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Comment by zizzles | Hacker News Reader

Not surprising.

Trying to overcome faulty genetics with medication is a double edged sword. You are almost always trading one issue for another, tit for tat. Prostate cancer medication? Enjoy dementia. Chemotherapy treatment for cancer? Enjoy having healthy cells destroyed. SSRI for depression? Linked with autism in pregnancy, heart disease, numerous other issues. Steroids for improved performance? Gynecomastia. Ball shrinkage. Acne because of raised hormones. Accutane to fix acne? Liver problems. Crohns. Finasteride to retain your hair? Lowered DHT levels, diminished sexual drive.

That's just the tip of the iceberg. Mother nature seems to be an unstoppable force.

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No, that's not true.

A huge number of medical treatments and interventions have been developed - mostly over the last 100 years - that are way more beneficial than they are risky. Some treatments have side-effects. Some have unexpected, or long-term side effects. Some have awful life-altering side-effects. That's all true.

But to say "mother nature is an unstoppable force" to support the idea that all medical treatment does equal harm and good is crazy. Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century.

> Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century.

Public health interventions, such as clean water and vaccines, have lengthened life expectancy. Drugs haven't made much of an impact though.

Antibiotics?

And vaccines. Those two alone account for some huge chunk of our wins against death. The upthread posters are making a sorta valid point: the low hanging fruit has been picked, and recent innovations are more incremental. And that's true enough, though I agree that cynicism isn't the right response.

Statins are only about 20 years old. As are hypertensive drugs. Both have had clear impacts on longevity.

Can we be so sure that the next generation of superdrug won't give rise to a comparable revolution in reducing risk? I'm not, and I work in the pharma industry.

True, I'm not especially upbeat about the prospects of jobs here or the survival of individual pharma companies (oft mismanaged, IMO). But I do believe major innovations are on the horizon and may have major impacts, bigger than the aforementioned statins.

Gene therapy, pluripotent cell line therapy, immune system driven therapy -- these all have stunning potential on a wide range of targets. Yes, the future of traditional small molecule drugs is cloudy. But the next generation of genomics and biologics may blow your socks off.

Well the question is whether drugs overall improve people's life expectancy, not whether some specific class of drug can lengthen people's lives. Some drugs make people live longer, but other drugs decrease life expectancy.

And even with antibiotics in specific, they save lives, but they also kill among the most people of any class of drug. They're a clear win if you're a burn victim or something, but most situations that are less acute either go away on their own or else were treated successfully with plant-based antibiotics. Despite what the pharma industry would have you believe, there's no law of the universe that decrees that fungi-based antiobiotics should be inherently more effective that plant-based antibiotics, the main reason the former are used today is just that they're less expensive to mass produce.

Further proves my point: Antibiotic resistance. 300 million projected to be dead by 2050.

Tit for tat.

https://www.chemistryworld.com/news/antimicrobial-resistance...

https://www.theguardian.com/science/2016/mar/11/antibiotics-...

Although, why is my above post getting downvoted? Too cynical? I'm sorry. Next time I'll lie and say pharmaceutical industry is doing a splendid job and mother nature has taken second place and nobody is getting dementia from prostate medication.

Clearly, life is just roses and daisies here on HN.

Antibiotic resistance is a problem because antibiotics may not save as many lives in the future as they have in the past. That's not what "tit for tat" means. But it seems you've made up your mind already.

Wow. Such a bold indefensible statement. By any chance, are you running for President?

Children with infections might beg to differ with you. Or people with hypertension. Or coronary disease. Or HIV. Or diabetes. Or organ transplants. The lives of many millions like these added decades due to drugs.

The impact of vaccines on increasing life expectancy is simply staggering, and vaccines are virtually indistinguishable from biologic drugs.

Literally BILLIONS of people live for decades longer and better because of drugs.

> Wow. Such a bold indefensible statement. By any chance, are you running for President? [...] Literally BILLIONS of people live for decades longer and better because of drugs.

Too dumb to use Google?:

https://www.ncbi.nlm.nih.gov/pubmed/8007898

Ever heard of Penicillin?

I agree with both of you, but let me combine the thoughts.

An unknown number of medical advances do more good than harm. Maybe it's over 50%, maybe not.

Regardless, from the US citizens I've spoken with in several states, people often are not educated about know side effects when being put on a new drug. Many drugs have serious side effects and since most people are put on several over the course of a treatment, people need to be aware of the potential danger to a different area of their live / lively hood.

Medical error is still arguably the 3rd largest killer of US citizens, so misinformation (or a lack of communication) about side effects is very present as well.

> people often are not educated about know side effects when being put on a new drug

Since you're talking about the US, that's a defect with the people, not system. When you pick up a medicine from the pharmacy, the cashier asks if you want a consult with the pharmacist to talk about the medicine (including side effect). You can decline.

The medicine itself comes with an insert outlining usage and side effects in great detail.

If you don't know possible side effects of a medicine you're taking, you've got nobody to blame but yourself.

> The medicine itself comes with an insert outlining usage and side effects in great detail.

Senator Nelson called hearings (1970) when women started dropping dead from their birth control prescriptions [1]. The outcome of the hearings was that the drug companies had to warn their customers that their prescriptions might have side effects.

Eventually the drug companies realized women didn't need so much estrogen to shut down their menstrual cycles. All the old high-estrogen pills have now been withdrawn, but a few women still react very poorly to their birth control prescriptions. Doctors commonly don't consider the role that birth control plays in their patients' problems.

[1] http://swindledandpimped.org/womens_health_a_modern_tragedy/...

I agree people should read, but it starts with the doctors.

By the time they arrive to pickup a prescription they have already discussed everything with their doctor. It's kind of late to start questioning if this is the best choice or if there are other alternatives.

Though some still do.

That's absolutely true, but we often forget that all medical interventions have to be balanced in terms of risk and benefit. Most patients expect treatment when they go to their doctor, even when the only available treatment options are marginally effective and carry significant risk.

For a variety of reasons, healthcare professionals find it very difficult to refuse treatment. We tolerate the risks of treatment far more readily than we tolerate the risks of watchful waiting, which leads to a lot of bad clinical decisions.

From the opiate epidemic to antibiotic resistance to rampant increases in insurance rates, overtreatment is a slow-burning crisis in healthcare.

https://en.wikipedia.org/wiki/Unnecessary_health_care

Lift weights and cut calories? Accusations of steroid use for the rest of your days. Life is hard, man.

^Luddite spotted.

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