[HN Gopher] The Uselessness of Phenylephrine
___________________________________________________________________
The Uselessness of Phenylephrine
Author : hprotagonist
Score : 427 points
Date : 2022-03-30 17:26 UTC (5 hours ago)
(HTM) web link (www.science.org)
(TXT) w3m dump (www.science.org)
| christkv wrote:
| I remember somebody calculated the cost of making meth from over
| the counter pseudoephedrine tablets and it would be the single
| most expensive drug available.
| hilbert42 wrote:
| Derek Lowe makes a good point that we're wasting everyone's time
| and money with useless phenylephrine and the fact that
| pseudoephedrine is so much better as a decongestant.
|
| The fact is that pseudoephedrine is not only banned in the US but
| it is also banned in many other counties for the same reason that
| it's a precursor for meth.
|
| The trouble is that banning pseudoephedrine seems to have only
| made matters considerably worse as I learned from this HN story a
| few months back: https://news.ycombinator.com/item?id=29027284
|
| Banning pseudoephedrine has led drug cartels to ramp up
| production of the precursor P2P, phenylacetone, which, it seems,
| is a better precursor anyway. It's worth reading this story in
| conjunction with this one. As Lowe hints, given the
| circumstances, we'd be better off going back to a decongestant
| that actually works.
|
| Quote from the earlier HN story:
|
| _" Meth in the US shifted to P2P synthesis between 2009 and
| 2012.
|
| In the before times, meth was made with ephedrine or
| pseudoephedrine. However, in 2006, the US banned over-the-counter
| sales of pseudoephedrine, and in 2008 Mexico banned almost all
| sales. In response to this, meth makers switched to a synthesis
| based on P2P, which can be made from many different, widely
| available, source chemicals."_
| [deleted]
| pwned1 wrote:
| Pseudoephedrine isn't banned, you just have to ask the
| pharmacist for it.
| hilbert42 wrote:
| Right, 'banned' is a blut word here, I suppose I should have
| used 'restricted schedule' as per officialdom but the earlier
| HN article used 'banned'. Incidentally, many countries have
| banned it or made it only available on script (i.e.: where I
| live).
|
| Never tried to get it myself since it went on script.
| Personally, I find it repulsive stuff - makes me feel sicker
| than the cold or flu alone so I no longer use it (makes me
| feel queasy on the stomach).
| blakesterz wrote:
| The Wikipedia article they link to [0] has a pretty long list of
| brandnames. Many of them are the "-D" version of whatever the
| thing is. Claritin-D, Zyrtec-D and so on. I think the version
| without the "-D" doesn't have Pseudoephedrine?
|
| [0] https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names
| bvinc wrote:
| In those cases, Claritin and Zyrtec are allergy medicines. The
| -D indicates that this allergy medicine comes along with a
| decongestant. The version without the -D will just be the
| allergy medicine.
| hammock wrote:
| Specifically, drugs with -D indicate that they come with
| pseudoephedrine. In the US, they (like the non-PE version of
| Sudafed) are only available behind the pharmacy counter.
| sp332 wrote:
| It might not do much if taken orally, but a phenylephrine nasal
| spray can be pretty powerful.
| NoPie wrote:
| This. Derek has missed that spray is rather effective. Also
| other agents, such as oxymetazoline is used. They all have a
| rebound effect, so their use should be limited to 7 days at
| most.
|
| Also, this is mostly for comfort. There is no really reason to
| go back to pseudo-effedrive and risk side-effect (high-blood
| pressure etc.). Also people value their comfort a lot, they are
| not so good with assessing risks. Apparently that is the
| reasoning to continue selling phenylephrine because people want
| to get something even if it is not distinguishable from
| placebo.
| djrogers wrote:
| > Also, this is mostly for comfort.
|
| Spoken like someone who has never had _severe_ nasal
| congestion. A week or two of not being able to sleep, taste,
| or speak with your normal voice would change your view of the
| importance of good decongestants.
| genewitch wrote:
| When i lived in california, this was a yearly ordeal. I
| also found out that when a bottle says "do not use for more
| than 4 days" they mean that. I very nearly choked on my
| tongue because i couldn't move it in my mouth due to the
| insane dryness, i didn't think it was even possible to
| accomplish that level of dry.
|
| I discovered "neti pots" because in a bout of panicked rage
| i snorted nearly an entire can of saline nasal wash, had
| immediate relief, and went and bought my first plastic neti
| pot. I never use deionized or whatever water, the chances
| of toxins in my water is extremely low, and i usually just
| do it in the shower anyhow, where there's hot water right
| there. Sodium Bicarb + NaCl just works.
|
| More recently for the sort of dry allergy nasal stuff i
| started putting mentholated petrolatum jelly directly in
| and around my nose. I'm sure in 10 years i'll find out that
| i'll get nostril cancer or something, but whatever, i can
| breathe, thank you very much.
| r2_pilot wrote:
| Please use boiled water at least(and definitely not just
| hot shower water) due to the possibility of Legionnaires'
| Disease:
| https://en.wikipedia.org/wiki/Legionnaires%27_disease
| gojomo wrote:
| So perhaps they should sell the sprays, for their topical
| effectiveness, but stop the wasteful sales/promotion of pills.
| ketchupdog wrote:
| True, but they have a significant rebound effect.
| mh- wrote:
| Only relevant if you ever let it wear off. (/s)
| selimnairb wrote:
| First, I find that Phenylephrine works well enough as a
| decongestant for me, without the jitters and heart palpitations.
| Of course, others' mileage may vary.
|
| Second, how did this sentence:
|
| "There are a number of synthetic procedures for doing this, some
| of them quite alarming, and several of which can indeed be
| performed in the barn, garage, basement, or trailer park of your
| choice..."
|
| make it through editing. This reeks of insensitivity and
| classism.
| tptacek wrote:
| No, not really. Meth manufacturing is famously a scourge of
| trailer park communities, where the manufacture itself poses
| risk to residents that probably outstrip the risks of the drug.
| Trailers and barns just happen to be an efficient place to
| stand up makeshift meth labs.
| sydthrowaway wrote:
| I am suffering with a bad/cold flu right now and this has made me
| mad as hell! What if someone is so sick they can't fathom to walk
| into a pharmacy?
|
| Fuck senators.
| djrogers wrote:
| Thank God I have about 100 different people I could call and
| ask to pick up medicine for me were I in that situation.
| sydthrowaway wrote:
| Lucky you.
| stjohnswarts wrote:
| Nothing works as well for allergies for me as zyrtec-d. I get the
| 12 hour variety and just use benadryl at night. Luckily I only
| need it a month or two out of the year. Don't know about taking
| that stuff year round :) (pseudoephedrine)
| perardi wrote:
| I'm skeptical the regulations will ever get rolled back, because
| it's just so trivially easy to get spooked by the idea of making
| meth, but as mentioned in this article, I don't think
| pseudoephedrine would become a _significant_ source of
| methamphetamine again if it was made easily available over the
| counter.
|
| Because the cartels have gotten really, _really_ good at making
| meth. Extremely pure and extremely cheap, and the proper
| psychoactive isomer. There's a massive supply of cheap and "good"
| crank out there, so I doubt deregulation of Sudafed would really
| make a blip in the total supply.
| cmrdporcupine wrote:
| Pseudoephedrine is a stimulant and not a particularly pleasant
| one at that. Here in Canada there's still cold medicines with it
| in them, and to be honest, when I see it, I avoid it.
|
| It may not be as good of a decongestant but phenylephrine won't
| keep me up at night. And when I'm sick with a cold what I really
| need is a good sleep.
| jonhohle wrote:
| I have the same feeling. I'm very sensitive to pseudoephedrine
| jitters and do my best to avoid it. It may be placebo, but
| phenylephrine "works" for me and can "tell" days that I forget
| to take one in the morning when I have post nasal drip. Knowing
| it should have no clinical effect, I'd be interested in
| blinding myself to a placebo to convince myself it really has
| no effect.
| jfengel wrote:
| I've certainly found it useless, and when I need a decongestant I
| make certain I'm getting actual pseudoephedrine. The 12 and 24
| hour slow-release versions are fantastic. I've never done a
| proper blind trial on myself, but I feel quite certain that I
| could tell the difference.
|
| I suppose people must be buying it, and given how strong placebo
| effects are in general I guess it's doing something for them.
| tcherasaro wrote:
| Same, Sudafed is a silver bullet for me. The 12 hour release
| absolutely works to clear my sinuses and relieves the sinus
| pressure headache (almost completely when combined with
| ibuprofen).
|
| My wife insists Phenylephrine works for her and thats all she
| will take. She has offered it to me a couple times when we
| didn't have any Sudafed and Phenylephrine had 0 noticeable
| effects for me.
|
| Edit: I forgot to add that Alavert-D 12 also has
| Pseudoephedrine and works for me too and is what I take when my
| congestion is allergy related.
| mh- wrote:
| One of many such studies:
| https://pubmed.ncbi.nlm.nih.gov/19230461/
|
| Keep in mind this doesn't say that it's not effective. It's
| just not more so than the placebo effect, which is quite real
| even on physiological matters.
| thehappypm wrote:
| The article suggests the uptake is widely variable person to
| person so perhaps she's just a lucky one.
| nvahalik wrote:
| Same here. Actual Sudafed works for me and anything else I
| think generally only tends to work with whatever NSAID they
| bundle with it.
| angry_octet wrote:
| If there were a darknet way to buy medical grade Sudafed that
| would be fine by me.
| bigbillheck wrote:
| I haven't really been able to take pseudoephedrine for a number
| of years now due to getting heart palpitations with even a small
| dose. Luckily fluticasone is available without a prescription and
| I've had success with that.
| 14 wrote:
| It is sad that society has gone into such a protectionist stance.
| In our great grandfathers day you could buy opiums and cocaine
| you name it. Now everything is so locked up heaven forbid someone
| abuses drugs. The problem with a useless drug like this is people
| won't get the desired effect and start compounding more drugs
| into their system. Like what I had to do with an abscesses tooth.
| I don't abuse drugs, I no longer drink and don't smoke marijuana
| I don't even drink coffee anymore. But when my tooth went bad all
| I was allowed was Acetaminophen and ibuprofen which didn't even
| come close to touching the pain. So I took extra acetaminophen
| and ibuprofen anyways despite the risks out of desperation. Then
| I started using copious amounts of oral gel tooth numbing
| medicine which has benzocaine I believe which can also increase
| heart rate I believe. I was so desperate for any form of relief
| while I waited to get to the dentist that I was forced to abuse
| anything I could get for relief that one narcotic medication
| would have easily treated. I have often wished I could return
| unused narcotics I have been given to show the doctors "look I'm
| returning drugs I don't have an abuse problem I only use them for
| pain control please continue being generous with them in the
| future".
| The_rationalist wrote:
| Levo-methamphetamine is a legal decongestant BTW
| ncmncm wrote:
| Where does one obtain that? From the waste stream of the
| methamphetamine producers?
| somebodynew wrote:
| It is sold over the counter in most US pharmacies under the
| Vicks inhaler brand. The active ingredient label conveniently
| uses a spelling that most people will not recognize which is
| probably effective in preventing alarm from customers who
| aren't familiar with the dramatic difference in the effects
| of the two enantiomers.
| The_rationalist wrote:
| btw racemic meth is legally prescribed for ADHD under the
| brand desoxyn, although it's probably hard to find doctors
| prescribing it over regular amph
| pkaye wrote:
| Used to get Vicks inhalers with it. I don't know if its still
| available.
| starwind wrote:
| A1 headline right there. Not clickbait, but right to the point
| jrnichols wrote:
| phenylephrine is a great drug in hospital for sepsis patients,
| but as a nasal decongestant, it really is useless.
|
| the "war on drugs" push to restrict pseudoephedrine created more
| problems than it's worth. "the new meth" has been even worse.
|
| https://crimeandjusticenews.asu.edu/news/chemically-differen...
|
| There's a really good Atlantic article about it as well (google
| "the new meth" Atlantic) but it's behind a paywall.
| caturopath wrote:
| 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.
| PaulHoule wrote:
| It is even easier to make
|
| https://en.wikipedia.org/wiki/Methcathinone
|
| from pseudoephedrine. You can just oxidize PE with potassium
| permanganate and purify the product... No need to risk blowing
| yourself up the way you would making methamphetamine.
| Reason077 wrote:
| At least in the US and UK, you can actually still get
| pseudoephedrine-containing products from a pharmacist. In some
| countries (New Zealand!), it is prescription-only. Same with
| anything containing codeine.
| [deleted]
| cwkoss wrote:
| I had a friend who would keep pseudoephedrine in his glovebox to
| be used for alertness in case he became drowsy driving. He was a
| chem nerd, so was not particularly remarkable to me.
|
| I have to wonder if the restrictions on pseudoephedrine have
| driven anyone to purchase meth. The safety profile of
| pseudoephedrine is pretty good - I think it could be argued its a
| good legal stimulant to offer to the public.
|
| Could increasing it's availability be a legitimate harm reduction
| measure that would displace/prevent meth use among some
| populations?
| scythe wrote:
| Doubtful. Caffeine is already a legal recreational stimulant.
| What distinguishes methamphetamine/cocaine is that they are,
| for want of a better word, prosocial. People don't just do
| meth, they seek out other people who are also doing meth.
| Pseudo will not fill that niche.
|
| There may be other "safe(r)" substitutes, such as HDMP-28 or
| amfonelic acid or something, but they have to reproduce the
| social function of recreational stimulants to _culturally_
| substitute.
| cwkoss wrote:
| Ah, yeah the social aspect probably can't be replaced by
| pseudoephedrine.
|
| However, meth can be functional enough that I would guess
| it's used for wakefulness/focus among a significant
| proportion of users (especially in early stages of
| addiction): truckers using it to drive longer, students using
| it to study, graveyard shift workers using it to stay alert
| while operating dangerous equipment, etc. These use cases
| seem like they could potentially substitute pseudoephedrine,
| and in doing so, could function as an "anti-gateway-drug":
| users who solve their use case without the euphoria are less
| likely to get addicted or transition into social usage.
| tyingq wrote:
| It's interesting how many younger people in the US aren't even
| aware that the only useful decongestants are behind the counter.
| I assume they just think there isn't a useful treatment for the
| symptoms.
| taeric wrote:
| I remember when the over the counter stuff just seemed to stop
| working. I just assumed that something about my body changed.
| Took me a year or so to find that the ones behind the counter
| still worked very well.
|
| I think I'm lucky, in that I don't really need too much help
| that often. I can only imagine if my sinuses were as bad as
| they were back in the day, though.
| AaronM wrote:
| If you get the chance, go read all of his (Derek Lowe) blog posts
| about things he refuses to work with. Highly entertaining read.
| genewitch wrote:
| FOOF (or FOOOOOOF)
| samatman wrote:
| Thanks for pointing out the author, the headline is not news to
| me and I would have passed on reading it.
| oh_sigh wrote:
| Strange that you were reading all the comments about the
| article you weren't interested in...
| samatman wrote:
| I didn't say I wasn't interested in the [headline] I said
| it wasn't news to me. It's a topic I find interesting, and
| as it turns out, by an author I already enjoy.
|
| The article was not informative [to me], but it was fun
| reading. _Since_ it was not informative to me (as I deduced
| correctly from the headline) I could have easily read the
| comments and not the article.
|
| Hope that helps!
| astrange wrote:
| The problem with this advice (which gets posted to all of his
| articles) is those posts aren't meant to all be read at once.
| They're basically all the same thing, which is why he hasn't
| written any new ones recently.
|
| I still want to know what isocyanide smells like.
| floren wrote:
| My assumption has always been: people know pseudoephedrine works,
| so that's what they want to buy, but you can no longer sell
| pseudoephedrine over the counter. However, you can offer
| phenylephrine, which still lets you reasonably name the drug
| "Sudafed PE" or whatever. Customer browses the shelves, sees "PE"
| in the drug name, this triggers a vague impression that it
| contains pseudoephedrine and thus will actually work well.
| denimnerd42 wrote:
| or maybe like sudafed pe is an advertisement, a reminder to
| check behind the counter for the real thing
| floren wrote:
| The "PE" stands for "placebo, essentially"
| dkryptr wrote:
| That's essentially the selling point behind Zicam and other
| homeopathic drugs.
| smm11 wrote:
| I'd be crippled without Bronkaid.
|
| And weed.
| djrogers wrote:
| I'm not sure mixing uppers and downers like that is a great
| idea, but Bronkaid has been a life saver for me.
| HL33tibCe7 wrote:
| Reminds me of docusate, a very commonly prescribed "Laxative".
| The problem? There's seemingly barely any evidence that it
| actually works. And plenty to suggest it has no effect over that
| of a placebo. Yet there's a culture of prescribing it, so on
| prescribed it goes.
| insickness wrote:
| Wow. I've purchased more than a few bottles of ducosate. But it
| looks like you're right:
|
| Reevaluating the Use of Docusate in the Management of
| Constipation https://www.drugtopics.com/view/reevaluating-the-
| use-of-docu...
