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Comment by pochamago | Hacker News Reader

My dad actually switched doctors because his original one refused to prescribe metformin to anyone who wasn't fully diabetic

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And rightfully so given the state of the evidence.

What would you consider satisfying evidence?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839379/ https://pubmed.ncbi.nlm.nih.gov/31405774/ https://pubmed.ncbi.nlm.nih.gov/31954752/ https://ncbi.nlm.nih.gov/pmc/articles/PMC4287273/

Years and years of widespread clinical practice would be my standard, but I'll make do with multiple large-scale randomized studies AND precise guidelines if absolutely necessary. As for evidence seeking, clinical research happens to be part of my job so I don't really need assistance, thanks.

> Years and years of widespread clinical practice would be my standard

How do you get "years and years of widespread clinical practice" if no one will let people try it?

The point of research is to have a controlled experiment. Not a bunch of individuals taking whatever they like on their own.

Research is not "years and years of clinical practice". Do you agree that "years and years of clinical practice" is not a good criteria to use for prescription, or are you just saying you don't use anything until other people have been using it for years and years. (and in this case, hasn't it been used for years and years?)

I don't use anything not covered by guidelines if I can avoid it. And in the event I can't avoid it, I'll always go for the more usual practice, i.e. the one backed by years and years of experience. If you want to participate in clinical trials, that's another matter entirely and has nothing to do with usual care or individuals taking whatever on their own.

I think that much was pretty clear already.

This is an appeal to authority.

Yes. To say that I don't need assistance. It spares people the effort of scouring Pubmed for nothing.

FWIW I didn't scour pubmed, I had already read those studies quite some time ago. I didn't just google "metformin pubmed" or whatever.

That seems like a silly standard, but do you.

It's the standard of one particular professional with 15y of clinical practice and research who's seen every kind of manipulation and incompetence in medicine. But yeah, it may be silly. We'll see about that in the coming decades I guess.

I'm not planning to take metformin but it was discovered a century ago and has been in use for half that time. A quick look shows me that it's the 4th most prescribed medication in the US. I find it hard to understand how this would not satisfy "years and years of widespread clinical practice", at least with regards to understanding negative implications.

But as you said, you can do your own research, so I'll leave things where they stand. You just sound more like someone who's annoyed by pop-science more than someone who actually has strong opinions about the article or Metformin.

I am well aware of the downsides of metformin since someone ends up in my ER (and sometimes dies) because of it most weeks. So you'll excuse me if an off-label and very new potential indication is not an immediate go for me. When we want to open a new indication for a particular drug, evaluation of the risk-benefit ratio for this particular indication has to be performed. There are many factors at play and results are completely unpredictable.

As for the rest no, I'm all for pop-science because it's what stimulates the interest of the masses. The problem in my eyes is more that academic medical studies available to the wider public are akin to a very sharp saw, and people will get cut if they don't know what they're doing.

Yeah I'd recommend you open up with information like that in the future, just right off the bat. It's a lot more interesting and at least somewhat useful.

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