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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#581

Post by galangalalgol »

opportune wrote: post #389
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…

The problem with empowering people medically is that 10% of people will benefit from it but 90% of people will get info from Facebook and infomercials and fall victim to quacks. Hence everything being gated behind credentials and prescriptions (along with some good old regulatory capture). I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of m…

I feel like autoimmune, endocrine, and GI issues, and various combinations of those are the biggest frustration to people, along with complicated surgeries/replacements that we just haven't figured out yet. But those first three are horribly complicated and interrelated systems whose disorders affect probably close to a third of the population, maybe half. Just autoimmune thyroid issues affect about a fifth of women. Not to mention all thyroid issues, autoimmune diabetes, other diabetes, chrons, ibs, fibro myalgia, maybe long covid, etc. You are right to point out that many suffering from those conditions wouldn't even be alive without modern treatments and that we don't notice all that modern medicine can solve. But we also need to acknowledge there are many people for whom we dont have answers yet, and we are using evidence based medicine to say that because we don't have studies yet, there is nothing to be tried. I also think diet and lifestyle changes get undersuggested due to ebm. No one seems as eager to fund a study that tests a diet or activity to treat a condition as they are to fund investigation into a new drug, surgery, or diagnostic equipment.

Re: The Uselessness of Phenylephrine

#582

Post by stichers »

mnw21cam wrote: post #562
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…

I also think that doctors tend to dumb-down and downplay the actual truth of the effectiveness of treatments. Partly because for the majority of patients, being told that a treatment is realllyyy good can actually make it more effective, by the placebo effect. It also makes the patient happier and more confident in the abilities of the doctor. I noticed that since I got "Dr." put in front of my name on my medical rec…

I've noticed that too. I went to the ER with a dog bite and the triage nurse was keen to know if I was a medical doctor before she looked at it.

Re: The Uselessness of Phenylephrine

#583

Post by simonh »

kelnos wrote: post #560
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…

> 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?

Does the fact it's already a problem mean it's ok to make it worse?

Re: The Uselessness of Phenylephrine

#584

Post by ridgered4 »

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.

You probably don't have a chronic pain condition, but a fair number of people do, especially as they get older.

Re: The Uselessness of Phenylephrine

#586

Post by refurb »

headsoup wrote: post #566
refurb wrote: post #532

Earlier quoted context omitted.

But that's true in general. What's another way to describe the "best doctor in the country"? "Marginally better than the next best option".

If it has a word like 'standard' in it, you would assume there is a measure or definition for that standard, not just 'not the worst.' Best doctor in the country can quite easily still be "bronze standard." There's an expectation of quality in saying something is Gold Standard, it's not an entirely arbitrary label.

Maybe it’s a lingo thing. “Standard of care” is used all the time and just means “standard” in the sense of “best supported by data”.

But the standard of care might just be “give morphine to ease pain until death”.

Re: The Uselessness of Phenylephrine

#587

Post by mardifoufs »

MertsA wrote: post #570
mardifoufs wrote: post #394

Earlier quoted context omitted.

They already add a bittering agent to ethanol when it's sold as a disinfectant. It's not toxic, just very unpleasant

Not true, they add a bitterant but if it's in the US they're still required to add acetone and methyl isobutyl ketone as well. https://www.law.cornell.edu/cfr/text/27/21.49 That formula clearly spells out rubbing alcohol and disinfectants under the authorized uses. It's toxic and unpleasant.

Woah! I think it's different here in canada then.

Re: The Uselessness of Phenylephrine

#588

Post by BurningFrog »

sxg wrote: post #489
BurningFrog wrote: post #420

Earlier quoted context omitted.

My impression is that data science on healthcare records is mostly illegal due to HIPAA and other regulations.

It's not illegal. It's just very complicated to do correctly, and you risk large fines if you do it incorrectly.

For most practical purposes, that's has the same effects.

Re: The Uselessness of Phenylephrine

#589

Post by lkrubner »

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…

"the complete lack of enforcement of what goes in supplements"

This is because of the oddly libertarian 1994 DSHEA act:

https://ods.od.nih.gov/About/dshea_Wording.aspx

From 1904 to 1994 the FDA was fairly strict about banning most herbal remedies. Indeed, the FDA was created, in part, to limit the types of "snake oil" treatments that used to abound, and to limit the claims that could made for unproven treatments. But DSHEA opened the door to unproven treatments. In theory, the companies behind these treatments are not allowed to make medical claims, but we've all seen them walk right up to the line and make claims that sound somewhat medical.

Re: The Uselessness of Phenylephrine

#590

Post by paulmd »

zerocrates wrote: post #284
seszett wrote: post #267

Earlier quoted context omitted.

Not sure I understand what you're saying about blister packaging? Are there drugs that don't come in blister packaging in the US? Here all I can think about are the paracetamol/acetaminophen effervescent tablets that come in tubes of 8 x 1g (or 16 x 500mg).

There are drugs that come just in bottles: the typical OTC pain relievers (acetaminophen/paracetamol, ibuprofen, etc.) are all offered this way and you can easily buy bottles containing hundreds of pills. And of course there are others. Prescription drugs are pretty routinely dispensed in just pill bottles also, though I'm sure there are some for which this isn't allowed.

I'm pretty sure there are also "degrees" of blister packaging too. You've got the ones that are just foil, you've got ones with a paper backing, and then you've got ones where I'm pretty sure the paper is glued to the foil so it's basically impossible to get it to separate and you have to cut it out with a knife.

The first doesn't really bother me. The last one is absolutely obnoxious. I'm guessing the FDA is pushing the last type for "drugs of concern" like sudafed or imodium.

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