| munificent wrote:
| My drug of choice for colds is NyQuil. It's always been great for
| opening up my nasal passages enough to let me breathe easily and
| then knocking me the fuck out so I could sleep off most of the
| cold.
|
| I remember several years ago when all of a sudden NyQuil stopped
| doing anything useful. I had no idea why but I directly observed
| that it was like it had been replaced with a non-functioning
| placebo.
|
| Only a couple years later did I make the connection that this was
| right when they passed the law restricting pseudoephedrine. I got
| my hands on some NyQuil D and everything was back to normal and I
| had a functioning cold remedy again.
|
| Phenylephrine is completely useless.
| lkxijlewlf wrote:
| Probably would be better to take two shots of whisky, a
| teaspoon of honey and a shot of Afrin in each nostril[0].
| NyQuil isn't what it used to be.
|
| [0] Careful, you can easily form an "addiction" to this med.
| 542458 wrote:
| In Canada you can find cough & cold medications in both the
| Phenylephrine and Pseudoephedrine formulation, often under
| near-identical labels (IIRC one can buy "Tylenol Cough and
| Cold" with either active ingredient, for example - carefully
| checking the label is the only way to tell). I didn't realize
| there was a difference until one day after running out of
| Phenylephrine-based medication I bought the Pseudoephedrine-
| based one - it was a night and day difference! Now I tell
| everybody with a cold to check the labels and buy the good
| stuff.
|
| Interesting case study in being able to sell a low-quality
| product (one of the most important active ingredients doesn't
| work!) side-by-side with a much better product and most people
| won't ever notice that one is better.
| JPKab wrote:
| In US, same deal, but you have to show your ID at the counter
| to obtain the pseudophedrine version. Phenylephrine is so
| useless. Nothing worse than getting to a store after pharmacy
| hours and being forced to only get the useless garbage.
| joezydeco wrote:
| Original NyQuil also had a healthy shot of ethyl alcohol in it.
| Exactly the thing you weren't supposed to mix with
| pseudoephedrine.
| sva_ wrote:
| I believe you're just not supposed to drink alcohol on
| Pseudoephedrine because you'd be combining an upper with a
| downer, and it's very easy to go overboard with the downers
| when you're on an upper (tolerance to alcohol increases
| dramatically and increases overdose risk along with all the
| other side effects and risks.)
|
| So a small amount of alcohol won't really have much of an
| effect, I'd claim.
| joezydeco wrote:
| In my experiences with old NyQuil it was enough to make you
| drowsier. And getting to sleep was the primary objective of
| NyQuil.
|
| Back in my college days you could replicate it with one
| 30mg Sudafed and a shot of Jagermeister. =)
| sva_ wrote:
| > NyQuil
|
| I don't know about this medication in particular (since I
| don't live in the US), but I see it contains DXM
| (dextromethorphan), which is a dissociative (such as ex.
| ketamine), which probably causes the effects you
| described. I'm seeing it also contains acetaminophen,
| which probably makes it hard on your kidneys, if you take
| too much, so that is probably why people don't abuse it
| more (I guess or hope).
| genewitch wrote:
| in the US Robitussin DM is the one you get if you aim for
| disassociation(?) - NyQuil is explicitly a sleep aid with
| some other stuff mixed in, I'd have to go dig a bottle
| out but i think the active ingredient is an anti-
| histamine (diphenylhydramine i think) - as a sleep aid,
| mind you. It is true that NyQuil used to have alcohol,
| and didn't have DXM or acetaminophen. If the liquid you
| are looking at is Orange, that's the "daytime" stuff, and
| that's overpriced garbage.
|
| One could buy generic "tussin DM" (or pill form of
| dextro), mucinex (for guafenasin), and benadryl (or
| generic diphenylhydramine) to get the same usefulness
| that a bottle of liquid NyQuil has.
| Damogran6 wrote:
| Didn't they also drop the alcohol percentage? It's 10% now (I
| know this because post Covid I seem to be catching EVERYTHING),
| I could have sworn it was 14% or higher growing up.
| InCityDreams wrote:
| Maybe if people wore masks you'd catch less?
|
| Based on.... How much i respect/ed (mostly) Asian cultures
| that wore masks pre-covid.
| tptacek wrote:
| _Eschew flamebait. Avoid unrelated controversies and
| generic tangents._
|
| https://news.ycombinator.com/newsguidelines.html
| djrogers wrote:
| This may be regional, but it's been 10% here for as long as I
| can recall - although the alcohol free version is much more
| prevalent than it used to be.
| fullstop wrote:
| This works for one or two nights with me, and then it feels
| like I've built up a tolerance to it and I think that it
| actually keeps me awake. I'll use it if I have a cough which
| keeps me awake, and, if I time it right, I'm pretty good at
| recovering within a day or two.
| munificent wrote:
| Yes, I have the exact same response. If I take it more than a
| few days, I'll get a rebound effect.
|
| My strategy is to take it full strength for a day or two and
| then taper it off gradually for the next few days after that.
| nostromo wrote:
| American law is so disjointed.
|
| On one hand, we're decriminalizing drugs. Pot is widely legal
| now. Other states are allowing mushrooms and LSD. Cocaine and
| heroin are not legal, but have all but been decriminalized on
| the West Coast.
|
| Meanwhile it's harder than ever to get pain killers from your
| doctor, even when you have a demonstrated need for them. Same
| with ephedrine -- a very useful drug -- it's very difficult to
| get even when in need. And if you mention enjoying tobacco
| products, you're treated as a leper.
|
| I wish we had a self-consistent view of the issue.
| noobermin wrote:
| There is probably some truth to this but it is worth noting
| the opiod epidemic is largely why it's hard to get pain
| killers now. A few of the pharma companies have settled that
| they sort of knew people were taking them from pharmacies and
| selling them on the black market.
| ianai wrote:
| "Cocaine and heroin are not legal, but have all but been
| decriminalized on the West Coast."
|
| Citation needed. Never heard this before now. Or is this just
| some California thing?
| svnt wrote:
| In several cities they are now citations. You may get a
| fine for possession but you will not be arrested. In
| Portland for example the ticket is around $150, which is
| about the same as the fee for an expired vehicle
| registration. This change in policies has basically stopped
| enforcement. As you can imagine it is not a profitable
| practice to ticket the unhoused.
| munificent wrote:
| It's not inconsistent to treat different things differently
| and different drugs are _radically_ different in their
| individual health and societal effects.
|
| I live in Seattle where marijuana is legal. Alcohol and
| marijuana are widely consumed and I rarely see any large-
| scale problems from it. Obviously, there are many people who
| can't handle either of those, but their failure to handle it
| well seems to not impinge on others as much. And, compared to
| them, there are a huge number of people able to consume
| alcohol and marijuana in a safe, healthy, non-problematic
| way.
|
| I also live next to a couple of homeless encampments. Many of
| the people living there are clearly addicted to opioids
| and/or meth. In _just this month_ and _within a mile of my
| house_ :
|
| * I saw a woman, topless, brandishing an umbrella, wandering
| between the sidewalk and into the street screaming at no one.
|
| * A man was shot in the stomach in front of a food bank.
|
| * Another man was shot in the neck at an encampment.
|
| * A drive-by shot up an RV and car. (The people inside
| fortunately weren't hit.)
|
| There's more I'm sure but these are just the ones I know
| about in the last few weeks.
|
| It's entirely consistent to say that we should treat drugs
| that lead to the latter behavior differently from drugs that
| don't. Opioids and meth are incredibly destructive. I'm not
| saying what specific policies I advocate for them, just that
| it is reasonable to have _different_ policies for those drugs
| compared to others.
| afiori wrote:
| I believe the parent is referring to policies about how
| addiction is defined; a good article on the matter is
|
| https://slatestarcodex.com/2019/09/16/against-against-
| pseudo...
|
| Essentially by rules a patient asking for higher dosage of
| an addictive drug is automatically seen as a sign of
| addiction, even if sometime it might just be that the
| current dosage is too low.
| ray__ wrote:
| The fallout from the over-criminalization of opioids, meth,
| etc is a big reason that you're observing these behaviors.
| Stigmatizing drug use perpetuates the punitive approach to
| this problem. If the law treated addiction and the abuse of
| hard drugs with compassion rather than the draconian
| approach that we have in place currently you'd be seeing a
| lot less of this stuff.
|
| This post could have easily been written about alcohol in
| the prohibition era. We've since learned that criminalizing
| alcohol makes its impact on society worse rather than
| better. We can't strip drug users of their autonomy and
| their ability to lead any sort of normal life and then act
| surprised when they turn to crime or turn back to drugs
| when they have nothing left.
| lamontcg wrote:
| You don't see anyone who is using opioids in the privacy of
| their own home who aren't out on the streets, so your
| sampling is massively biased.
|
| And the way we should look at drug addition with opiates
| isn't by looking at the homeless users, but consider the
| fact that we're all potentially one bad car accident away
| from getting hooked on pain killers, and asking what kind
| of support we would need to avoid winding up homeless due
| to that.
|
| Punishment via the criminal justice system is what is
| likely to wind up with you losing your job and winding up
| out there in that camp with them. So how should you be
| treated if it happens to you?
|
| And the glib answer of "put a bullet in my head" or
| whatever isn't an acceptable response. Treat the problem
| seriously and propose how society helps you help yourself
| to get clean without at trip through a homeless camp. And
| the people who refuse to deal with the reality that it
| could happen to them or engage with the problem are likely
| those most at risk of lacking the self-awareness to
| recognize when it starts happening to them.
| coward123 wrote:
| >all but been decriminalized on the West Coast.
|
| There's talk that WA is going to introduce a bill in the next
| session to completely decriminalize.
| rangersanger wrote:
| I just finished reading The Urge: Our history of Addiction.
| If you're interested in some background on how we got here,
| the author does a great job of laying out the historical,
| legal, and social constructs that have resulted in the
| inconsistent mess.
|
| https://www.harvard.com/book/the_urge/
| mise_en_place wrote:
| From what I've read, d-amphetamine[0] was the decongestant of
| choice for much of the 20th century. It's just that the
| counterculture weirdos were abusing it and that led to its
| restriction. Compared to pseudoephedrine its way more useful
| with minimal side effects like drinking a cup of coffee.
|
| [0]https://www.theatlantic.com/health/archive/2012/04/the-
| lost-...
| erosenbe0 wrote:
| 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
| astrange wrote:
| Dexedrine is a normal ADHD medicine so this has been
| studied and it seems fine.
|
| eg
| https://journals.sagepub.com/doi/10.1177/1087054719896857
| erosenbe0 wrote:
| This is really good news but hardly a comprehensive meta
| analysis over thousands of infants.
| joecool1029 wrote:
| I mentioned in my last comment that Sudafed had effects in
| treating my ADHD.
|
| Ultimately I couldn't use it this way more than a few days a
| week or I'd get lower back pain. I've also tried steeping
| ephedra tea but did not notice any effects on concentration.
|
| Later on when I was formally diagnosed and prescribed proper
| meds I was placed on Adderall first and had similar unwanted
| side effects after a time. Ultimately, I settled on Dexedrine
| and no more side effects (other than insomnia if I take it
| too late) and haven't felt a need to up the dose for years
| now. It does still have decongestant effects like the other
| two.
|
| Considering I'm caffeine dependent and can't cycle off daily
| intake without crippling headaches, where I cycle Dexedrine
| off on the weekends/holidays without any withdrawal effects,
| I'd have to agree: So long as it's a therapeutic dose it's
| on-par or safer than coffee.
| nimish wrote:
| Counterculture weirdos and Paul Erdos
| hammock wrote:
| NyQuil is a combination medicine. The cough, cold and flu
| formula contains Tylenol (fever/pain reliever), DXM (stops
| cough) and an antihistamine (dries out your runny
| nose/postnasal drip).
|
| NyQuil can be a great all-in-one product when it's what you
| need. It's useful to know what it is composed of and why. All
| of the medicines in it treat symptoms, not the underlying
| cause, which will be fought off by your immune system. If you
| have only one or two symptoms, you can always buy each drug
| separately - doing so allows you to more precisely control
| dosage and timing as well.
|
| FYI, two other common symptoms not covered above are sinus
| congestion - which can be treated with Sudafed - and chest
| congestion (e.g. a phlegmy cough) - which can be treated with
| Mucinex.
| bcrescimanno wrote:
| Prior to the regulation of pseudoephedrine, NyQuil _also_
| contained pseudoephedrine and since the nasal congestion from
| a a virus can often be the most disruptive factor for sleep
| (at least, in my personal experience, that 's the case) it's
| considered by some to the be most important component.
|
| NyQuil with pseudoephedrine included is now marketed as
| "NyQuil D" and is available behind many pharmacy counters
| with the same restrictions as other pseudoephedrine products.
| However, it could also rightly be called "NyQuil Classic" (to
| borrow branding from Coca-Cola).
| vidanay wrote:
| We haven't been able to find NyQuil D for almost a year
| here in Illinois
| Robotbeat wrote:
| I feel like the true "Cocaine Cola Classic" would still
| have some of that, um, _regulated_ stimulant in it.
| Cocaine. Might be good for decongestion?
| rscho wrote:
| Cocaine is indeed an excellent decongestant. To the point
| that it'll pierce a hole through your nasal septum
| through vasoconstriction.
| genewitch wrote:
| afaik coca cola is the only entity in the US allowed to
| import actual coca leaves, so, technically?
| Cannabat wrote:
| I'm not sure if it is still legal, but importing "coca
| tea" - that is, tea bags filled with shredded coca leaves
| - was legal at some point and a few enterprising folks
| imported a few kilos of it and processed it into the
| drug.
| hammock wrote:
| While true, the cocaine is processed out of the leaves
| themselves and sold to pharmaceutical companies. The
| remaining leaf product is used in the flavoring.
| tshaddox wrote:
| DXM doesn't actually suppress cough either, right?
| hammock wrote:
| According to whom?
| lostcolony wrote:
| Sort of! There isn't consistent evidence that -any-
| antitussive is more effective than placebo. A majority of
| studies show a statistically significant result for DXM,
| but not all, and they aren't fully replicable which
| definitely calls it into question. But that's true of every
| purported cough suppressant, and there's understandable
| reasons for that; coughing is a voluntary response to
| irritation, so there's definitely a lot going to determine
| whether you cough or not on beyond a purely autonomous
| system response. Plus there's not really much clarity in
| how to measure improvement (reduction in frequency may not
| actually be a reduction in irritation; reduction in
| severity is hard to measure. Etc).
|
| So, really, for a given incident, try it, see if it helps.
| If it does, great, if it doesn't, stop taking it.
| fpgaminer wrote:
| NyQuil also contains alcohol and pseudo (in some
| formulations).
|
| My pet theory is that NyQuil's biggest effect is simply to
| make you mildly "faded" so all your symptoms are more
| tolerable. DXM, the antihistamine, the pseudo, and the
| alcohol are all drugs that would definitely do that if taken
| in larger doses. While NyQuil doesn't have those larger
| doses, the combination of all of them may amplify the
| otherwise weaker effects into a general buzz/haze that helps
| you go about your day/night.
| lostcolony wrote:
| Multiple clarifications -
|
| Antihistamines do not directly dry up your runny nose/post
| nasal drip. Rather, they reduce the histamine response, which
| is helpful when something is caused by allergies. It's
| usually not that helpful with an actual cold (but allergic
| rhinitis is often mistaken for a cold).
|
| Sudafed is what the parent was referring to with
| Pseudophedrine; a decongestant. This works by shrinking blood
| vessels, causing swollen passageways to open back up. It
| doesn't actually do anything to reduce the runny nose or post
| nasal drip, but by opening the passages more can help them
| drain more efficiently, preventing that feeling of congestion
| (hence the name).
|
| Guaifenesin (Mucinex being the name brand) is an expectorant;
| it causes you to generate more mucus, and reduces the
| viscosity, allowing you to cough/sneeze/etc your mucus/phlegm
| based congestion out more easily.
|
| Otherwise I totally agree; it is worth understanding what
| each of these do so you can pick and choose what you need.
| Nyquil includes DXM (dextromethorphan) to reduce cough
| severity, but the acetaminophen is not helpful unless you
| have a fever or headache, and the Doxylamine Succinate and
| Phenylephrine (both antihistamines; the Doxyl is added to
| Nyquil because it's also a sleep aid) aren't particularly
| helpful unless your cold symptoms are actually allergy
| related.
|
| Better to buy DXM separately usually; fewer side effects,
| cheaper, and you can pair it with what else will help you (if
| you need something to help you sleep, you can add Doxyl or
| Diphenhydramine if you want; YMMV as to how effective they
| are)
|
| Don't take Guaifenesin before bed (the increased mucus/phlegm
| production will make it harder to sleep), but it's good
| during daytime.
|
| A common side effect of Sudafed is trouble sleeping; if you
| don't have this side effect it can be helpful in reducing
| congestion while you try and sleep, but if you do have this
| side effect, obviously, don't take it before bed.
| nsxwolf wrote:
| Do any of these compounds actually do what they say? I have
| always found all cold medicines to be entirely worthless.
