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By Josh Witten | October 21st 2009 05:16 PM | 16 comments | Print | E-mail | Track Comments
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About Josh Witten

100% of this the rugbyologist's revenue is donated to Doctors Without Borders (Medecins Sans Frontieres). A click on one of my articles is a click that helps bring high quality medical care to the... Full Bio

There are benefits to being an emotionally deficient scientist. At least, there probably are. You can't prove a negative[1]. Anyway, there are definitely some drawbacks. One of which is the list of things that irritate you to no end, like getting credit for doing something absolutely useless. Like using a diaper service[2].

After bad marinara sauce, rubbery calamari, and anti-vaccine quackery, my number one irritant of the moment is the public conception of pharmaceutical "side effects". This B&M[2] was prompted by the following post at MrXStitch, which, despite the hilarity of the NSFW cross-stich Saturdays (NSFW, duh), got itself naturally selected out of my RSS feed. This was not intended to be cute, but to show the "scariness" of prescription medications (the title is "Say No to (Scary) Drugs").

While the side effects and interactions of any pharmaceutical should be taken very, very seriously, they need to be put into the proper context. AltMed woonackery, especially in the form of "natural" remedies and homeopathy[4], has changed the nature of the debate making "no side effects" the goal.  Why does the woonackery not list side effects on their boxes and legitimately claim "no known side effects"? Because they are not required to test their products for safety or efficacy.

While I personally know no people named "Seven", that does not mean that I can conclude that there is no one named "Seven", never has been a person named "Seven", nor will there ever be a person named "Seven". I'd have to do some serious research before I could make any such statements.  

Where do those long side effect lists come from? They generally come
from placebo controlled, random, double-blinded clinical studies, in
which the side effects exhibited by patients are painstakingly
documented and reported[6]. Not only is this required for FDA approval,
but is essential for allowing doctors to make accurate cost-benefit 
assesments of treatments.

Think about it. What are the odds, really, that you can have a treatment that not only has a strong effect on a biological process and whose effects are completely confined, in a positive direction, to that process. Biology is compicated folks.

According to the artist Mandyhello:
A few months ago, I had what I thought was a little headcold and my
doctor prescribed me 3 different medications (I didn't fill any of
them, and got better in about a week).  Before that, I went in for my
yearly exam, and she tried to prescribe 3 (different) medications
(including something for allergies, and I've never had allergies). . .Lately, I've been trying to let my body alone, to not add any chemicals I don't have to..[sic] 

Say it with me: cost-benefit analysis. I have no way of knowing whether Mandyhello's doctor is a good doctor. But, the knee-jerk philosophical opposition to prescription medication makes no sense. Happily, Mandyhello[8] got better in a relative short period of time. Of course, she could have had recovered more quickly or with less intense symptoms had she followed her doctor's advice. You know, Mandyhello, they don't prescribe them for fun. Well most of them don't. No one is perfect.

NOTES:
1: Which, oddly enough, means that we cannot prove that statement. Or this one. Ad infinitum.
2: Which is fine, if you do, because there are a number of pros to that approach, but you are not saving the environment. Water usage is a bigger problem than landfill fillage.
3: Which stands for "bitch and moan" [7], which I put down here, because I like to believe Hank hates it when I cuss. That whole not-being-Puritanical thing is just a facade, and you know it.
4: Which, when they aren't pretending to be homeopathic, actually does have no side effects other than being thirst quenching[5].
5: But no more thirst quenching than placebo.
6: When done correctly.
7: Not to confused with a "BM". All you parents of babies in day care know what I mean.
8: Doesn't that make you want to go "Mandy, HELLO!"

Comments

Gerhard Adam's picture
I don't think there's necessarily a "knee-jerk" reaction, although I'm sure many people feel that we tend to be over-prescribed in many ways.  So, unless people are feeling particularly bad, most view doctor's as being a bit zealous about writing prescriptions even when it doesn't seem warranted by the patient.  This perception seems to be supported (or at least implied) by the following statements.
American consumer groups have expressed concern about the way
pharmaceutical companies lavish gifts and speaking fees upon doctors.
They say this may influence what drugs doctors prescribe.

Consumers International says they’ve documented that 50 percent of the
drugs in the developing world are what they call irrationally
prescribed. This means the drugs are unnecessary, or they’re prescribed
in doses that are too large, or expensive drugs are prescribed in place
of generics.
http://www.scientificamerican.com/podcast/episode.cfm?id=0AFF2ABE-0902-9394-4191EF703EFAF959

jtwitten's picture
It is knee-jerk in the case of an individual if the position is absolutist and not evidence based, which are mutually exclusive.

How does the fact that alternative medicine is generally a crock of superstition and false hope somehow validate the medical/pharma establishment? The way we live - eat, drink, work, breathe, interact, etc - is, in general, way out of line with the evironments in which our ancestors evolved.

