data is kept, turned into metrics that then become the basis for goals ("I want to have a better-than-average success rate,…

I think you are right that there is a natural and understandable psychological resistance to a data-based evaluation system. I understand that the doctor may realize something about the patient that will lower his/her chances of success. I'm arguing that a sufficiently comprehensive system would take in to account whatever that doctor realized (and perhaps much more) and compensate for it when determining expected ou…

I'm guessing that the bureaucracy of such a system would be a significant burden. To avoid having the system badly gamed, you'd need a second evaluation, yes? By a _neutral_ party, (not a doctor working in the same practice, e.g.) At added cost and time. Not to mention I've heard more than one surgeon say "That was more difficult than I expected based on the imaging ... once we got in there we found ".

I'm also arguing that it's not just a psychological resistance to a data-based evaluation system. That people understand the system would be subject to being gamed, and the overall quality of the work would actually suffer. (A bit analogous to how peer-review and the tenure game has interfered with good science practices.)

Re: The Uselessness of Phenylephrine

#405

Post by sxg »

grog454 wrote: post #371
sxg wrote: post #364

Earlier quoted context omitted.

Yes, it's absolutely very difficult to do rigorous statistical analysis. Genetics is oversimplified to non-physicians. It's cool that we can diagnose and predict the likelihood of getting Huntington's disease using our knowledge of genetics, but extremely few diseases are this simple. There are huge swaths of the human genome that we don't understand but are likely playing some important role in the regulation of oth…

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 opt to just not share any data. Any research that is performed is done internally on local populations with de-identified data sets. A few brave institutions go well out of their way to create and share de-identified data sets publically, but these data sets still undersample the general population. This is a critical problem because certain diseases are highly prevalent in certain regions (e.g., Lyme disease in New England) but unheard of in other regions (e.g., Lyme disease in Colorado). If your ML model is trained on data largely from New England, it's going to diagnose a patient with the classic "target-shaped" rash with Lyme disease even if the patient is from Colorado (high false positive rate). If the model is trained on data from Colorado, it will underdiagnose Lyme disease in patients from New England (high false negative rate). The only way I know to overcome this problem is to create even larger data sets, but this just isn't possible with data privacy laws.

Re: The Uselessness of Phenylephrine

#406

Post by caturopath »

To quote the alt text from https://xkcd.com/971/

> Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

Re: The Uselessness of Phenylephrine

#407

Post by rscho »

stuckonempty wrote: post #402
rscho wrote: post #365

Earlier quoted context omitted.

If data science was that efficient on healthcare records, we'd know it by now and everyone would do it. There is no 'big healthcare data'. We gather mostly noise, and records are full of blatant mistakes. Medicine is still more art than science today, and records mostly give you a 'feeling' for the patient's condition in light of your MD education, with a little hard data sprinkled on top.

This is a fallacy. At any point in history you can say “if X field was so good, we’d have Y by now”. In 1925 you could’ve said, “if biology’s understanding of bacteria is so good, we’d have antibiotics by now”. Within 5 years, they did. There is certainly noise in healthcare data especially when patient-reported, but is it noise to say that a patient having X procedure later does or doesn’t have serious complications…

> Big data is coming

Big _bad_ data... Let's see how we fare in 5y, then. My prediction as a clinician with a special interest in stats: close to zero medical progress. But insurance priced by a ML algorithm, and much greater efficiency in coverage and claim denials.

Re: The Uselessness of Phenylephrine

#408

Post by rscho »

asmithmd1 wrote: post #400
rscho wrote: post #391

Earlier quoted context omitted.

I have 10+ years of clinical experience in academic hospitals, and have worked in Boston at Brigham and Women's. From this experience, I can tell you 2 things: 1. Being a lecturer at Harvard does not correlate with being a skillful clinician 2. Your view of the clinical system is very skewed, and will bring you more risks than benefits.

Completely agree with point 1. There are many researchers in the area who like to also practice, that lead me to ask the # of surgeries question. My bias is towards surgery at a good regional hospital (Newton-Wellesley for example) with a surgeon who teaches downtown and does lots of surgeries. What is my skew that that is bringing me more risk? I used to think all doctors were about the same. Now I realize that is a…

> The trick is figuring out who is who, because other docs won’t say

Precisely. And I assure you, as a patient you can't possibly figure out who's who. Your bias is you think you can.

Re: The Uselessness of Phenylephrine

#409

Post by throwaway48375 »

cardiffspaceman wrote: post #109
hammock wrote: post #23

Earlier quoted context omitted.

Citation? Dextromethorphan works very well for me. (Also DXM is a recreational drug which is why it's always sold OTC with either Tylenol in it or as an extended-release formula)

Chris Rock has a few brilliant, hyperbolic, minutes on how in some neighborhoods "tussin" is a cure-all.

Back then I'm pretty sure robitussin had codeine not DXM.

Re: The Uselessness of Phenylephrine

#410

Post by refurb »

klodolph wrote: post #338
refurb wrote: post #293

Earlier quoted context omitted.

500 deaths (many intentional attempts at suicide) in a country of 350M where arguably every household has acetaminophen present is incredibly low .

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.

Post reply on HN