| Supposedly a study found guaifenesin to be no better than a
| placebo:
|
| http://rc.rcjournal.com/content/59/5/788
| cheald wrote:
| Phenylephrine is utterly useless on me. Maybe it works for some
| people but it may as well be Pez for all the good it does me.
|
| I make it a point buy a pack of actual pseudoephedrine from my
| pharmacist every 6 months or so, to ensure I have a stock when I
| need it. Fortunately, I don't need it too often, but there's no
| good substitute when I do.
| cperciva wrote:
| Pseudoephedrine is wonderfully effective, but beware of its side
| effects.
|
| I used to take it regularly due to congestion related to seasonal
| allergies, but at a recent medical visit I discovered that my
| blood pressure had jumped from its usual 120/75 up to 150/105.
| (My doctor was also alarmed!) I no longer take pseudoephedrine.
|
| I'm told that the effect on blood pressure is _usually_ mild, but
| based on my experience I 'd recommend blood pressure monitoring
| to anyone planning on using it, just in case (like me) they're
| one of the unlucky people who experiences a dramatic increase in
| blood pressure.
| genewitch wrote:
| there was a study published february 2022 that showed that
| acetaminophen _also_ increases blood pressure. I was pretty
| aware that both pseudoephedrine and ephedrine raised blood
| pressure _slightly_ - but it 's always good to see it mentioned
| online where other people may not have known.
| cperciva wrote:
| In my case, I was taking ibuprofen+pseudoephedrine, so
| acetaminophen wasn't a confounding factor.
|
| And yes, there's plenty of literature showing a slight
| _average_ increase in bp -- but it seems that there 's a wide
| variance, with some people having dramatically larger side
| effects.
| asdff wrote:
| How did you control for the pseudoephedrine in this experiment?
| VLM wrote:
| I'm not OP, but its elimination half life is about six hours,
| so you'd superficially expect OP's BP to drop in a curve with
| a half life of six hours after the last dose. It would be
| really easy to chart with one of those wrist BP monitors and
| an excel spreadsheet.
| cperciva wrote:
| I stopped taking pseudoephedrine and the following day my
| blood pressure was back to normal.
| 60secz wrote:
| The herb ephedra (Ma Huang/Mormon Tea) contains appreciable
| amounts of ephedrine and is prepared as a tea in Chinese medicine
| as a remedy for asthma and cold congestion.
|
| It can easily be purchased online and the ephedrine ban does not
| apply to it.
|
| https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...
| jacobmartin wrote:
| Any idea how pure or clean these online sources are?
| meepmorp wrote:
| NB: ephedrine and pseudoephedrine are related (they're
| stereoisomers), but are different drugs with somewhat different
| pharmacokinetics.
| pstuart wrote:
| This is one of the more benign bits of stupidity that is The War
| On Drugs(tm).
| dataangel wrote:
| 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 common conditions in the
| human population (e.g. back pain), medical device approvals
| abusing the shortcut of being "substantially similar" to an
| existing device to evade regulatory scrutiny, the complete lack
| of enforcement of what goes in supplements... I feel like my
| entire understanding of the medical system in the US was a lie.
| We're constantly touting that we have the most advanced
| technology but if you have a complex condition you are likely to
| fall prey to multiple kinds of grift.
| tastysandwich wrote:
| Nowhere is this more evident than in the treatment of
| endometriosis.
|
| It seems like even gynaecologists are woefully ignorant &
| untrained in this disease, leading to so much unnecessary
| suffering by women (my wife included).
|
| Guys & gals, if you or your partner suffer from endometriosis,
| listen up!
|
| * Find the best gynaecologist you can that specialises in endo
| & can perform excision surgery.
|
| * Burning off the lesions (ablation) is _not_ an effective
| treatment. Excision surgery is by far the most effective
| current treatment. Unfortunately, it seems like many
| gynaecologists do not have the training to perform this
| surgery, and therefore don 't even mention it (lest they lose
| your valuable business).
|
| * There is absolutely zero evidence that pregnancy "cures"
| endometriosis, despite doctors continually repeating this myth.
| My wife's awesome gyno told us - and you can research yourself
| - that this is absolute rubbish.
|
| https://theconversation.com/pregnancy-doesnt-cure-endometrio...
|
| It causes me to wonder when I go see a doctor, what else are
| they ignorant about? I like to think I can defer to their
| expertise, and set my mind to other things. Maybe not.
| tpoacher wrote:
| It's not just the US, it's pretty much the same everywhere.
|
| Ex-doc here.
| petschge wrote:
| And now I am reminded of
| https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 and the fact
| that there is no randomised controlled trials that show the
| effectiveness of parachutes either.
| astrange wrote:
| As of 2020 there wasn't an RCT for surgical masks being
| helpful in surgery.
| thedailymail wrote:
| Au contraire! https://www.bmj.com/content/363/bmj.k5094
| petschge wrote:
| Note that this is the study that prompted the study I
| linked to. But yes, worth a read too.
| travisathougies wrote:
| 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 very
| common and serious, that medicine simply has no idea how to
| treat. The set of completely treatable / curable conditions is
| much much much smaller than the set of all possible diseases,
| yet people act as if it's the opposite. 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.
| tayo42 wrote:
| > many people have a quasi-religious belief in the capability
| of modern medicine to perform what would otherwise be called
| a miracle.
|
| That's probably because miracles are being pulled off on
| ocassion
| opportune wrote:
| 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 medicine/public health is so effective we barely think
| about it. Of course we are going to notice and pay more
| attention to the things medicine sucks at treating, because
| they're real problems that inflict a lot of pain due to the
| lack of treatment.
|
| But medicine is very good at treating plenty of things like
| infections (of many different kinds), traumatic/acute
| injuries, and many disabilities. Most of the chronic issues
| that medicine fails to address are simply lifestyle issues
| that medicine tries to alleviate the symptoms for. Yes there
| are certain conditions medicine doesn't begin to fully
| understand like Alzheimer's or various chronic pain
| conditions, or where treatment is still pretty middling like
| Cancer, but a lot of the biggest things are treatable very
| well - we just don't notice them much because they are
| treated so well.
| s0rce wrote:
| Since when is "evidence based medicine" defined as ignoring
| patients with currently untreatable conditions. There are
| enormous amounts of funding and effort constantly devoted to
| developing new treatments. I'm not sure how else you want to
| practice medicine other than "evidence based".
| jl6 wrote:
| I feel proponents of evidence based medicine are perfectly
| aware of the enormity of the problem, and are working hard to
| improve the situation.
| twofornone wrote:
| But the point is that laymen are not, and they put too much
| faith, on average, into our medical institutions.
|
| Our understanding of the human body has advanced enormously
| with the advent of modern science, but it is still far less
| complete than most people probably realize when they
| interact with doctors. Not to mention systemic issues
| (common to any technical discipline) where medical
| professionals have to effectively practice with a degree of
| faith because no one has time to actually review the
| literature underpinning any given consensus, and that
| occasionally breeds long lived orthodoxies which do more
| harm than good...
| SalmoShalazar wrote:
| Who exactly should the laymen put their faith into if not
| medical institutions? That, and the scientific process,
| are all we've got.
| ipaddr wrote:
| Medical practice and research can be decades away from
| each Other. Use your own judgement. Smoking was a weight
| cure before it wasn't.
| ajross wrote:
| > 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.
|
| Modern medical results would _absolutely_ be viewed as a
| miracle to someone just a few decades back. Something like
| 90% of cancer cases are either cured or successfully
| suppressed (to the extent that the sufferer ends up dying of
| some other cause). Almost all endemic diseases have vaccines.
| Virtually no one dies of a bacterial infection today. Even
| most autoimmune disorders have effective treatments now.
|
| The fact that there are problems yet to solve in medicine,
| and remaining voodoo in its practice, still doesn't change
| the fact that we're living in a miraculous age.
| chimeracoder wrote:
| > Something like 90% of cancer cases are either cured or
| successfully suppressed (to the extent that the sufferer
| ends up dying of some other cause).
|
| This is not correct. It's true in the US for prostate
| cancer, which is one of the most notoriously treatable
| forms of cancer, but it's not true for cancer at large.
|
| (It's also not true for prostate cancer in many other
| developed countries, which actually have a worse track
| record at treating cancer than the US does)
| greedo wrote:
| 90% of cancer cases are cured or suppressed? I have to call
| BS. Cancer is the number two cause of death in the US.
| eurasiantiger wrote:
| That just goes to show how unfair the medical system
| there is. Not everyone can afford treatment, and those
| who cannot are already otherwise more at risk due to the
| affordability of processed foods imposing unhealthy
| "lifestyle choices" as well as downright hazardous living
| and working conditions.
| chimeracoder wrote:
| > That just goes to show how unfair the medical system
| there is. Not everyone can afford treatment, and those
| who cannot are already otherwise more at risk due to the
| affordability of processed foods imposing unhealthy
| "lifestyle choices" as well as downright hazardous living
| and working conditions.
|
| I get that this explanation fits with a common
| preconception of the US, but it doesn't bear out in
| reality. The US has a _higher_ survival rate for all
| common types of cancer than all other developed
| countries, and this has been consistently the case for
| the last three decades.
|
| https://www.thelancet.com/journals/lancet/article/PIIS014
| 0-6...
| robotresearcher wrote:
| UK data from 2010-2011:
|
| "Half (50%) of people diagnosed with cancer in England
| and Wales survive their disease for ten years or more"
| [0]
|
| Since lots of cancers and lots of deaths are in old
| people, 10 year survival is quite a high bar.
|
| [0] https://www.cancerresearchuk.org/health-
| professional/cancer-...
| chimeracoder wrote:
| > "Half (50%) of people diagnosed with cancer in England
| and Wales survive their disease for ten years or more"
| [0]
|
| Lumping all forms of cancer together is misleading,
| because cancers have dramatically different mortality
| rates. You need to separate by type of cancer, or else
| you're really just measuring the relative prevalence of
| different cancers.
|
| As it turns out, the UK has a relatively low survival
| rate of cancers compared to other developed countries,
| including the US.
|
| https://www.thelancet.com/journals/lancet/article/PIIS014
| 0-6...
| Spooky23 wrote:
| We have miracle cures for many things, but medicine is worse
| than ever.
|
| I grew up with ER doctors. There are dozens of things that
| would have killed you on 1990 that you'll walk away from
| today.
|
| But in the slow transition from a professional discipline to
| a sort of IT help desk for health delivery, billing comes
| first, and even that sucks.
| AussieWog93 wrote:
| >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.
|
| I found the same thing for science in general. When I did my
| PhD and saw how the sausage was made, I was blown away by how
| obviously unscientific and irrational the entire process of
| science was.
| csnover wrote:
| 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 gush about amazing wonder drugs, then I go and
| read the actual Phase 3 trial data on the patient information
| sheet and it has a 15% _response_ (not remission) rate. I've
| been told I'm being given a "gold standard" treatment--but
| not that the "gold standard" response rate is actually only
| about 33%, and in another ~33% of cases it makes things
| worse.
|
| I've had doctors refer me for surgery, tell me about how
| amazing the surgeon is, what a great job they'll do, that if
| their own kids were sick they'd send them to this person.
| When I ask for hard data on the surgeon's actual success rate
| for this type of surgery, well, they don't track that--but
| look, just trust me, the guy's realllyyy good.
|
| Out of dozens of specialists I've seen over the years, I've
| only had one ever explicitly acknowledge that, yes, I had a
| real problem, but modern medicine just was not advanced
| enough yet to identify the cause, so they're just kind of
| winging it. For the rest, there are "many new options",
| "great responses", "positive outcomes", "extremely effective"
| --or there's nothing wrong with you, it's all in your head,
| and the princess is in another castle.
| rscho wrote:
| > When I ask for hard data on the surgeon's actual success
| rate for this type of surgery, well, they don't track that
| --but look, just trust me, the guy's realllyyy good.
|
| For good reason. Tracking of clinical outcomes is the wet
| dream of insurance companies. It's very toxic to the
| healthcare system, because it pushes practitioners to focus
| on easy cases where a good outcome is expected and causes
| major inequalities in access to healthcare.
|
| I'm not saying the present situation is ideal, but for the
| system as a whole in its current form, tracking clinical
| outcomes is a very bad idea.
| wins32767 wrote:
| 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 can
| make via regulation.
| rscho wrote:
| 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 doing easy cases will be better.
| And in addition, they'll be correct. That's what really
| matters.
| AussieWog93 wrote:
| >Risk adjusted scoring is entirely viable in this age of
| data science
|
| It's just not unviable, I don't think it's even possible.
| As soon as a metric becomes tracked, people are
| incentivized to game it.
|
| From my own experience as a very high-volume eBay seller,
| mandating a certain return rate led us to simply
| discourage customers from using the (convenient, well-
| designed) integrated returns systems. Mandating that only
| a tiny fraction of a percentage of items can be cancelled
| due to being out of stock leads to sellers sending either
| the wrong item or a fake tracking number (this gets us
| all the time on AliExpress).
|
| If data-driven software companies can't handle it for
| something as simple as eCommerce, I have no idea how the
| medical industry is supposed to get it right.
| melq wrote:
| A good portion of the largest insurance companies are
| non-profits, look at Blue Cross Blue Shield and their
| affiliated companies. They still make tons of money, keep
| tons of cash on hand, enjoy the same high salaries as
| for-profits (not saying they necessarily shouldn't), and
| get special tax statuses/breaks.
|
| And the for profit ones are making plenty of money
| whatever regulations theyre subject to:
|
| >During 2010, Health Care Service Corporation, the parent
| company of BCBS in Texas, Oklahoma, New Mexico, Montana
| and Illinois, nearly doubled its income to $1.09 billion
| in 2010, and began four years of billion-dollar profits.
|
| I'm not saying they're villains, but "they're going to
| make money no matter what" isn't a compelling argument to
| me, and I have precisely 0 faith in the government to
| meaningfully regulate them.
| csnover wrote:
| I could see that problem occurring if the metric was
| "what is the success rate of everything that Surgeon X
| does". I can't see that problem occurring for "Surgeon X
| performing Procedure Y has N% of patients reporting
| relief and M% of patients reporting complications after
| the surgery". What am I missing here?
|
| Edit: Follow-up question: notwithstanding the dysfunction
| of congress and the ability of companies to find
| loopholes, and assuming no universal health care to
| eliminate the role of insurers, surely a solution would
| be to prohibit the use of this information in the same
| way that ACA prohibits the use of pre-existing conditions
| to deny coverage?
| lcuff wrote:
| In my mind it gets worse when the procedure is
| identified: A difficult shoulder surgery by an orthopedic
| surgeon gets refused because it might be result in a
| mediocre outcome and lower his 'success' rate. The
| patient can't get the surgery because no surgeon wants to
| 'risk' his success rate numbers.
| grog454 wrote:
| Seems like a good system to me. If a doctor expects a
| lower _than average_ success rate for performing some
| specific operation, he should let some other doctor do it
| anyway.
| lcuff wrote:
| 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, as a
| surgeon") then the system gets gamed.
|
| I had a boss once propose to down-rate agile teams that
| didn't get done everything they took on in a sprint. He
| apparently didn't realize that teams would immediate game
| the system by taking on less actual work. They could up
| their 'point' estimates for each task, and always get the
| work done.
| grog454 wrote:
| 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 outcomes.
| lcuff wrote:
| 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.)
| rscho wrote:
| Other doctors? And where will you find those? No one will
| ever touch you, except if you pay more. Pay more for
| worse outcomes, really.
| sxg wrote:
| 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 measure
| anything in a meaningful way that should influence
| decision making. To use your example, surgeon Z may also
| perform procedure Y but has (N-5)% of patients reporting
| relief and (M+5)% of patients reporting post-op
| complications. However, surgeon Z works at a community
| hospital and treats a poorer patient population with more
| co-morbidities. Can you really say if surgeon X is better
| than surgeon Z?
| grog454 wrote:
| 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
| rate on average => Good (or lucky) doctor.
| sxg wrote:
| 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 other genes and diseases. We are
| nowhere close to being able to look at a patient's genome
| to predict anything useful outside of a handful of
| exceptions.
|
| Patient histories are honestly often garbage--I say that
| as a physician. I look through dozens of patients' charts
| every day, and there are constantly errors, incomplete
| documentation, and fragmented records across multiple
| institutions. Just last week I read a chart for a patient
| who had a documented hysterectomy from years ago. The
| brand new CT scan I saw showed a perfectly normal uterus.
| Once something goes in a patient's history it's nearly
| impossible to correct or remove. If some doctor from ages
| ago said the patient is allergic to medication X, but the
| patient denies it, what do I do? Usually, we opt to leave
| the allergy listed out of fear of the consequences if the
| patient is wrong.
| grog454 wrote:
| 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 "advanced" would be
| a better term? If you get a patient with a contradictory
| medical history that somehow also contradicts what they
| are telling you, simply adjust your expected chance of
| success appropriately (to zero perhaps). In that extreme
| case, if you get a good outcome, congrats you got lucky.
