[HN Gopher] New treatments give an example of how treating one p...
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       New treatments give an example of how treating one patient can
       benefit others
        
       Author : jseliger
       Score  : 22 points
       Date   : 2023-09-21 14:59 UTC (8 hours ago)
        
 (HTM) web link (randomactsofmedicine.substack.com)
 (TXT) w3m dump (randomactsofmedicine.substack.com)
        
       | uslic001 wrote:
       | One of the great successes of modern medicine. When I first
       | started treating Hepatitis C patients in 1995 our Hepatitis C
       | treatments had terrible side effects and rarely worked after 48
       | weeks of treatment. Now the treatments are 98% effective in 8-12
       | weeks and have minimal side effects. People need to stop saying
       | that big pharma doesn't find cures.
        
         | spondylosaurus wrote:
         | One caveat to "big pharma finds cures" is that, to my
         | understanding, a lot of the _research_ is done via public
         | institutions, big pharma just handles the manufacturing and
         | distribution.
         | 
         | I know adalimumab's discovery was funded (at least in part) by
         | government grants, but Humira still made AbbVie richer than
         | god.
        
           | sudosysgen wrote:
           | Big Pharma also often handles the clinical trials and
           | approvals. I don't know if there is a mechanism for a public
           | lab to get approval for a medicine? Probably if we found a
           | way to drive down the cost of clinical trials, we'd be able
           | to structure the system in a way to eliminate the middle-men
           | here, but that's much easier said than done.
        
             | spondylosaurus wrote:
             | Ah, good point... are clinical trials expensive to run?
        
               | sjducb wrote:
               | A couple of billion per drug.
        
               | PeterisP wrote:
               | They are a bit more than half of the total drug R&D
               | costs, so they cost more than all the research,
               | experimental synthesis and pre-clinical experiments
               | combined. If you've discovered a drug which works in
               | vitro and on animals, and want to start clinical trials,
               | you're not even halfway done.
        
       | murphyslab wrote:
       | There's a lot of literature in medicine of how often one small
       | subset of patients consumes a disproportionate level of
       | healthcare resources, i.e. the Pareto principle. It's fantastic
       | seeing just how much providing _effective_ treatment for that
       | small subset offers drastic benefits to everyone else. For liver
       | transplants, it 's a very 1-to-1 situation, but for other
       | resources such as hospital beds, the ripples probably go much
       | farther.
        
       | Herodotus38 wrote:
       | This is a good article. One of the sad things is that the rates
       | of NAFLD (non-alcoholic fatty liver disease) are increasing in
       | proportion to the increase we see in morbid obesity, diabetes,
       | etc... and this can also lead to cirrhosis and the need for liver
       | transplantation.
       | 
       | https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
       | 
       | However, with the newer GLP-1 agonists (like
       | Ozempic/semaglutide), we might be seeing an ability to better
       | treat NAFLD and its downstream cirrhosis.
        
         | m463 wrote:
         | I've been listening to "The glucose revolution" and I believe
         | getting glucose monitors into the hands of the general public
         | might prevent a lot of this.
         | 
         | Right now continuous glucose monitoring requires an expensive
         | patch, lasts for a finite time and is available to few people.
         | 
         | The holy grail would be a non-invasive monitor such as a watch.
         | 
         | It seems avoiding glucose spikes might be the key to preventing
         | much nafld, diabetes, obesity, heart disease, etc.
        
           | thimkerbell wrote:
           | What is the most convenient and cost-effective spike-
           | flattening food that you could take with your high-glycemic
           | meal?
        
             | m463 wrote:
             | Haven't gotten through the whole thing, but it is
             | enlightening in lots of ways, not just "eat this".
             | 
             | For example, I like what it said about eating your food in
             | a different order. With no change but the order - eating
             | fiber first, then proteins and fats, and carbs last - your
             | glucose spike will be minimized, by quite a lot.
             | 
             | It also said we get cravings when our blood sugar drops.
             | And it always drops after a spike.
             | 
             | also, walking for 10 minutes after a meal helps lessen
             | spike.
             | 
             | EDIT: good summary someone prepared:
             | 
             | https://www.believebig.org/wp-
             | content/uploads/2022/12/Glucos...
        
               | thimkerbell wrote:
               | A restaurant should do this, rather than bringing out the
               | bread first. And show how helpful/healthful it is.
        
           | thimkerbell wrote:
           | If a physician randomly hands these blood glucose monitors
           | out to some motivated but non-health-nut people, has them try
           | it for a week, do they develop long-term better eating
           | patterns?
        
             | m463 wrote:
             | I believe that's basically what happened in the author's
             | case.
        
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       (page generated 2023-09-21 23:02 UTC)