The medical establishment is based on the idea that the disorders stemming from this sick environment can be addressed satisfactorily with pills that are taken for a specific purpose, even though, as you mention, they affect myriad known/unknown systems of the body in powerful, inevitably detrimental ways. And you buy this?

jtwitten's picture
Since they have apparently extended WiFi coverage to the semi-arboreal habitats at the forest/savanna boundary in the Rift Valley, I suppose any comments about the increases life expectancy, span, and quality as we move away from ancestral modes are now irrelevant. I am curious to know after which ancestor should we be modeling our lives?

And, "inevitably detrimental"? That's just being pessimistic. In the real world, you cannot have benefit without cost.

Was I just called a monkey by a f****ing rugby player who writes like a hs dropout?

Maybe we should base it on the ancestors who didnt extend their lives to miserable lengths with pharmaceuticals (that would be any of them)? And increases in quality? Really? Before you break out the antibiotic championing, read up on that whole AB resistance thing that's coming our way...

And "inevitably detrimental" is a less retarded way of saying "you cannot have benefit without cost."

jtwitten's picture
The powers that be might not like it, but I don't mind if you swear. Go ahead and use your big boy* letters.

Far from intending insult, I was optimistic that you had embraced the lifestyle of our ancestors that you championed so passionately. Based on the recent Ardipithecus finds, it appears that our hominid ancestors lived a semi-arboreal lifestyle on the forests boundaries. I'd never call you a monkey (unless you are a typing monkey, which would be really cool) as that would be phylogenetically imprecise.

There is not much evidence to support the idea that antibiotics have improved life expectancy. Now vaccines, sanitation, and that not getting eaten by leopards thing that our ancestors had to deal with on the other hand. . .

*Or girl. I don't want to be biased, but that whole boy/girl thing ruins the rhythm (Strunk's got my back on this one).

Hank's picture
Was I just called a monkey by a f****ing rugby player who writes like a hs dropout?

Productivity is going to grind to a halt until I figure out what that word is.   I can narrow it down though, contextually.   'Frothing', maybe, but 'farthing' would make no sense at all, for example.

And a biologist here called you a monkey?   That's in defiance of the evidence, I agree.   Darwin's greatest fear was the biologists would continue to get evolution wrong but, thankfully, he knew anonymous people on the internet would fix it all up.

Becky Jungbauer's picture
Productivity is going to grind to a halt until I figure out what that word is.

Flirting? Flipping? Frogging? Fainting? There are so many options! We
know it can't possibly be a swear word, as there are one too many
asterisks in f****ing and clearly someone whose name is "its a sh** sandwich" wouldn't add an extra asterisk unless it was in some obscure ironic sense. Then again, you'd think that person would also use proper punctuation, but alas we can't all be sh** for brains.

Wow, next time I'll make sure to count my asterisks. Judging by all the ad hominems, your as-yet-to-be-revealed counter arguments must be really strong...

You guys really seem threatened by me pointing out the obvious. Reminds me of alt med people.

For those of us trying to honestly figure things out, that's kind of a sh** sandwich.

Hank's picture
Judging by all the ad hominems

What ad hominems?  That was r***cule.

You're disputing things that make no sense.  Josh does not know it, but one of the first css guys I contracted for the beta of this site is named Seven.  This does not overthrow his article.

jtwitten's picture
If you can provide orthogonal data to confirm your single observation, I will accept the existence of people named "Seven", although he may just be a statistical anomaly.

Yes, I am disputing things that make no sense. Glad you follow. Surprised, but glad.

All you had to ridicule was hastily typed punctuation. What exactly do you dispute regarding my original post? Read something about how cancer rates correlate with modernization, pollution, etc.

Hank's picture
Living longer correlates to more cancer too.  Your correlation-causation arrows are what are going off in strange, disjointed places.

In the 1800s people moved to Colorado because the dry climate was good for tuberculosis.  So more people died of tuberculosis there than any place in the country.  To you, that means Colorado caused TB.

The cancer-industrialilzation correlation holds up when the factor of population size is controlled...

Beyond leaving that obvious point out, I haven't asserted any kind of logic that relates to your example.

I'm not making any kind of Noble Savage, "everything was great in the evolutionary past" argument. I'm just pointing out that modern medicine is not all that it's cracked up to be by the "science will save us" crowd.

jtwitten's picture
So does the industrialization-cancer detection correlation, including false positives.
The way we live - eat, drink, work, breathe, interact, etc - is, in
general, way out of line with the evironments in which our ancestors
evolved.

This is saying that many of our medical problems would be to revert to ancestral modes and habitats.

Science and medical practice only partially overlap, sadly.

All of this is a devastating argument, but my patience waned...

Has anybody considered asking this chick why she went to a doctor in the first place?

START
Feel weird
Omygod maybe I'm gonna die ****(true enough)
I want somebody to hold my hand...
They're trying to poison me with drugs!
Fuck 'em, what do they know?
GOTO START
STOP***(die)

Oookay....

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