| If you don't, it should have 0 impact on how you are
| evaluated as a doctor.
| sxg wrote:
| 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.
| asmithmd1 wrote:
| > I feel like this is one of the few applications where
| it could shine.
|
| Read "The Alignment Problem", a very good just above pop
| sci level book about machine learning. They have one
| example where ML determined seniors with COPD were at
| reduced risk from pneumonia, and obviously non-sensical
| result. Patients with COPD wound up in the hospital at a
| lower rate than average because doctors know they need
| careful attention right away.
| rscho wrote:
| Statistics are not the problem. The data is. 'Big
| healthcare data' does not exist. Building what you are
| thinking of would require huge data gathering
| capabilities, that are very clearly out of reach.
|
| Most big medical co do a lot of data science (Kaiser and
| others). Very efficient from a managerial pov. Totally
| useless, medically speaking.
| rscho wrote:
| The number of factors you'd have to consider to achieve
| that is huge enough that it makes it completely
| unrealistic, both practically and financially speaking.
| In fact, I'm 100% convinced that it's currently
| impossible to build such a system, given the extent of
| medical knowledge.
| grog454 wrote:
| 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?
| rscho wrote:
| 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.
| stuckonempty wrote:
| 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
| rscho wrote:
| > 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.
| aerostable_slug wrote:
| Surgeons would steer away from difficult, lower-
| percentage-outcome procedures which is precisely what you
| don't want.
|
| You want risk-takers who repeatedly tackle the surgeries
| and (ideally) get a more positive outcome percentage than
| a newbie.
| rscho wrote:
| Surgeons will concentrate on easy procedures and will
| basically all have an almost identical track record of
| quasi perfection. So there will be nobody left to perform
| procedure Y, where Y has an intrinsically high rate of
| failure. Same thing for difficult patients. No one will
| touch Mr X who's got a complex problem.
| asmithmd1 wrote:
| There are some things that are helpful that they will
| answer that have steered me away from a surgeon: How many
| of these surgeries do you do per year? An answer of 50 or
| above is good. What is YOUR rate of <specific
| complication mentioned in the consent>? Keep pushing
| until they tell you their rate, not the overall rate.
| rscho wrote:
| They almost universally don't know their own rate. I
| don't know my own rates of complications. But, if I want
| you to go away because you seem to be the kind of guy
| that will come back to bite me, I'll gladly tell you I
| have a huge rate of complication.
| asmithmd1 wrote:
| For a colonoscopy I asked about the risk of a perforated
| bowel. Their first response was, "that is meaningless, if
| it happens to you the rate is 100%." I said if the
| chances are 50:50, then I am not doing it. They said it
| has happened twice in their career and based on my lack
| of risk factors, it would not happen to me.
|
| For my daughters tonsillectomy, the doctor was very happy
| to share how her stats for post surgery bleeding compared
| to both other doctors in her group, and the national
| average. But I live in a Boston suburb and every doctor
| is a lecturer at either Harvard or Mass General.
|
| Another question to ask is will an intern take part in
| the surgery. At teaching hospitals the answer is almost
| always yes. You can ask if they operate at any other
| hospitals, and again the answer is almost always yes,
| they operate at a suburban, non-teaching hospital where
| they will be the only one operating.
|
| I got a little bit humbled at Boston Childrens Hospital.
| I was doing some Googling about the risks of a CAT scan
| and asked if they did low-dose ones. They informed me
| that they in fact invented that procedure. Sure enough,
| the paper I was looking at was authored by a doctor on
| their staff.
| rscho wrote:
| 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.
| asmithmd1 wrote:
| 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 about as true as all baseball players are
| the same. There are hall of famers as well as some who
| could be sent down to the minors. The trick is figuring
| out who is who, because other docs won't say.
| sterlind wrote:
| unfortunately if you need a rare surgery (to treat a rare
| condition), this doesn't work very well. it also isn't
| enough for surgeries with subjective outcomes (such as
| vaginoplasty.) with the former you look for a competent
| surgeon with many good outcomes on related surgeries of
| similar complexity, and who keeps up with or participates
| in research. with the latter... image boards? word of
| mouth? whoever your insurance covers? I get hung up on
| that kind of choice.
| commandar wrote:
| 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; more suggesting that
| we're currently relying on metrics that are even more
| perilous than actual clinical outcomes.
| dd36 wrote:
| Every doctor is the best.
| Raineer wrote:
| "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."
|
| Citation needed.
| beebmam wrote:
| Ignoring them is unethical. Treating them with an
| unscientific treatment is unethical.
| telchior wrote:
| And the ethical alternative is, for chronic conditions,
| someone who suffers for their entire life and is not
| allowed to do anything about it?
|
| Look at every wastebasket diagnosis (yes, that's a real
| term) out there. There is no "ethical", approved treatment.
| In fact, there's not even an understanding of what the
| condition is. Instead, doctors work down a list of bad
| ideas with their patients: all the various medications,
| supplements, and even surgeries that have ever reputedly
| worked. Many have uncertain evidence, many more have no
| evidence at all. Some patients eventually hit on something
| that works for them. Others don't.
|
| According to your short statement: that's unethical. Bad.
| Stop!
|
| So what's the alternative? Suicide? Doing nothing is
| intolerable.
| sterlind wrote:
| I think you're being a little unfair to wastebasket
| diagnoses. you need _something_ for insurance codes, for
| drug indications, for publishing research on. having a
| bucket of similar syndromes is a start for drilling down
| further. and often you can treat things supportively,
| even if you can 't modify the disease itself.
|
| doctors need to be up front with patients about
| wastebaskets though, and rule out other diagnoses. it's
| wrong to chalk someone's fits up to FND until you've
| ruled out epilepsy and other organic causes, for example.
| and even things like FND are probably "real", we just
| don't know enough about them yet.
| taurath wrote:
| Depends heavily on your definition of unscientific. There
| are many treatment modalities that exist that are
| considered "ineffective" simply because they don't work en
| mass on large populations. AKA they don't scale for
| identified conditions. This can be as much a problem with
| diagnostics and labels which create cohorts as much as the
| effectiveness of treatments.
| caymanjim wrote:
| > OTC medicines that by current standards would not be made OTC
|
| Acetaminophen would almost certainly be in this category, if it
| could even get FDA approval at all. The effective dose is
| dangerously close to a toxic dose that causes liver damage, and
| not comfortably-far from the LD50. The only reasons
| acetaminophen is OTC is that it's been informally grandfathered
| in, makes an absolute fortune for pharmaceutical companies, and
| doesn't get you high.
| sniperjoe360 wrote:
| Although perhaps true about FDA clearance, I wouldn't be
| alarmist and characterize the effective dose as "dangerously"
| close to the LD50.
|
| The highest dose that therapeutically is used is about 1000mg
| per dose. The fatal dose is about 15 times that amount.
|
| To put it into perspective, a patient would have to be
| willfully taking 45 tylenol (325mg/pill) all at once to cause
| lethal liver damage. Doses like that are usually not
| accidental.
| klodolph wrote:
| Not accidental, but very tragic. It's the #1 cause for
| calls to poison control, and accounts for 26,000
| hospitalizations every year, and 500 deaths. Dying from an
| acetaminophen overdose is not a good way to go out, you
| spend a couple days in the hospital suffering as your
| organs fail and your loved ones watch.
|
| Other OTC drugs are much safer. I don't allow acetaminophen
| in the house. Pseoudoephedrine? Yes.
|
| Acetaminophen also should not be taken as a hangover cure,
| due to interactions with alcohol (alcohol and acetaminophen
| compete for the same metabolic pathways in the liver, and
| this exacerbates the toxic effects of acetaminophen). The
| problem is that someone who's drinking and has a hangover
| is probably going to reach for one of the two most common
| OTC pain relievers in their medicine cabinet, and not
| consider that one of those two pain relievers should not be
| combined with alcohol.
| sniperjoe360 wrote:
| Yes, agree with everything factual you said. I guess the
| problem isn't the compound itself but rather not enough
| information regarding its use.
|
| I personally keep tylenol in the house because it's
| probably the best non-narcotic non-NSAID pain medicine.
|
| We use it all the time in patients who are elderly with
| decreased renal function because they don't do well with
| opiates or NSAIDs (ibuprofen)
| refurb wrote:
| 500 deaths (many intentional attempts at suicide) in a
| country of 350M where arguably every household has
| acetaminophen present is _incredibly low_.
| klodolph wrote:
| 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 to cherry pick the scariest
| statistics. I'm not fearmongering here, just trying to
| illustrate that acetaminophen should be treated with more
| care than we currently do. I think we could be making
| better health policy decisions about which medications
| are OTC and which aren't, although this topic is
| incredibly complicated and doesn't just come down to
| simple facts like toxicity.
| [deleted]
| refurb wrote:
| I doubt it.
|
| Ibuprofen and other NSAISDs were approved not that long ago,
| cause plenty of GI bleeds, have nephrotoxicity when used
| chronically and increase the risk of cardiovascular events.
|
| And they're OTC.
|
| Acetaminophen is actually very safe considering the number of
| serious events and the facts it's in hundreds of different
| OTC combinations.
| skyechurch wrote:
| This is very silly, acetaminophen is very effective against
| pain, and for many people (e.g. me) is tolerated much better,
| especially at higher doses, than ibuprofen etc. There is
| already way to much panic about drugs/medicines, especially
| pain meds, especially especially for chronic conditions,
| without further hysterics about the 'threat' of useful and
| well tolerated chemicals. (Not a doctor, not offering medical
| advice.)
|
| >doesn't get you high
|
| A huge point in its favor if you can't lay in bed opiated all
| day.
| tssva wrote:
| I find acetaminophen almost completely useless for pain.
| Ibuprofen is better but still not very effective. Naproxen
| sodium is the only OTC pain medicine which is effective for
| me.
| nick__m wrote:
| accordind to the American Dental Association, 500mg of
| acetaminophen in combination with 200mg of ibuprofen is
| more effective than naproxen for pain relief.
|
| https://jada.ada.org/article/S0002-8177(18)30117-X/fullte
| xt (the result are in table 1)
| slowmovintarget wrote:
| 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, ibuprofen) or blowing out my
| liver (acetaminophen).
|
| I had a really weird 1-in-ten-million side-effect with
| Naproxen sodium. It caused hard insomnia (confirmed under
| a doctor's care, this was before it was OTC).
| caymanjim wrote:
| I'm not saying it'd be good if acetaminophen got you high,
| just that one of the reasons it's still OTC is that it
| doesn't get you high, so there's no one champing at the bit
| to crack down on it, the way they robbed us of the highly-
| effective and fairly-harmless pseudoephedrine for the one
| and only reason that it can be illicitly turned into a
| street drug.
| genghisjahn wrote:
| How is this "dangerously close to toxic"? Extra strength is
| 500mg. Adults should not take more than 3000mg in a day.
| Taking 7000 more more can lead to liver problems.
|
| https://medlineplus.gov/ency/article/002598.htm
|
| Common dosage forms and strengths:
|
| Suppository: 120 mg, 125 mg, 325 mg, 650 mg Chewable tablets:
| 80 mg Junior tablets: 160 mg Regular strength: 325 mg Extra
| strength: 500 mg Liquid: 160 mg/teaspoon (5 milliliters)
| Drops: 100 mg/mL, 120 mg/2.5 mL Adults should not take more
| than 3,000 mg of single-ingredient acetaminophen a day. You
| should take less if you are over 65 years old. Taking more,
| especially 7,000 mg or more, can lead to a severe overdose
| problems. If you have liver or kidney disease, you should
| discuss the use of this drug with your health care provider.
| thedailymail wrote:
| My understanding is that acetaminophen toxicity has been a
| problem particularly for children, because 1) the toxic
| dose is lower, 2) many common OTC products for children
| include some amount of acetaminophen among their active
| ingredients and 3) parents may give their children multiple
| such products (one for runny nose, one for fever reduction,
| one for nighttime relief, etc.) over the course of a day
| and end up exceeding the safe dose, leading to liver
| toxicity. That was the situation a few years ago at least.
| freedomben wrote:
| acetaminophen is often put in medications _because_ it 's
| toxic. It's there to dissuade people from *gasp* taking
| too much and possibly experiencing some positive feelings
| or enjoyment that offends the sensibilities of decision
| makers. Better that we destroy a few people's livers than
| that those people get a buzz. (to be clear, this last
| sentence is not my view. I'm mocking that view)
| skyechurch wrote:
| This also is silly, illegal drug users constantly take
| their dosages mixed with much worse things than Tylenol
| with no noticeable dissuasion effect that I am aware of.
| Acetaminophen is mixed with oxycodone etc bc it increases
| the pain relieving effect of the opiate drug (which for
| many people (e.g. me), are of limited effectiveness
| relative to the side effects/"buzz"), and because, unlike
| NSAIDs, it doesn't thin your blood so it can be taken
| after surgeries.
|
| Having chronic pain sucks, having something that you can
| take for it, especially something boring like Tylenol
| that can't be snatched away from you by
| doctors/police/etc, is a huge quality of life issue.
| samtho wrote:
| I don't think anyone reasonable is actively arguing to
| delist Tylenol as OTC, rather we shouldn't be so
| restrictive on these medications that can actually really
| help people. In addition we should be giving people
| resources for discontinuing use when they no longer need
| it.
|
| Also, we need to really research the NSAIDS after surgery
| thing, afaik, there has been nothing super rigorous on it
| and is only going off of the common knowledge that they
| do thin blood. I do not like Tylenol and my partner is
| allergic, we've both broken the rule about nsaids post
| surgery.
| freedomben wrote:
| Yes absolutely. I don't want to see Tylenol go away. I
| want more options, not less. I think as long as companies
| are being _honest_ about the product they are selling,
| even if it 's ineffective I think it should be available.
| caymanjim wrote:
| This is the one and only reason that Vicodin and Percocet
| exist. They don't want people getting high, so they're
| punishing them by trying to kill them. It's barbaric.
| Literally evil.
|
| Edit: just to be clear, there are times when it might
| make sense to take oxycodone or hydrocodone alongside
| acetaminophen, but they should be prescribed separately
| and with caution. The reason they're combination drugs is
| because the toxicity is a "desirable" side-effect meant
| to discourage abuse. It's that reasoning that is evil.
| paulmd wrote:
| 5:1 ratio (a dose is "take two 325mg") between therapeutic
| and danger doses is really low as far as modern drugs would
| be concerned. Most drugs are more in the 50:1 or 100:1
| range, drugs with a 5:1 ratio typically would not be
| approved and certainly would require very close
| supervision. Tylenol being OTC is complete insanity (or
| rather, regulatory capture and general public comfort with
| it).
|
| Also note that those dosages are only for single usages!
| Tylenol also has a fun thing where daily/chronic usage
| within the "safe" dose can still cause liver damage.
| Chronic usage, you need to halve those doses.
|
| The causal mechanism is believed to be basically low-level
| liver damage. Drinking a sixpack of beer once every couple
| weeks is fine - it's still not healthy, it damages your
| body, but your liver will repair itself in the meantime -
| but do it every day and your body cumulatively cannot
| repair the damage, while drinking a ton could cause acute
| failure. Tylenol actually works the same way - every dose
| is damaging your liver a bit, but if you don't do it every
| day it's fine, your body will repair it. But if you do take
| it daily, your body doesn't get a chance to repair the
| liver damage that tylenol causes, and the actual "safe"
| dosage becomes lower.
|
| That puts the actual "safe" dose at closer to 1500mg per
| day for an adult. Having a 2.5:1 theraputic ratio on an
| _over-the-counter drug_ is _absolute fucking insanity_.
|
| And worse, those numbers are for men - they're lower for
| women. Yes, so is the theraputic dose, but they don't make
| special pills for women. Taking a standard dose (two 325mg
| pills) twice a day can cause liver damage to women, that's
| above the safe threshold for daily/chronic use. And that's
| not something people really consider when they pop a couple
| tylenol.
|
| And then you've got combination products. OK, so you get
| sick, you take a couple tylenol and a dose of cough syrup.
| The dose of cough syrup likely is another 500mg or so of
| tylenol. So you actually took a 1125mg dose. And then you
| do it again before you go to bed. That's edging into
| dangerous territory with tylenol.
|
| Obviously "don't do that", read the label and don't double
| up on an active ingredient that's already there in
| combination, but combination products are implicitly
| dangerous, they are _fishing_ for that to happen,
| _encouraging_ it. But the FDA wants it because it
| "discourages abuse". That's literally more important than
| burning out your liver.
|
| The rest of the world uses tylenol in very niche
| situations. Usually it's behind the counter at a minimum
| (not always, but usually) and you probably will be told to
| take some ibuprofen instead. Ibuprofen and Aspirin are not
| perfect but they are _much, much, much_ safer than tylenol
| is.
|
| Tylenol is absolutely, completely, absurdly dangerous and
| should not be anywhere near as common as it is in the US,
| but drug war + legacy product sales rule the day.
