All: please don't perpetuate flamewars. It's not what this site is for, and it destroys what it is for. When it starts happening, the most important thing is not to feed it. All this is in the site guidelines:
Bi-weekly, 5mg doses of prednisone to treat chronic pancreatitis have extended the life of one of my cats going on 5 years now, and greatly increased her quality of life in her senior age. The same dose occasionally treats another cats intermittent IBD that otherwise, before treatment, would eventually progress to triaditis and hospitalization.
Yes, it has side effects, and patients should be made aware of that. But acting like it's something that should never be given is ignorant at best. It is cheap, widely available, and is a first-line treatment for a number of conditions.
Try getting medical care for someone allergic to pred and watch how confounded the doctors are how to proceed.
Medical history is replete with drugs and treatments that every doctor prescribed all day every day, until they didn't. If you had a stomach ulcer in 1990, the approved "treatment" certainly would have included a bland diet. Now they know it's caused by a bacteria.
Sinus rinsing is something else that's been covered here. It is NOT disapproved by doctors, at least, but I don't think it would be the first recommendation most of them would give you.
(We might blame that one on patients who want a drug for everything, or else they're not getting their money's worth.)
The sad truth is that you always have to look out for yourself. You need to take care to read up on your conditions and your prescribed treatments, but don't let that fool you into thinking you've got a medical degree or that doctors are out to get you, or that science isn't trustworthy. Most doctors are doing the best they can to make you feel better using the best understanding of medicine and biology we currently have. You may look at medical history as a series of errors and mistakes, but it really just shows the progress of our understanding.
Things like sinus rinsing have their uses. It may not be the first thing doctors recommend to people, but there are likely several reasons for that beyond people demanding pills. The main reason being a lack of strong evidence that supports it being more effective than current recommendations which may be easier for people to do and/or carry fewer risks. As soon as the data overwhelmingly supports recommending sinus rinsing over current treatments, doctor's recommendations will start to slowly change.
My point is, watch our for yourself and be careful, but don't let bad experiences or bad actors cause you to lose faith in the process itself.
Doctors are not out to get you, but they aren't perfect either.
When you suspect sockpuppet abuse on HN, I've found it highly effective to email dang directly (hn@ycombinator.com) rather than engaging further with the suspected bad actor (though I admire and commend your diligence and steadfastness ;).
HN is an internet watercooler—not an academic journal. The goal is to have curious conversation. Conversation involves anecdotes and it involves people being wrong about things, including important things, much of the time. People are allowed to be wrong here, and when they are (or you feel they are), piling on or shaming them is not helpful. It is only going to evoke worse reactions from themselves and from others, and throw the thread off balance.
Fortunately, we don't have to look far for examples of how to get this kind of thing right. These other users all responded to the same comment in a conversational way:
https://news.ycombinator.com/item?id=30042547
https://news.ycombinator.com/item?id=30041780
https://news.ycombinator.com/item?id=30040903
https://news.ycombinator.com/item?id=30040694
https://news.ycombinator.com/item?id=30040674
They made much the same point that you did, but they did it respectfully and in keeping with the site guidelines: https://news.ycombinator.com/newsguidelines.html. If you'd please review the guidelines and use HN that way too from now on, we'd be grateful. Of course it's not always possible—we all have our triggers and we all get into states where the internal reaction overflows. But in those cases, it's important not to post.
> I am not judging or insulting you
I believe you are the wrong one to evaluate that. Not after you abstract-ify this into "conspiracy theory" and all sorts of things I didn't say.
I didn't "obliquely claim that doctors do not get training on prescribing prednisone." Of course they do. I'm not anti-vax, either.
I'm sure this vet did "get training" but I cut her some slack: it's the 27th most prescribed drug in the formulary, and she sees hundreds of pets per week, and probably most of the ones she gives it to, get well. Yet: another vet at the same clinic had no issues with my objection, and gave me a different drug instead. The dog's not licking his paws constantly and has no other symptoms, so I count that a successful objection.
