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Comment by wantsanagent | Hacker News Reader

This is a big hammer. Please note this section:

"A proton pump inhibitor (PPI) pantoprazole 40 mg/day was also prescribed for gastric protection. Such a regime must only be followed under strict and qualified medical guidance to obviate any dangers, especially haemorrhagic bleeding, and of the therapy as a whole."

Induced hemophilia is no joke.

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To be clear in case it's not clear to others, the PPI is not the 'regime' that creates the risk of bleeding, it's the thing you take to provide some stomach protection against the damage/potential damage from the other drugs.

Right. PPIs are available without prescriptions in the US, and are considered very low risk medications.

Using PPIs for a short duration is safe, using PPIs chronically is not safe and the risks have to be weighted very carefully. It's by far the most intervened on medications by clinical pharmacists (usually discontinuing for inappropriate use)

Maybe. Here's a skeptical view: "Despite a large number of studies, the overall quality of evidence for adverse effects of long-term use of PPIs is low to very low." [0]

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463334/

10 years ago, as a young post-grad I spent a ridiculous amount of hours analyzing ALL the published peer-reviewed literature on the pros/cons of PPI prophylaxis for CVD patients and published my results in a peer reviewed article. I am literally the expert in that topic lol. Here is a nice paper[0] by Adly (me!), et al. I am biased, but I find it to be very comprehensive (and an excellent cure for insomnia!)

[0]: https://pubmed.ncbi.nlm.nih.gov/23386069/

Awesome, what else can you teach us about PPI that isn’t mainstream knowledge

On the other hand, it has been linked to much higher rates of autoimmunities:

https://doi.org/10.3389/fimmu.2021.736036

Many of those autoimmune disorders cause pain and inflammation. And many pain relievers and anti-inflammatories can cause damage to the stomach lining, which leads to a prescription for a PPI. I don't see any accounting for this possibility in the paper (that ADs cause PPIs, rather than vice versa).

yikes, PPI's. As a GERD sufferer thats come off PPI's after years of use, I wonder if non GERD sufferers will get the "kick back" when they come off the PPI's.

Do people really get holes in their stomach often enough that this regiment would cause them to bleed to death?

Yes. Absolutely. GI issues are some of the most common medical problems. Ucers, polyps, sores, diverticula...

My dad got a hole in his stomach from taking too much Advil (ibuprofen) for pain related to a broken vertebra.

jeez. NSAIDs can do some nasty stuff when taken regularly. Most people just pop 'em like candy.

> Induced hemophilia is no joke.

Note that this is one of the possible side effect mentionned in Pfizer documentation of their covid vaccine, reported in article research articles like [1], and it doesn't seem to bother too much people.

[1] https://pubmed.ncbi.nlm.nih.gov/33783953/

I don't see where the research article mentions a link to Pfizer (i.e.: acknowledgement, confirmed side effect, etc.) and googling the terms + "pfizer" brings up no official documentation about it.

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