|
| To echo another sibling commenter here, I don't allow
| acetaminophen in the house period. It is an accident
| waiting to happen. I _certainly_ don 't allow combination
| products, and I will actively go out of my way to buy
| anything that doesn't include it. This is overkill as a
| single childless person who is aware of the danger, but you
| never know when something could go wrong and the cat knocks
| the bottle off the counter and the dog gets it, etc. You
| just should not keep dangerous things around unless you
| absolutely need to. Some things you can't avoid, but it's
| not hard to just buy ibuprofen instead of tylenol.
| astrange wrote:
| Are you actually an MD?
|
| I actually only ever hear about acetaminophen/paracetamol
| being dangerous from Americans - in other Anglo countries
| everyone will happily suggest you take it all the time,
| it is available OTC, and it comes as something kids will
| mistake for lemonade.
|
| https://www.amazon.co.uk/Lemsip-Cold-Blackcurrant-
| Flavour-Sa...
|
| > Ibuprofen and Aspirin are not perfect but they are
| much, much, much safer than tylenol is.
|
| Only short term. Ibuprofen is less safe taken
| chronically, it'll destroy your stomach lining.
| cortesoft wrote:
| > For the average healthy adult, the generally
| recommended maximum daily dose is no more than 4,000
| milligrams (mg) from all sources. But in some people,
| doses close to the 4,000 mg daily limit for adults could
| still be toxic to the liver.
|
| https://www.health.harvard.edu/pain/acetaminophen-safety-
| be-...
|
| 4,000 mgs is easy to hit for people who don't realize
| that it can be dangerous. I know lots of people who would
| say "Well, my pain is bad, let me take double"... which
| for extra strength would be 4 x 500 MG, which is 2000 MGs
| in a single dose... which then if you do it twice in a
| day is right there at the 4000 MG mark. Most people are
| fine with that, but some people can get really sick.
|
| If the person then does it 3 times a day, they are close
| to the danger zone for most people and over the danger
| zone for some people. Then multiply that by a few
| days....
|
| You can easily say, "Well, they are taking more than they
| are supposed to!", but it is really common to take a bit
| extra if you feel really bad without realizing how
| dangerous it is, because Tylenol is `safe`
| paulmd wrote:
| No, I am not. It's a dune reference.
|
| Ulcers ("destroying your stomach lining") is less bad
| than "destroying your liver", and typically you will have
| to screw up harder before other NSAIDs reach that level.
| Tylenol literally is dangerous _following the directions
| on the bottle_ , because those directions aren't
| calibrated for chronic usage, when they say "daily max"
| they don't mean you take it _daily_ , that dose is even
| lower.
| rscho wrote:
| This is wrong. Kidney failure from NSAIDs is very common,
| and also very dangerous. And can develop at recommended
| dosage.
| astrange wrote:
| I had a roommate who nearly died (his words) from taking
| a chronic regular dose of ibuprofen for a month or two
| when he was sofa-ridden after tearing his ACL.
| ulfw wrote:
| Actually every country is different in that regard. In
| many parts of Asia (e.g. Singapore, Hong Kong) good luck
| even finding ibuprofen or aspirin. It's usually behind
| the counter rather than in open display.
|
| Instead there's dozens and dozens of GSK's Panadol
| paracetamol (acetaminophen), some of which even next to a
| cash register as a throw in.
| cwkoss wrote:
| Note that metabolism of drugs is roughly proportional to
| bodyweight. A petite 100 lb person may only need 200mg for
| an effective dose. An obese 400 lb person may require ~4x
| that dosage for the equivalent effect.
|
| The one-size-fits-all drug dosing we do in this country
| seems crazy to me.
|
| "Research Chemical" drug users have developed techniques to
| calibrate doses of substances with unknown potency - start
| with ~100th of what you expect to be an active dose and
| then gradually double it until proper effects are achieved.
|
| I'd imagine it would be more expensive for pharmacies to
| distribute drugs in this way, but allowing patients to
| titrate their doses could significantly reduce/avoid
| negative side effects from just throwing the same
| standardized dose at every person with a prescription
| regardless of bodyweight.
| ratsmack wrote:
| This is especially important when it comes to children.
| This is because kids vary in weight in relation to age
| more than adults do, but the vast majority of drugs are
| dosed by age. This is just insanity at it's finest.
| cwkoss wrote:
| Yep, and that's only using the rough metric of
| bodyweight. There are a number of other major factors
| like size and health of liver, whether the patient has
| any under/over expression of metabolic enzymes, etc that
| can further complicate the determination of proper
| dosage.
|
| Would be super cool if we had an objective measure of
| proper dosage - such as blood concentration or excreted
| metabolites - to give us more insight into how the drug
| is being metabolized by the individual.
| simulate-me wrote:
| Is there any evidence that harm is being caused from age-
| based dosing?
| cowmoo728 wrote:
| Most people don't read the label on medicines that they
| take. Take two extra strength acetaminophen tablets,
| combination liquid cold medicine, some of the sleep aids
| with diphenhydramine + acetaminophen, a glass of wine,
| repeat for 3 days, and you're easily into danger territory.
| emerged wrote:
| Well I was in the ER 2 days ago and my liver enzymes were
| bad. I don't drink, he said it was the acetaminophen I've
| been taking. I had been taking significantly less than the
| recommended amount for less than a week.
| paulmd wrote:
| (to be clear: not a doctor)
|
| the "daily" recommended doses are for a single day. If
| you are taking it daily you need to _at least_ halve the
| recommended dose. I wouldn 't have said a week was a
| problem but... yeah. Tylenol is dangerous.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/
|
| Specifically this study referenced:
| https://jamanetwork.com/journals/jama/fullarticle/211014
|
| > One study reported that ingestion of the recommended
| maximum amount of 4000 mg of APAP for 2 weeks resulted in
| the asymptomatic elevation of alanine transaminase, up to
| three times normal, in 40% of patients.19 These
| transaminase elevations did not amount to any clinical
| significance, and after the APAP was discontinued the
| transaminase levels returned to normal.19 Yet, while
| asymptomatic, chronically elevated aminotransferases may
| be of concern to healthcare providers, leading to further
| costly diagnostic studies or changes/restrictions in
| necessary medications
|
| If anything the summary in that review is underselling
| it. Average was 2.78x baseline (3x is considered
| clinically significant) and 20% of the population was
| over 5x the peak (so, 20% had clinically significant
| elevations from the study). By peak levels, around 27% of
| the population saw peak levels of 8x baseline. So
| basically, even the "average" participant was almost to
| the threshold of clinical significance just from this
| study (at the recommended daily dose) and a cohort of
| around 20-25% will see clinically-significant warning
| signs at the recommended dosage, even among healthy
| patients. And risk factors significantly increase that.
|
| That's basically a "liver stressor" enzyme, even if it's
| not killing the patients over the course of the study,
| it's not a good thing. That's your body's warning signal
| that it's stressed. And generally that's an
| uncontroversial finding I think, everyone agrees tylenol
| is a liver stressor, but they just have various
| thresholds of the acceptable risk. Would I do it daily?
| No.
|
| And in med-speak, that's what they're saying here too.
| Use with caution, don't go above the recommended dosage
| in acute situations and use caution with chronic dosing.
| https://pubmed.ncbi.nlm.nih.gov/11847957/
|
| Anyway, the rule of thumb I always heard is that half of
| the "daily" dose appears to be more appropriate for
| _chronic daily_ usage. I am not a doctor and you can do
| whatever you want, but that is personally what I would
| hold to. Going less, or picking a different FDA-approved
| alternative like ibuprofen or aspirin, is always a
| perfectly acceptable choice.
|
| That number appears to be reasonably supportable too.
| Instead of "half of our patients were over triple their
| baseline ALT level" this study found that 50% of the
| daily doage, chronically over 12 weeks, gets you to a 20%
| average increase in ALT levels. It's never not going to
| be a liver stressor and if you have other risk factors
| then you should probably stay away entirely (I think
| that's just good advice in general) but 20% increase in
| ALT after 12 weeks is a hell of a lot better than
| tripling your ALT in 2 weeks. But even then, during a
| 12-week study of 94 healthy adult patients, at half the
| recommended dose, they still had to withdraw one
| participant due to hepatotoxicity.
| https://pubmed.ncbi.nlm.nih.gov/25899926/
|
| (as far as risk factors, see the first link above for a
| good review, aggravating factors for hepatoxicity can
| include things like non-alcoholic fatty liver or
| nutritional deficiency. Which basically describes an
| overweight computer-toucher with a poor diet to a tee.)
| rscho wrote:
| > the "daily" recommended doses are for a single day.
|
| No. We've got thousands of people living more or less
| permanently on the maximum daily dose, including some
| children and vulnerable populations. Yes, some of those
| people have elevated liver enzymes. Yes, Tylenol is
| dangerous, but certainly not more than the alternatives.
| NSAIDs are certainly not any less dangerous, especially
| in populations with high prevalence of diabetes and
| kidney failure.
|
| Tylenol overdose is one of the most frequent suicide
| plans in teens, with lethal doses usually starting from
| 8g. This is one of the reasons Tylenol has such a bad
| reputation.
| paulmd wrote:
| The intervention-based study (giving patients a
| controlled dose and measuring the enzyme response) found
| that over half of study participants will have
| clinically-significant elevation of ALT at the
| recommended dose, and 20-30% will have numbers as bad as
| 5x sustained. Short study aside, that's not what I would
| personally choose.
|
| Remember, there were never Phase trials showing 4g is the
| right maximum either. It's just grandfathered in Uber the
| "well I guess if it were dangerous we'd have noticed by
| now" standard. But did a statistically large enough
| segment take exactly 4g over a course of years such that
| we can definitively say that's safe? Most people are
| taking lower doses and shorter doses. At least on paper.
|
| It's "there's no double-blind study that shows masks can
| prevent the spread of covid!" redux. And actually it's
| worse because there already is a standard for what
| clinically-significant elevated levels of that enzyme
| are, and _healthy study participants_ are blasting right
| by it. That 's not relevant .... because?
|
| It's not just a random number going up from some un-
| related mechanism, it's liver stress, they even think
| they know what the mechanism is. It's a reaction that is
| well-known for this drug, as a warning sign for this
| problem. Claiming that it suddenly doesn't mean the same
| thing it'd mean if you took 0.001mg more is just
| pedantic. It was never formally studied and approved, it
| would be completely unsurprising if they got the number a
| little wrong.
|
| And again - that's study participants who are _chosen to
| be healthy_. If you 're fat, or aren't getting your
| macronutrients, your risk is much higher.
|
| Using a lower dose or using something else is always a
| valid option. "The dose makes the poison" and using the
| lowest effective dose is absolutely standard practice and
| any doctor is going to tell you that's a baseline they
| always operate under.
|
| Anyway, do whatever you want personally, but I would
| personally think strongly about staying at half the
| recommended dose or less for chronic usage, or looking
| for an alternative option. 20% of the healthy population,
| plus the unhealthy population, is a decent chunk of
| people.
| rscho wrote:
| I personally prescribe loads of painkillers, including
| the whole range of the WHO ladder, and many of those
| patients have liver tests. It rarely happens that we have
| to discontinue Tylenol due to hepatitis. I see people on
| NSAIDs with kidney failure every week. So again yes,
| Tylenol is toxic. But from personal experience, it's
| rarely a clinically relevant problem.
| consumer451 wrote:
| Here are some interesting related HN posts regarding
| Acetaminophen:
|
| https://hn.algolia.com/?dateEnd=1648670057&dateRange=custom&.
| ..
| paulmd wrote:
| > doesn't get you high.
|
| this is the big one. Phenyl-epinephrine doesn't work at all,
| it's consistently failed to outperform placebo, and the only
| reason it's on the market is because the FDA doesn't like
| pseudo-ephedrine (sudafed) because it can be used as a
| precursor for meth. Same reason they've required individual
| blister packs for sudafed (if only there was some illicit
| drug which gave you the focus and drive to perform repetitive
| tasks for hours on end...)
|
| Same thing for imodium. The reason all of a sudden it's in
| blister packs? People found a way to abuse it and the FDA is
| going to ruin it for the rest of us.
|
| In the case of acetaminophen, the FDA actively uses it as a
| poison to "discourage" addicts from taking large doses of
| painkillers or cough syrup. The point is explicitly that if
| you take too much, you'll burn out your liver, the FDA is
| actively inserting poison into the medicine to "discourage
| abuse".
|
| In all of these cases, the common factor is that it makes
| things much more annoying or even dangerous/lethal for
| average people, while addicts are completely unaffected. No
| opiate addict in the world is going to get clean because of
| _individual pill blister packaging_. Meth addicts will just
| pop some pills and churn through the sudafed blister
| packaging, etc.
|
| I am waiting for the other shoe to drop on imodium, now that
| the FDA is targeting it, it can't be too long until it's
| behind the counter or pulled entirely. And as someone who
| (TMI warning) suffers from what I'd term as moderately
| frequent IBS (never diagnosed but maybe I should) that's
| really going to suck for me.
|
| The FDA is simply an instrument of drug-war policy, they're
| not oriented towards patient care and outcomes at all.
| edmundsauto wrote:
| What makes you say the FDA is actively adding poison to
| other drugs, are there first hand sources from them? This
| sounds like it could also be a case where they want to
| lower opiate consumption, and so adding some Tylenol
| increases pain relief without increasing opiate intake.
|
| I am not sure that's wise policy, but if you don't think
| Tylenol is all that bad (again, I'm not sufficiently
| informed to say this, but the FDA obviously thinks it's
| safe), then it's not a bad overall policy.
|
| It sounds like it could be either situation, I'm just
| looking for more evidence before making up my mind. (Yes, I
| am aware the US government poisoned people during
| prohibition in this exact manner, but I dispute that has
| any relevance as the decision makers and cultural awareness
| is very different now. We've come a long way since the 30s)
| samtho wrote:
| Why can you go to the store and buy rubbing alcohol to
| drink? It's primary ingredient is just ethanol. The FDA
| literally mandates that the ethanol is not able to be
| safely consumed and is cut with poison that is not easily
| separated from ethanol.
|
| Similarly, cutting opioids with Tylenol is not actually
| intended to be a deterrent to someone who gets their
| hands on the pills rather it deters people involved with
| illicit drug manufacture and distribution from using it
| as a base to grind up and sell.
|
| Tylenol is really not super safe, at least by todays
| approval standards. Most official sources, which
| unsurprisingly have a huge bias towards Tylenol's safety,
| state that allergic reactions are very uncommon, but
| recent meta-analysis' are beginning to uncover that mild
| to moderate allergic reactions to acetaminophen is more
| common that originally thought. It does not get reported
| because if you're already feeling like crap when you take
| it, some mild itchiness, redness, and discomfort would
| not be out of the ordinary without the Tylenol. As
| mentioned before, the toxic dose is much too close to the
| effective dose, I've heard from medical professionals
| that doubling a single recommended dose on extra strength
| Tylenol is enough to cause long-term damage to your
| liver. On top of all that, the fact that it is a weak
| pain reliever at best would solidly put this as a drug
| that's not super useful.
|
| I have a very low opinion of how we go about drug policy
| in the US. I am on a very controlled medication due to a
| sleep disorder (that causes hypersomnia) which I cannot
| go off for safety reasons. I also cannot get it filled
| more than 24 in advance without complicated authorization
| procedures that must be completed in the correct order.
| It's a goddamn mess and serves only as a punishment to
| law-abiding patients for needing this medication. It also
| does nothing to curb illicit use because synthesis of a
| more potent product is so trivial.
|
| This is an example of poorly targeted legislation, which
| was put into place because it's the only thing they could
| exert control over. It does not further the stated goals
| of drug enforcement because it's so easy to manufacture
| this stuff and the resulting product is so easy to move,
| bad actors can simply avoid this system. While I'm
| spending 3 hours every month orchestrating the
| complicated dance of my prescription between my
| providers, the pharmacy, and my insurance, someone is
| making a batch of shake-and-bake meth in about 3 minutes.
| rootusrootus wrote:
| > Why can you go to the store and buy rubbing alcohol to
| drink? It's primary ingredient is just ethanol.
|
| AFAIK most/all rubbing alcohol (at least that which is
| sold in the US) is isopropanol, not ethanol. You can buy
| ethanol in not-for-consumption form, as denatured
| alcohol.
| wombatpm wrote:
| And it's chemistry that forces the additional benzene in
| denatured alcohol. Water- ethanol forms an Azeotrope at
| 95% ethanol. Benzene is added to break the azeotrope and
| get to 99.99% ethanol. Chemistry not a conspiracy
| ac29 wrote:
| No one is selling 99.99% grade alcohol as an antiseptic
| in the US. Its usually 70%.
|
| There are additives in ethanol sold as an antiseptic to
| discourage drinking (various bitterants, not benzene).
| aaaronic wrote:
| Rubbing alcohol where I am is isopropyl alcohol (which is
| highly toxic -- your body metabolizes it into acetone),
| not ethanol. A kid in my high school class ended up
| getting his stomach pumped when drinking it to try to get
| drunk.