So find some other outlet for your passions today.
How much "training" do you think doctors get with respect to the thousands of drugs that they may prescribe? Doctors are almost all specialists, and read the same side effects labels (or google them these days) that you do. You are not required to rely exclusively on your doctor's risk/benefit analysis for a given prescription. Furthermore, as the commenter pointed out in his example, often times doctors simply do not know what is causing a problem and will throw drugs at it - a lot of medicine is guesswork.
>Prednisone is on the WHO's list of essential medicines
Which says nothing about its side effect profile
>The fact that it can be dangerous when misused is not in any way evidence that it should never be used.
Drugs have side effects even when not misused.
>Put simply, your stance is anti-science. I hope that you will reconsider it. Whether or not you do, I hope that no one reading your comment puts any weight on your opinion, which is not grounded in fact or knowledge.
Not treating a doctor's word as gospel truth is hardly "anti-science" - on the contrary, blind faith is anti-science. And what is researching a drug's side effect profile if not grounding oneself in "fact or knowledge"?
Doctors make mistakes. Not proactively sanity checking their treatments is irresponsible when you have the same resources that they do.
I said: "prednisone is on the WHO's list of essential medicines," which is very strong evidence that the claim is incorrect.
Your response obliquely claims that doctors do not get training on prescribing prednisone, by making reference to thousands of drugs that a doctor might prescribe. This is not an argument, it is an insinuation. You have no idea how much training doctors get, nor apparently are you aware that in 2019 prednisone was the 27th most prescribed drug in the United States [1]. It also has well known and possibly severe side effects. If, as you obliquely claim, doctors are not trained in its correct use, then it must also be the case that medical schools are astonishingly incompetent.
I will note at this point that I am referring to your oblique claim because I suspect it was intentionally stated vaguely so that you could attempt to slip out of any counterargument merely by saying that you meant something else.
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Stepping back: the belief espoused in this thread is nothing short of a conspiracy theory, and you are engaging in classic conspiratorial thinking in order to support it.
I encourage you, and anyone else reading this thread, to read "The Conspiracy Theory Handbook" by Stephan Lewandowsky and John Cook [2].
Let's go through the ways in which your argument maps directly to several of the hallmarks that are listed on pages 6 and 7 of the above pamphlet. I'm certain that if we continued this conversation (which I will not) we would see even more examples of such thinking.
- Contradictory: you believe that doctors are specialists, and yet you appear not to believe that the specialist doctors at the WHO who decide which drugs are essential are qualified to balance the benefits and the side effects.
- Overriding suspicion: if, as you claim, doctors throw drugs at problems with such frequency that one should almost never take a doctor's advice to take prednisone---in spite of the fact that it was prescribed nearly 23 million times in 2019---it must be the case that doctors are almost uniformly some heady mix of incompetent and malicious.
- Immune to evidence: your response to my argument makes clear that you are not interested in reconsidering your position on prednisone---your belief system is a closed epistemological loop. The WHO's listing prednisone as an essential drug makes not a dent on your claims about its side effects---never mind that it is completely outlandish and unreasonable to believe that a cost-benefit analysis would not be considered when selecting a drug "with due regard to disease prevalence and public health relevance, evidence of efficacy and safety and comparative cost-effectiveness" [3].
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I am not judging or insulting you. It is easy to fall into a pattern of beliefs that is not supported by facts, and to begin to identify with the beliefs themselves rather than the evidence that backs them up. I implore you, examine your beliefs and take seriously the possibility that you have fallen victim to conspiratorial thinking. The pamphlet I have linked above is a short and very worthwhile read, and I am confident that if you take its contents seriously you will gain valuable perspective.
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[1] https://clincalc.com/DrugStats/Drugs/Prednisone
[2] https://www.climatechangecommunication.org/conspiracy-theory...
[3] https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021...