| CamperBob2 wrote:
| _What makes you say the FDA is actively adding poison to
| other drugs, are there first hand sources from them?_
|
| "Not everyone thought it was a good idea to make alcohol
| deadly, when making it illegal hadn't stopped drinkers,
| and New Jersey Senator Edward I. Edwards called it
| "legalized murder." However, the Anti-Saloon League
| persisted, arguing that legal alcohol had killed many
| more in its day than denatured alcohol would kill during
| the transition to a teetotaling world. "The Government is
| under no obligation to furnish the people with alcohol
| that is drinkable when the Constitution prohibits it,"
| said advocate Wayne B. Wheeler. "The person who drinks
| this industrial alcohol is a deliberate suicide... To
| root out a bad habit costs many lives and long years of
| effort...""
|
| https://time.com/3665643/deadly-drinking/
| drdeca wrote:
| This makes me wonder if it would have been possible to,
| instead of using something that causes significant harms
| to health, instead something which just causes a rather
| unpleasant experience.
|
| But, I guess one important thing is whether such an
| additive is compatible with the altered substance still
| being usable for the purpose for which it is being made
| available.
|
| Now, presumably something as simple as "dissolve large
| amounts of capsaicin in it" wouldn't work (I'm not even
| sure if capsaicin can be dissolved in alcohol), but, what
| about something along those lines? Or something that just
| causes headaches, or vomiting?
| mardifoufs wrote:
| They already add a bittering agent to ethanol when it's
| sold as a disinfectant. It's not toxic, just very
| unpleasant
| CamperBob2 wrote:
| I think that's what they ended up doing, post-
| Prohibition. A bottle of rubbing alcohol from the
| drugstore is either isopropyl alcohol, which is toxic by
| itself but not intentionally so, or ethanol mixed with a
| denaturing agent that's more benign than methanol or
| whatever they were using back in the day.
| rootusrootus wrote:
| I also wonder where the idea that the FDA 'denatures'
| hydrocodone with acetaminophen comes from. AFAICT, if you
| overdose on vicodin it's more likely the hydrocodone will
| kill you before the acetaminophen.
| netizen-936824 wrote:
| This is entirely false.
|
| You can overdose from ~4 grams of APAP which you can
| ingest by taking 6 7.5/750 hydrocodone/APAP tablets
|
| That's not nearly enough hydrocodone to kill you
| salawat wrote:
| Look up DXM.
|
| You will never find it without either Gualfenisin or
| acetaminophen.
|
| Does DXM need either of those to do what it does?
|
| No.
|
| Would it simplify dosing to be sold alone so that laymen
| didn't have to worry about potentially overdosing on
| three drugs at once instead of just one?
|
| Yes.
|
| However, from the war on drugs perspective, that makes it
| "easier to abuse" to achieve it's hallucinogenic side
| effect. Bundled with acetaminophen or gualfenisin
| however, you'd have to be a chemist intimately familiar
| with how to seperate the other two components to distill
| DXM in any amount with abuse potential, and the naive
| non-chemist trying to get high will either end up puking
| their guts out (Gualfenisin OD) or burning out their
| liver (Tylenol OD, which is exacerbated by alcohol
| consumption as well).
|
| The Tylenol one is particularly problematic, because
| acetaminophen is also commonly prescribed with other
| common multi-drug formulations that people may not
| realize are additive.
|
| When you take the route of adding a substance that does
| harm to discourage a pattern of behavior, you are
| poisoning. Poisoning being the act of artificially and
| with intent increasing the toxicity of an imbibed
| substance to disincent some pattern of behavior.
|
| This is actually based on a natural pattern of behavior
| by the way. There is a mushroom that is generally
| completely harmless... Until you drink alcohol.
| Metabolizing the mushroom depletes the supply of the same
| enzymes that detoxify alcohol (and Tylenol).
|
| https://en.m.wikipedia.org/wiki/Coprinopsis_atramentaria
|
| So to be clear... If you call this mushroom poisonous,
| and it targets the same enzyme that alcohol does, then
| adding something like tylenol to something that doesn't
| need it to do it's job, you are poisoning.
|
| It just happens to be handwaved because in the
| establishment's mind, those damn druggies aren't worth
| caring about anyway.
|
| Not a partaker of DXM, but _very concerned with the
| ethical implications, and the adverse contribution to
| trust in public health measures that this practice
| entails._
| lr4444lr wrote:
| Dextromethorphan HBr? It's definitely sold on its own in
| the US.
| throwaway48375 wrote:
| https://www.amazon.com/dp/B005E74U3W/
|
| https://www.amazon.com/dp/B09LKLNKZ7/
| Broken_Hippo wrote:
| You keep mentioning blister packs: I wish they were on all
| OTC drugs and many prescription drugs. On OTC drugs, I also
| support package size limits. These keep folks safer,
| lowering both accidental and intentional overdoses. I
| suspect that it taking longer to open and having a handy
| way to estimate what youve taken helps.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31616/
|
| There is plenty of cough syrup without acetaminophen sold
| in the US, by the way. People like all-in-one products,
| though, hence there being many with it in it. I'm gonna
| need some evidence for the "FDA actively uses it as a
| poison", though. I'm not so convinced a lot of folks think
| about side effects of tylenol but instead, see it as rather
| safe.
|
| And it really doesn't matter if a few folks will find ways
| around an intervention. An improvement doesn't need to be
| perfect to be implemented nonetheless - because, it is _an
| improvement_ and as such, better than before.
| seszett wrote:
| 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).
| replygirl wrote:
| oxy doesn't even come in blister packs here. at least not
| as of a few years ago, when i got it for spraining my
| ankle
| zerocrates wrote:
| 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.
| m-p-3 wrote:
| > official sounding diagnoses that on inspection are actually
| defined as "we have no idea"
|
| I suffer from IBS, and it's basically a diagnosis of exclusion
| of everything else.
|
| > lack of consensus about how to treat some of the most common
| conditions in the human population (e.g. back pain)
|
| Back pain isn't a condition, it's a symptom. And with the
| amount of conditions and diseases that have this symptom in
| their list, it's not surprising there isn't a "one-size-fits-
| all" remedy or cure to it.
| FireBeyond wrote:
| Before my gout became more obviously gout (I had elevated
| uric acid, but there was often little to no crystallization),
| one of my diagnoses was "seronegative arthritis" - "It looks
| like you have arthritis, but you have neither RF or CCP in
| your blood, so... huh."
| lowbloodsugar wrote:
| In the US medicine is a _business_. Their job is not to make
| you better. Their job is to get as much money as possible out
| of you.
| Madmallard wrote:
| I'm feeling this way too hard. I have a condition where any
| food I consistently eat I become sensitized to and begin
| developing severe reactions that are alike anaphylaxis in
| nearly every way but not quite as severe. I have been
| hospitalized several times now with starvation issues. Yeah
| immune suppressants sorta worked but you can't exactly stop a
| full on immune response so it just bought a little bir of time.
|
| (1) mast cell testing - negative (2) ige testing - mostly
| negative but i also avoid things i react to (3) endoscopy -
| mostly negative but some inflammation (4) psychological -
| medications didnt do anything
|
| (5) Non-allopathic stool testing from Genova Diagnostcs?
| astronomically high secretory IgA levels, high zonulin levels,
| disturbed gut flora populations and altered stool enzyme
| levels. -> point this out to doctors "sorry cant help ya there.
| _that's unvalidated_"
|
| Me - well fucking figure out something to try then!!!!
|
| Dead end. I am so sick of evidence based medicine.
| emmelaich wrote:
| I had a condition recently, now resolved. During that time I
| had many consultations with specialists and did quite a bit of
| research myself.
|
| It's astonishing. 80pc or more of shelf products in a pharmacy
| will do nothing and many will make things worse.
| lkxijlewlf wrote:
| > in the US was a lie. We're constantly touting that we have
| the most advanced technology but if you have a complex
| condition you are likely to fall prey to multiple kinds of
| grift.
|
| I feel like so much of what goes on day to day is one grift or
| another.
| zoba wrote:
| Hopefully you never get something unrecognized by current
| medical knowledge. You visit progressively more esteemed
| experts: local, regional, national, global. Then you get to the
| top, and (in my experience) that's it.
|
| I thought for sure there was a "ok now we hand this off to the
| labs so we can learn" step... but, no. It was just a shrug and
| literally "come back in 8 months if you're still having
| problems."
|
| I became my own lab and fixed my problem. I reported my
| findings to the doctors, and never heard back.
|
| Pretty disappointing.
| perlgeek wrote:
| My impression of the medical system (both here in Germany, and
| through reports from the US) is that it's very much like
| everything else: much is crap, much is mediocre, some good, and
| a very small, excellent sliver.
|
| This goes for doctors, drugs, surgeries, devices.
|
| If you want good results, you really have to take matters into
| your own hands, search for possible treatments yourself,
| evaluate several doctors until you find a competent one,
| research possible adverse side effects yourself etc.
|
| Example: somebody in my family had two different surgeries by
| non-standard methods that gave her significant advantages over
| the regular methods; one of them offered (to our knowledge) in
| only one hospital in Germany, the other in three. In both cases
| her regular doctors didn't know about these methods, and were
| really surprised to hear about them afterwards. In both cases,
| she learned about these methods through some non-medical
| channel (a relative read about it in a newspaper, stuff like
| that).
|
| If you just go to the next specialist for the field you need,
| chances are you don't get the optimal treatment, and the rarer
| the disease, the less like you get a good treatment.
| rscho wrote:
| Robot?
| ipaddr wrote:
| This is the reason why the US system is better than Canada.
| In Canada you can't shop around and need referrals for
| specialists.
| fpgaminer wrote:
| IIUC the vast majority of Americans don't have that
| privilege either and need referrals. You have to be on more
| expensive health plans to be able to pick your specialist.
| (That's been my past experience with HMOs). I finally got
| on a PPO recently and it was a bizarre but pleasant
| experience to just ... refer myself to a specialist :)
| s0rce wrote:
| Why can't you shop around? You aren't forced to go to a
| specific doctor. It certainly might be challenging but
| that's also the case in the USA.
| paxys wrote:
| You can find the best medical care in the world in the US
| if you have the means to pay for it. I don't think people
| will agree though that it is the indicator for the best
| healthcare _system_.
| ionicgiraffe wrote:
| I would even say that any person of any country with
| enough financial resources could afford and get the best
| treatment in whatever country of the world would happen
| to be offered.
| sterlind wrote:
| I think you can shop around in Canada, if you have private
| insurance. the universal healthcare system is just a
| baseline, to keep people from dying on the street after
| medical bankruptcy. many jobs offer supplementary health
| insurance as a benefit.
|
| the US just uses ERs as an infinitely shittier but equally
| costly version.
| jimbob45 wrote:
| >the complete lack of enforcement of what goes in supplements
|
| I agree with everything you said except for this. If resources
| are finite to approve and regulate drugs, 3rd-party supplements
| are the first thing I want tossed before any other more
| critical medication.
| kingkawn wrote:
| Welcome to medicine!
| egberts1 wrote:
| First hand experience.
|
| Totally useless as a decongestant for me.
|
| Stick with pseudoephedrine.
| sammalloy wrote:
| Now do cough medicine. The last time I looked at the literature,
| experts were asking why 95% of cough medicine was allowed to be
| sold when none of it was known to work. The list of OTC medical
| products that don't work is very large.
| emmelaich wrote:
| For some, pseudoephedrine make scuba diving _possible_.
|
| The difficulty of getting some is very annoying.
| twofornone wrote:
| I have the impression that many cold drugs are similarly useless.
| Dextromethorphan comes to mind[0]. I think its the nature of
| colds, they are not particularly severe and symptoms are easily
| influenced by placebo effects. Many of them are really just
| relying on caffeine for daytime meds and antihistamines for
| nighttime formulations. That whole market feels like a borderline
| scam.
|
| 0. https://pubmed.ncbi.nlm.nih.gov/11045895/
| annoyingnoob wrote:
| Are there any good decongestants?
|
| Seems like all of them have potentially serious side effects.
| Pseudoephedrine works but drives up my blood pressure. There are
| any number of sprays like oxymetazoline but they all create
| addiction issues if you use them too much.
| joecool1029 wrote:
| Phenylephrine does have one use that the author missed: It's used
| in ophthalmology to dilate the pupils before eye exams.
|
| On the topic of other use case medications, I used to take
| Sudafed (the real pseudoephedrine kind) during allergy season for
| a few weeks each year and noticed my productivity skyrocketed
| during that time, when I normally had issues context switching.
| Eventually I narrowed it down to taking Sudafed and saw this
| post: https://accidentalscientist.com/2005/08/the-sudafed-test-
| for...
|
| This lead to an ADHD diagnosis and proper meds and my life and
| work productivity improved pretty dramatically.
| belkinpower wrote:
| I ran into the opposite situation a few weeks ago. I was
| wondering why my allergies were so much worse on the weekends,
| and eventually narrowed it down to me only taking my ADHD meds
| on weekdays.
| throwra620 wrote:
| [deleted]
| astrange wrote:
| Bit disappointing that everyone starts commenting about
| amphetamines on a post about Sudafed working the same way as
| Strattera, which isn't a stimulant.
|
| Though him telling people Strattera has no side effects
| hopefully didn't surprise anyone when they went on it, it feels
| (literally) like being kicked in the stomach and can make you
| quite nauseous.
| joecool1029 wrote:
| I didn't like the safety profile on Strattera nor the
| inability to take it 'as needed'. Rare, but there were
| reports of liver injuries on it. My doctor seemed to be
| unimpressed in it when I asked about options on and said in
| her experience amphetamines almost always had the best
| efficacy in adult ADHD patients.
| trepetti wrote:
| The title is misleading as written in the article. It should be
| "The Uselessness of Phenylephrine as a Decongestant".
| Phenylephrine is a lifesaving medicine in emergency medicine to
| increase the blood pressure of people with hypotension.
| p_l wrote:
| The lack of availability of proper pseudoephedrine in USA led to
| situation where there are papers describing how to turn
| _methamphetamine_ into pseudoephedrine, not the other way around.
|
| With explanation in abstract that its easier to buy meth than
| pseudoephedrine.
| reincarnate0x14 wrote:
| It would be interesting to see if there were any reliable stats
| on how many, if any, people were caught by the ID check laws
| trying to manufacture from pseudoephedrine, because even at the
| height of the meth panic that engendered the laws something
| like 95% of pseudoephedrine outside of a handful of high-risk
| areas was very obviously not being used for any illegal
| purposes.
| stjohnswarts wrote:
| I don't about anywhere else but the only thing you have to do
| is walk up to the pharmacist and show an ID. I couldn't care
| less. I'm buying like a couple of weeks worth. I've had the
| same process in two different states, and not sure why it's a
| big deal? We can't have nice things because meth cooks were
| coming with shopping bags and stealing it all.
| cuteboy19 wrote:
| Are chemistry papers describing the synthesis of
| methamphetamine illegal?
| matthewmacleod wrote:
| No.
| techsupporter wrote:
| > With explanation in abstract that its easier to buy meth than
| pseudoephedrine.
|
| People may laugh at this, as they should since it is an absurd
| situation, but this isn't entirely wrong.
|
| Neither my wife or I drive and during the pandemic she gave up
| her license after getting an appointment at the DOL was
| difficult. Both of us carry US passport cards as our ID.
|
| This has resulted in several situations where we've been turned
| down for purchasing restricted items like alcohol or drugs
| containing pseudoephedrine, particularly the latter, because a
| passport card can't be scanned by the usual point of sale
| systems. There are a couple of places in Seattle that are happy
| to accept a passport card but even at them it's sometimes been
| dependent on who is working the counter that day.
| slaymaker1907 wrote:
| As someone who moved to Seattle during the pandemic, I knew
| when you mentioned getting an appointment with the DOL that
| it was probably WA. I had to go out to Wenatchee (2 hour
| drive each way) to get my license because everywhere else was
| booked.
| cdjk wrote:
| My favorite REAL ID compliant ID to use is my Global Entry
| card.
| Rediscover wrote:
| Gotta chime in on this. Seattle (in general a great place)
| has some pretty horrible things re: purchasing alcohol.
| Idiot/mis-placed store/bar-workers who only want a state ID.
| My U.S. passport=NO. My U.N. passport=NO.
|
| Freakin' weird.
|
| Edit: I worked at Boeing for eight years, _very_ often in a
| sec /reserved area. My passport was good there. Buying booze
| down the street from [Boeing] plant 2, no.
| mypalmike wrote:
| Weird. Even during covid when I was wearing a mask, I never
| got ID checked at a store in WA. It seems much laxer here
| than in other states I've lived in.
| ashtonkem wrote:
| Not entirely unique to Seattle, in my experience.
|
| Seared into my head is my experience of trying to buy
| alcohol in Boston back in 2009, when I was in town for a
| wedding. I had just turned 21 so buying alcohol was still
| novel and exciting. I had multiple bars and liquor stores
| refuse my valid Illinois license, forcing me to hand
| alcohol to my father to purchase, and find shady bars that
| wouldn't card me. It was extremely frustrating to have to
| rely on such tactics despite being legally allowed to
| purchase alcohol.
| morpheuskafka wrote:
| > My U.N. passport=NO.
|
| I wouldn't blame a regular store clerk for not knowing what
| a UN Lassiez-Passier is, especially since it doesn't have
| the word "passport" in the name. But a passport, especially
| one from their own country, definitely ought to be
| recognized.
| sbierwagen wrote:
| When I lived in downtown Seattle in 2010 I had no problems
| using a passport to buy alcohol. (Unfortunately, routinely
| carrying around my passport resulted in me losing it, and
| replacing a lost passport is a giant pain in the ass)
| mattkrause wrote:
| > People may laugh at this
|
| Not to spoil the joke, but the paper by "O. Hai" and "I. B.
| Hakkenshit" is satire--I would be absolutely gobsmacked if
| anyone is actually doing this.
| p_l wrote:
| The process described is true, but the authors are
| anonymous - and rightly snarky
| ericbarrett wrote:
| Why not get a non-motorist ID card? Every US state has these;
| here's Washington's:
| https://www.dol.wa.gov/driverslicense/gettingidcard.html
| michaelmcdonald wrote:
| I believe this is the key element:
|
| > she gave up her license after getting an appointment at
| the DOL was difficult.
|
| I'm not sure what DOL is a reference to; however I now many
| individuals struggled to get appointments at the Secretary
| of State (SoS) and that is also where one (at least where I
| live) would need to get a non-motorist ID. Same amount of
| frustration / time spent to get a non-motorist ID as it
| would be to renew your driver license.
| zacherates wrote:
| DOL = Washington Department of Licensing:
| https://www.dol.wa.gov/
| fragmede wrote:
| DOL ~= DMV = RMV
| cestith wrote:
| In Illinois, it's the Secretary of State's Driver
| Services office. In Texas, it's the Department of Public
| Safety, and your plates may be in one building/location
| and your driver's license/state ID in another part of
| town.
|
| Maybe the most honest state is Missouri, where plates,
| stickers for them, and your driver's license are all
| handled by the state's Department of Revenue.
| nostrebored wrote:
| But why get one? A passport/passport card is a _better_ ID
| document in almost every way. State non-motorist IDs should
| really cease to exist and we should increase access to
| passport cards
| [deleted]
| dylan604 wrote:
| Except for the way of not being scannable at point of
| purchase machines that was clearly stated. So if the one
| point qualifying for "almost every way" is hitting right
| out of the gate, then it doesn't seem to be that viable
| of an option.
| thrwy_918 wrote:
| >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
| InitialLastName wrote:
| 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?
| jacobsievers wrote:
| And, a government photo ID is required to get a passport.
| A state ID is very useful for non-driving citizens, as
| well as non-citizens.
| techsupporter wrote:
| We are aware of these. The reason is: Because unless you
| get the "enhanced" version, due to the ridiculous REAL ID
| situation you have to have another card anyway. For me in
| particular, where I work operates a medical clinic in a
| facility owned by the federal government so a non-enhanced
| card doesn't get me in the door, but a passport card does.
|
| For my wife, it's because she has even less tolerance for
| paperwork than I do and it's easier to just go to the
| pharmacies we know have their heads bolted on straight than
| it is to gather up all of the stuff and go to the
| overworked and harried DOL.
| [deleted]
| dylan604 wrote:
| Would that not still require an in-person visit that
| they've already stated was not possible? I'd assume the
| state would require a new photo for a new ID at the least
| to make an in-person visit required. Probably need new
| fingerpritns as well (if that's something WA does).
| f7ebc20c97 wrote:
| Society wouldn't function if people weren't willing to
| bend the rules.
| dylan604 wrote:
| Not really sure what you're on about here. There's a time
| and place where bending the rules is possible. Attempting
| to get a government issued ID and not following the basic
| rules of showing up in person is not really one of them
| in my book.
| hammock wrote:
| Many Americans have difficulty obtaining ID, because they
| cannot afford or cannot obtain the underlying documents
| that are a prerequisite to obtaining government-issued
| photo ID card.
|
| Underlying documents required to obtain ID cost money, a
| significant expense for lower-income Americans. The
| combined cost of document fees, travel expenses and waiting
| time are estimated to range from $75 to $175.
|
| The travel required is often a major burden on people with
| disabilities, the elderly, or those in rural areas without
| access to a car or public transportation. In Texas, some
| people in rural areas must travel approximately 170 miles
| to reach the nearest ID office.
| egberts1 wrote:
| All you had to do is ask for a free state ID card.
|
| - It's Federal law.
|
| I don't know why people keep forking over money for state
| ID. It's a state government scam.
| djrogers wrote:
| > Underlying documents required to obtain ID cost money
|
| Err, no they don't. At least not with any of the IDs I've
| gotten in California for the past several years....
| tshaddox wrote:
| Where can you get a certified birth certificate for free?
| scythe wrote:
| Yes, but you live in the People's Republic of California.
| Rebelgecko wrote:
| The county in California where I was born charges $32 for
| a birth certificate. Most (all?) of the proof of address
| documents also require you to spend money. If you already
| have multiple utility bills in your name it's NBD, but if
| you live with someone it could be a pain in the ass.
|
| Then a DL itself is another $40. A non-driving ID is like
| $30, although there's discounts depending on age and
| income.
| ericbarrett wrote:
| That's true and all, but the person I was replying to
| already has a federal passport, which suffices for all
| levels of state ID.
| dredmorbius wrote:
| Do you have any specific citations on that?
|
| I find it a credible claim. There was a story a few years
| back which made the rounds that ... turned out to be a
| case of fraud.
|
| http://www.miamiherald.com/news/nation-
| world/national/articl...
|
| https://www.inquirer.com/news/mark-damico-johnny-bobbitt-
| kat...
|
| That said, given frictions of obtaining ID and necessity
| of having same, I could well believe that this is an
| issue.
| deltarholamda wrote:
| The US would elect a baby-eating space alien from Tau Ceti VI
| as president if Zbleqq'takkx's primary platform plank was "make
| it so you can buy real Sudafed without a lot of hassle and
| faff."
| astrange wrote:
| Yeah, US voters do seem to like electing presidents for
| things only Congress has the power to do. Of course,
| presidents also like proposing things they can't do.
|
| Presidents' main differences are on foreign policy which is
| the one thing nobody asks them about.
| [deleted]
| arkades wrote:
| Pseudoephedrine is still available -behind the counter-. You
| literally just have to ask the pharmacist for it.
|
| Let's not turn grad students having a laugh into an actual
| statement on public policy.
| nanidin wrote:
| My state attempted to make pseudoephedrine require a
| prescription. One of the state lawmakers that was opposed was
| a doctor and he cited studies where phenylephrine was less
| effective than placebo. I wrote to my representative, who
| called me after voting for the bill to tell me that some
| sheriff told him phenylephrine is equally effective.
|
| Every time you buy the stuff from the pharmacist, they're
| logging the purchase in a national DB and you're signing an
| acknowledgement that it's a huge felony to go beyond the
| limit. But they never tell you where you are vs the limit,
| and the limits aren't clearly stated. End result: chilling
| effect.
|
| My mom timed her purchases incorrectly (family of 5 with mom
| shopping for all at the time) and went past the limit. After
| that she was flagged and had to have an actual doctor's
| prescription in order to purchase pseudoephedrine for 6-12
| months. That is a HUGE hurdle for most people, and doctors
| don't want to see people who have cold symptoms. Heck, I was
| turned away from a CVS Minute Clinic recently because I had
| COVID like symptoms in the last 7 days. As in refused to see
| me, even though I had recently tested negative for COVID and
| had a fever + persistent cough.
| ashtonkem wrote:
| "I asked a cop about how effective an OTC medicine is" is
| an absolutely insane thing for anyone to say, let alone a
| legislator. Sadly it does not seem like such behavior
| receives the social opprobrium it deserves.
| p_j_w wrote:
| Good to see your representative was getting his information
| on the effectiveness of medicine from a cop and ignoring
| the doctor. Emblematic of modern America.
| ibejoeb wrote:
| You don't just ask the pharmacist for it. You have to produce
| an acceptable form of identification that can be used to
| record the transaction in the universal database. It's
| unavailable to anyone who doesn't have one of those.
| leetbulb wrote:
| If you don't have any form of identification, getting
| pseudoephedrine from a pharmacy is probably not too high on
| your to-do list.
| ibejoeb wrote:
| I suspect you're wrong. How many people do you think
| would prefer not having medication to having medication?
| radicality wrote:
| He's definitely wrong. Sometime last year I had a cold
| and I know pseudoephedrine helps me.
|
| I ran out and wanted to buy some at the local cvs. Now,
| I'm not a US citizen but I've been here a few years
| already and am a permanent resident. I do not have a US
| state ID or a US driving license, and in my many years it
| has _never_ been a problem. Everyone was always happy
| with my green card as my ID - bars, domestic flights,
| international flights back to USA, bank account openings
| etc. But not for purchasing pseudoephedrine at CVS...
|
| I literally stood there with my green card and my
| European passport and was begging the cvs clerk to sell
| it to me, but the told me it's impossible, system doesn't
| accept those IDs (and they tried, even showed me their
| computer screen). And so I had to leave empty handed and
| with a runny nose, and came back later with an American
| friend to buy it...
| exolymph wrote:
| > Let's not turn grad students having a laugh into an actual
| statement on public policy.
|
| Not to put too fine a point on it, but... at least _this_ you
| can 't stop me from doing.
| gojomo wrote:
| Which means it's not available outside of the pharmacist
| counter's more-limited hours. And there's often an additional
| line to wait in before acquiring. And, as another thread
| points out, extra ID requirements.
|
| So how exactly do the costs/benefits on this "public policy"
| sum out?
|
| Benefits:
|
| * some grandstanding politicians enjoy the superficial
| appearance of being "tough on meth"
|
| Costs:
|
| * Americans waste $billions on an ineffective placebo
| decongestant
|
| * Legitimate manufacturers of a working medicine,
| pseudoephedrine hcl, lose sales due to extra
| cost/effort/stigma associated with the purchase. They shift
| real productive resources - inputs & worker hours - to making
| & marketing placebos instead.
|
| * Larger cross-border criminal organizations - of the kind
| that regularly murder politicians south-of-the-border - grow
| in market-share, sophistication, & power.
|
| * Meth continues to be available at high volume, & low costs,
| unaffected by the pseudoephedrine limits.
|
| * Recent meth formulations - likely prompted by the limits on
| the pseudoephedrine-process - seem to create a stronger &
| more-destructive addiction among abusers:
| https://www.theatlantic.com/magazine/archive/2021/11/the-
| new...
|
| If we don't listen to 'grad students having a laugh' who are
| pointing out the wasteful absurdities of 'public policy',
| we'll keep such nonsense destructive rules indefinitely.
|
| The 'serious folks' among politicians & suited 'public-
| policy' types are derelict in their duties.
| toast0 wrote:
| > Larger cross-border criminal organizations - of the kind
| that regularly murder politicians south-of-the-border -
| grow in market-share, sophistication, & power.
|
| Are you suggesting my neighborhood friendly drug dealer
| could hook me up with some real sudafed? Might be nicer
| than trying to get it from the pharmacy when I need it.
| leetbulb wrote:
| In my state, I'm able to walk down the road to a 24/7 chain
| pharmacy and buy pseudoephedrine whenever I want. The
| pharmacy, in combination with the state, uses ID to regulate
| how much an individual may purchase over some time frame(s).
|
| Most doctors will just write you a prescription and you can
| get it delivered to your home. Super easy.
| mypalmike wrote:
| Same here. But I think the edge cases are worth listening
| to as well. Green card residents, for instance. Sudafed is
| kind of a lifesaver for me at times and I feel fortunate to
| be able to buy it relatively easily.
| Johnny555 wrote:
| Around here, you pick up a card from the shelf with a picture
| of the product you want, then wait in line for the
| pharmacist. Then they say "Sorry, we're out of that one, what
| else do you want", "I don't know, what do you have", "sigh...
| here's what we have left...".
|
| Then you show your drivers license and the pharmacist records
| it and you pay and finally walk out with your sudafed. If you
| want to buy several boxes because it's allergy season, well
| too bad, you can't buy 2 boxes today, you have to come back
| tomorrow for the second one.
|
| It's actually easier to buy as a prescription, then the Dr
| can write you a prescription for any amount you need/want.
| dsp wrote:
| lol
| https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
| cjhveal wrote:
| Authored by O. Hai, and I. B. Hakkenshit
| BatmansMom wrote:
| "While N-methylamphetamine itself is a powerful decongestant,
| it is less desirable in a medical setting because of its
| severe side effects and addictive properties... Other side
| effects may include violent urges or, similarly, the urge to
| be successful in business or finance."
| [deleted]
| solveit wrote:
| Thank you for making my day.
| jjoonathan wrote:
| Phenylepherine has excellent "not being easily convertible into
| meth" properties, if only it had actual decongestant properties
| to go along with them...
|
| Sigh.
| bee_rider wrote:
| I bet sugar pills would be even harder to turn into meth.
| mh- wrote:
| And more useful, too. They can be turned into things like
| Pez, or Tic Tacs.
| chrischen wrote:
| I just recently got scammed by this. I'm not sure why they even
| allow selling and marketing this.
| akdor1154 wrote:
| For all phenylephrine oral is useless, FYI phenylephrine nasal
| spray seems to work well as a gentle decongestant, anecdotally
| much better than saline spray, and not as strong (or addictive)
| as oxymetazoline.
| AtlasBarfed wrote:
| My college buddy stayed with me about 22 years ago while he went
| to med school, and then when he graduated he moved out. I found
| after he left a box of phenylephine with "PLACEBO" scribbled over
| it.
|
| That is to say, this has been known for at least 20 years. And
| yet this big, ok, medium-big, lie persists.
| dr_orpheus wrote:
| There's only a couple drugs I know by name to look for on package
| labels and pseudoephedrine is one of them.
|
| The other one is diphenhydramine (an antihistamine i.e. Benadryl)
| because its common side effect of drowsiness means that its also
| one of the most common sleep aids. It has been more than once
| that myself or someone near me was having an allergic reaction
| and the 7/11 down the block didn't have any Benadryl but did have
| some sleep aid.
| baggy_trough wrote:
| Phenylephrine must be totally useless since pseudoephedrine
| barely does anything in my experience!
| [deleted]
| ygjb wrote:
| It's not super effective on me either, except for triggering
| crippling anxiety, but remember that we are outliers, and it's
| a very effective medication for most folks.
| throwawayboise wrote:
| Same. The original Sudafed did dry up a runny nose somewhat,
| but also made me jittery like I'd taken a big hit of
| caffeine.
| noobermin wrote:
| Man I have congestion so often and I always took phenylephrine
| and always felt it was hit or miss. Now I know it wasn't just me!
| thehappypm wrote:
| I need a tl;dr: what medicine should I take if I'm congested??
| JohnTHaller wrote:
| pseudoephedrine. The ingredient in Sudafed, Nyquil, etc that
| actually works. You'll usually need to go to the pharmacy
| counter to get it and show ID. They track how much each person
| gets because some folks were using it to make meth a while
| back. The replacement in the OTC Sudafed, etc out one the
| shelves, phenylephrine, doesn't work.
| Zak wrote:
| I wonder how difficult it would be to get the restrictions on
| pseudoephedrine rolled back now that it appears unlikely they're
| accomplishing their original goal of limiting the methamphetamine
| supply. Concern (legitimate and otherwise) over ability to
| breathe is a popular topic in politics lately.
| jrnichols wrote:
| Difficult. Dianne Feinstein was the figure behind the changes,
| as part of her war on drugs. She wanted pseudoephedrine made
| prescription only too.
|
| https://www.drugcaucus.senate.gov/press-releases/feinstein-g...
|
| ironically, OR and MS, the states listed in that report, are so
| far the only 2 that are starting to roll back the restrictions.
|
| Our elected officials seem adverse to admitting something
| doesn't work well and rolling it back, unfortunately.
| Zak wrote:
| Every time she's mentioned, there's something to make me
| dislike Feinstein more than I already did. It does seem
| likely her strong opposition would be a high bar to clear,
| though as the oldest current senator, she may not be a factor
| for a long time.
| noobermin wrote:
| Hate to do this but hopefully she will step down at some
| point, willingly or not due to her age.
| reincarnate0x14 wrote:
| It really is amazing how someone manages to be on the wrong
| side of seemingly everything, and yet is locked into office
| past the point of senility.
| noobermin wrote:
| Another arrow in my quiver for why the US is honestly not
| a country to bet on for the next 20 years.
| astrange wrote:
| The only countries with better demographic trends than
| the US are in Africa.
| sydthrowaway wrote:
| India?
| orthecreedence wrote:
| Yeah once in a while she does something and I think "ok,
| that makes sense." But she's generally a broken clock.
| vkou wrote:
| This means that either your calibration mechanism for
| 'wrong side' is flawed, or the system is rigged in a way
| that it consistently produces bad outcomes.
|
| Speaking for myself, am shocked and outraged that red
| senators and other congresscritters are consistently on
| the wrong side of seemingly everything, yet they keep
| getting elected. Of course, my political calibration
| mechanisms are quite in tune.
| Zak wrote:
| Feinstein is weirdly not aligned with the left or the
| tech industry given where she's from. Her strong anti-
| drug and anti-encryption stances are easy examples.
|
| If I had to pick a single organizing principle to
| describe her positions it would be a bureaucratic sort of
| authoritarianism (as distinguished from the strongman
| authoritarianism of someone like Donald Trump).
|
| I do believe the system is rigged in a way that
| consistently produces bad outcomes. The US Senate is
| structured to reward voters for keeping incumbents in
| office, and plurality voting virtually guarantees two
| dominant parties.
| orthecreedence wrote:
| > the system is rigged in a way that it consistently
| produces bad outcomes.
|
| Yes. That one.
|
| "Real" change (ie, still a useless liberal democracy, but
| at least a bit more in service to the people) would start
| with voter reform and getting rid of FPTP entirely.
| astrange wrote:
| You wouldn't like the results of either of those if you
| like "extreme" positions.
|
| - The most popular replacement for FPTP (which is biased
| away from centrism) is RCV (which is biased towards it).
|
| - FPTP does turn it into a two-party system, but US
| parties are weak. They don't control who joins them, who
| gets elected, or how anyone votes. In the UK you can
| actually get fired from the party for voting wrong.
| orthecreedence wrote:
| I don't care about "extreme" positions in the context of
| liberal democracies. I can confidently say that there are
| great improvements we can make within them while also
| supporting abolishing them entirely. I like to be at
| least somewhat pragmatic.
|
| RCV/STV is absolutely an improvement on FPTP in almost
| every way.
|
| As far as strong vs weak parties, that seems to be an
| issue with the UK. FPTP and weak-parties are separate
| sets. You could have FPTP with closed party membership,
| or RCV/STV with weak parties.
| reincarnate0x14 wrote:
| Feinstein's hard authoritarian and surveillance state
| preferences haven't endeared her to many people who are
| also shocked and outraged by the usual collection of
| utterly repugnant red senators, so option B there.
| [deleted]
| baggy_trough wrote:
| Very difficult. Regulations live on regardless of their
| negative effects because there's very little incentive to get
| rid of them.
| A4ET8a8uTh0 wrote:
| Worse, there is an incentive to keep them going as there are
| entire industries and associated careers built around them.
| astrange wrote:
| That's actually evidence they're good, since nobody's built
| a country with so many successful industries and no
| regulation. They wouldn't be able to solve the coordination
| problems.
| Zak wrote:
| For a long time, I've had the idea in the back of my mind
| that all laws should have expiration dates, and the maximum
| duration shouldn't be very long (12 or 18 years would be two
| or three senate terms in the US). Ideally, it would be
| combined with something to keep the scope of each bill
| narrow.
| baggy_trough wrote:
| It wouldn't work because what would happen would be a mass
| reapproval of all regulations.
|
| What I'd like to see is a constitutional amendment that the
| total body of federal laws and regulations can't be any
| longer or more complicated than a person of average
| intelligence can be taught in a week.
| kevinpet wrote:
| Or simply require that they be read in the house / senate
| before a vote. Not "read" but actually read, word for
| word out loud, by the sponsor.
| brimble wrote:
| > It wouldn't work because what would happen would be a
| mass reapproval of all regulations.
|
| Sunset provisions are an idea I tentatively like until I
| consider what happens with the fucking stupid, pointless
| "debt ceiling" crap Congress has decided to make
| themselves do. I imagine how fun it'd be watching months
| of idiotic brinksmanship over keeping murder illegal,
| because one group of legislators wants to grand-stand
| about abortion. Then repeat for practically everything
| else.
|
| No thanks.
| Zak wrote:
| I used to think a limit on the total size of the law like
| that would be a good idea, but some areas of regulation
| are inherently complex. I still hold a related position:
| an adult of reasonable intelligence should be able to
| easily learn all the laws that they're likely to
| encounter, _and_ learn which fields are subject to
| detailed regulation.
|
| To give an example, the regulations governing design of
| commercial aircraft can almost certainly be simplified
| from their current state without killing people, but
| probably cannot be simplified to the point that someone
| who isn't already an expert on aircraft design can learn
| them in a week without killing people. Knowing that field
| is subject to special rules is enough to avoid
| accidentally violating the regulations.
| baggy_trough wrote:
| Currently there's no limit to the complexity that
| governments can inflict on us. Since there's no garbage
| collection process for laws/regulations, we wind up with
| an enormous body of legislation and regulation which
| almost nobody understands or adheres to. It's terrible
| for the rule of law.
| cardiffspaceman wrote:
| Sunset provisions are popular actually. Jimmy Carter put
| that idea on his platform in '76, and it was carried out to
| some extent, and his own state was the example that sold
| people on it. I sense that they have waned since.
|
| I believe there are restrictions on the breadth of laws but
| they are not honored very effectively.
| dylan604 wrote:
| Pessimistic me says not likely. Once these regulations are put
| in place, it is nearly impossible to get them removed. It takes
| a literal act of Congress. Now you have to spend useless energy
| against attacks of "soft on crime/drug abuse/etc" types of
| nonsense for suggesting removing an item from the list. Don't
| bother resorting to facts. Those are useless in the emotional
| knee jerk reactions that will ensue.
| sva_ wrote:
| It probably still makes it a lot more difficult to make meth in
| a "homelab", as alternative synthesis paths are probably a lot
| harder. So they're leaving it to the "clandestine pros",
| ironically ;).
|
| Also, in legislation, it seems like making things illegal
| passes several orders of magnitudes more easily, than anything
| that gives normal citizens more rights.
| starwind wrote:
| WHY DO YOU WANT CHILDREN TO GET METH?--Opponents of rolling
| back restrictions on pseudoephedrine
|
| But more seriously, the FDA ends up regulating something like
| 30% of the economy and getting them to deregulate something is
| near impossible
| ashtonkem wrote:
| The restrictions the state places on us largely function as a
| one way ratchet, alas. There is a lot about American drug
| policy that is wildly unpopular, and yet here we are.
|
| A huge portion of the issue is that we're largely ruled by
| people who don't need to deal with any of the inconveniences
| they cause; if any senator or rep has a runny nose I'm sure
| they can get an aide to sort it out for them. The rest of us
| are not so lucky.
| JumpCrisscross wrote:
| > _how difficult it would be to get the restrictions on
| pseudoephedrine rolled back_
|
| Likely a non-starter until the FDA revokes phenylephrine's
| designation as a decongestant.
| eikenberry wrote:
| Pseudoephedrine restrictions were recently was rolled back in
| Oregon, where you had to have a prescription to get it. Now
| we're able to buy it over the counter with ID. So it can
| happen!
| rootusrootus wrote:
| It's happening slowly. Oregon had pushed it all the way to
| requiring a prescription to get pseudoephedrine. It does still
| require a visit to the store pharmacy and showing your ID to
| prove you are an adult, but at least you can buy it without a
| prescription now. I think only a couple states ever went that
| far. But at least it is a step back in the right direction.
| somebodynew wrote:
| The ID check isn't for age verification. Federal law requires
| IDs to be recorded* to enforce restrictions on the maximum
| quantity that an individual is permitted to purchase per
| month.
|
| * Edit: Where the word "recorded" appears, this comment
| previously said "scanned and submitted to a central
| database". While most states use a central database, the
| comment reply below pointed out that this goes beyond the
| minimum that federal law requires.
| rootusrootus wrote:
| I am not aware of a centralized federal database. My
| understanding is that federal regulations stipulate that
| the pharmacy must see photo ID and take note of who bought
| the pseudoephedrine, when, how much, and keep that
| information logged either on paper or electronically. To be
| available to law enforcement on request.
|
| The Oregon law does have a central database requirement,
| however I believe this is in all cases a decision made by
| each state individually.
| somebodynew wrote:
| You are correct, I was conflating two separate steps of
| the process. Federal law only requires keeping records
| and these could technically be done on paper. In
| practice, more than two thirds of the states participate
| in a central electronic database called the National
| Precursor Log Exchange.
| patwolf wrote:
| I'm also irked by the fact that OTC cough suppressants like
| dextromethorphan are equally useless.
| hammock wrote:
| 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)
| cardiffspaceman wrote:
| Chris Rock has a few brilliant, hyperbolic, minutes on how in
| some neighborhoods "tussin" is a cure-all.
| ConceptJunkie wrote:
| https://pubmed.ncbi.nlm.nih.gov/11045895/
| mrguyorama wrote:
| Mucinex (Guaifenesin) fixed all my illness cough problems. It
| makes your mucus thinner and produces more of it to make your
| coughs "more productive" which means you finally get that junk
| out of your throat. Eliminates tickly throat coughs and also is
| useful in pretty much all situations that involve coughing.
| It's a genuine magic bullet for me, where no cough suppressant
| has ever worked, through my entire 30ish year existence.
| djrogers wrote:
| In the vast majority of cases for my family, Dextromethorphan
| is a miracle drug. We're in the middle of cold and allergy
| season here, and my kids (and I) stop coughing within 5-10
| minutes of taking an appropriate dose.
|
| Once every 3-4 years I'll get a cough so bad that DXM won't
| fix, and when that happens my doc gives me a prescription for a
| codeine based cough syrup that fixes it (and renders me useless
| as a human being).
| genewitch wrote:
| I dunno, codeine makes me love my family even more, as an
| anecdote...
| mdoms wrote:
| When I get a cold I simply get plenty of rest and ride it out.
| Drugs are not necessary for minor ailments.
| codr7 wrote:
| I recommend simply getting a Yoga nose cleaning thingy, it will
| also help prevent getting sick in the first place.
| zaroth wrote:
| By the way, if you want something that works, that you can buy
| without a prescription, I cannot recommend "BronkAid" aka
| ephedrine sulfate 25mg highly enough.
|
| It's sold "behind the counter" in the US at major pharmacy
| chains, which means you have to ask for it by name, they won't
| even have the cards in the aisles that you then bring up and
| redeem.
|
| You have to show ID -- not sure if that's a Federal or a State
| thing, and you're limited in the quantity you can buy at once,
| but the limits are not overly restrictive.
|
| It's sold mainly as an anti-asthmatic. I personally have
| borderline asthma, meaning I've never had an asthma attack but in
| a test chamber my total lung volume increases 20% after puffing
| albuterol.
|
| It opens up my breathing tremendously, very useful as a pre-
| workout, has a nice nootropic effect, and for me personally does
| not cause any increased heart rate, although for many people that
| is an undesirable effect. Perhaps best not to stack with
| caffeine.
|
| And when I have a cold, I like it better than suppressants,
| expectorants, or even pseudoephedrine because I get clearing
| without turning into a leaky faucet.
|
| Just my anecdata...
| gojomo wrote:
| My understanding, consistent with your impression, is that
| ephedrine has more of a _full-system_ effect, including lungs
| & bronchial tubes, along with (in many people) more of a
| general full-system stimulation. In contrast, pseudoephedrine
| has a greater nasal/sinus effect with a bit less full-system
| spillover (but still noticeable in some people, or at higher
| doses, or in combo with caffeine).
|
| So it's worth it for people to be aware of ephedrine options -
| like ephedrine sulfate or ephedrine hcl ('Primatene') - but
| many will still find pseudoephedrine better for their symptoms.
| It's worth trying both, separately, depending on personal
| chemistry & concerns.
| djrogers wrote:
| Shh! Don't talk about the secret stuff! My pharmacies run out
| of it too often as it is...
| PragmaticPulp wrote:
| The article comes _so close_ to explaining a way to make it work,
| likely due to his hesitancy to recommend exceeding the
| recommended dose:
|
| > Why is oral phenylephrine so useless? It is extensively
| metabolized, starting in the gut wall. You can find a
| bioavailability figure of 38% in the literature, but that appears
| to be the most optimistic number possible, and you can also find
| studies that show 1% or less. Overall, the Cmax is highly
| variable patient-to-patient, and the lack of cardiovascular
| effects at low doses argues for very low systemic effects (and
| expected low efficacy as a decongestant). The bioavailability
| increases at higher doses as you apparently saturate out some of
| the metabolic pathways, but at the 10mg dose typically used for
| decongestants, you can forget it.
|
| Phenylephrine has variable Bioavailability. The bioavailability
| doubles if you take it with Tylenol, which is actually common in
| the context of colds. (Source:
| https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was
| probably chosen based on worst-case scenarios, whereas the
| average person who complains it doesn't work is probably
| absorbing much less.
|
| Always consult with your doctor, but I've found that taking a
| second dose of phenylephrine if the first one hasn't worked
| within about 30 minutes usually does the trick. Or just take it
| with Tylenol. It's worth checking your blood pressure to make
| sure you haven't started entering the realm of side significant
| side effects, though.
|
| Also I should point out that pseudoephedrine isn't available
| behind the counter everywhere. It's prescription-only in some
| places.
| JumpCrisscross wrote:
| Do we have a study showing these (second dose within 30 minutes
| or paracetamol + phenylephrine) performing better than placebo?
| PragmaticPulp wrote:
| We actually have a lot of studies where even standard 10mg
| phenylephrine taken alone outperforms placebo:
| https://pubmed.ncbi.nlm.nih.gov/17692721/
|
| Note that Figure 3 also mentions the Tylenol combination
| effect and even shows how 10mg Phenylephrine + Tylenol
| performs somewhere between 10mg and 45mg of phenylephrine.
|
| The article author just cherry-picked the one study where
| phenylephrine performed the worst. Cherry-picking a single
| study to support a conclusion and ignoring meta-analyses
| would normally get someone torn apart in the HN comments but
| apparently everyone loves pseudoephedrine so it gets a pass.
| natechols wrote:
| "Data from 7 crossover studies involving a total of 113
| subjects were reanalyzed and then pooled for meta-analysis"
|
| This is a huge red flag - I've read too many of Derek
| Lowe's blog posts to take that kind of study very seriously
| as medical advice. Much more promising leads than this have
| utterly bombed in clinical trials, it happens all the time.
| PragmaticPulp wrote:
| Read the whole abstract. They showed which studies
| reached statistical significance on their own.
|
| You could just read those studies and ignore the meta-
| analyses if you want.
|
| I honestly don't understand this current trend of
| assuming meta-analyses are inherently incorrect and
| cherry-picking the worst study as the source of the
| truth.
| natechols wrote:
| It's not the meta-analysis part that's the biggest red
| flag, it's "a total of 113 subjects". That's the size of
| a Phase I trial, and the road to Phase III and clinical
| approval has a crazy high attrition rate.
| epmaybe wrote:
| funnily enough, phenylephrine is used daily in ophthalmology for
| dilated eye exams. On that note, there's a bunch of esoteric
| drops that used to be used because of their useful
| pharmacokinetics, diagnostic/therapeutic abilities (cocaine,
| hydroxyamphetamine, pilocarpine 0.125%, homatropine), but are no
| longer being manufactured due to cost.
| boringg wrote:
| I used the, I believe, dayquil version one time (active
| ingredient pseudoephedrine) in the US and my ability to focus
| that day was on a completely different level even being sick. I
| almost wanted to keep using it for productivity purposes.
|
| Also love that I had to go to a controlled substance area of the
| pharmacy to get it.
| EamonnMR wrote:
| Sometimes I wonder if NSAIDs are the same deal, or if there's
| just a subset of people they don't work well on.
| throwawayboise wrote:
| Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen)
| does usually work. I used to get more headaches when I was
| younger, but I rarely get them now. Two things that have
| changed that might be related: I no longer use CRT screens, and
| I no longer drink diet soda (used to drink 4-6 cans a day, most
| days).
|
| Aside from headaches, Advil does better on other aches and
| pains than Tylenol, which does almost nothing. And it's better
| for the liver.
| genewitch wrote:
| better for the liver, worse for the stomach. It's a sliding
| scale, you have to decide how much you care about whatever
| hurts not hurting anymore versus damage to organs you can't
| even see.
|
| Also i used to get wicked headaches from diet soda when i was
| younger, too. Is it possible to be "slightly"
| Phenylketonuric? I had to google the spelling, and it's
| interesting that "hyperactivity and behavioral issues" is
| listed as one of the symptoms. I doubt "slightly" is
| possible, that was tongue-in-cheek.
|
| Also as an aside, for pain that the standard dose of
| ibuprofen doesn't seem to help, emergency medicine studies
| have found that an additional standard dose of acetaminophen
| alongside the ibuprofen has greater pain reduction efficacy
| than vicodin.
| JshWright wrote:
| There is a significant amount of evidence supporting the
| efficacy of NSAIDs. Note that they are more effective for some
| types of pain than others, due to the mechanism by which they
| work.
| skyechurch wrote:
| NSAIDs and Tylenol definitely work differently on different
| people and on different types of pain ime. The stronger ones,
| like Torodol, can be very effective on even quite serious pain,
| but you can't even get it _with_ a prescription anymore in the
| USA.
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