Comment by jnbiche | Hacker News Reader

Comment by jnbiche | Hacker News Reader

Parent Full thread

What if a pharmaceutical company invented a pill that resulted in a modest but significant reduction in the risk of heart disease in 90% of the population, but resulted massive increase in the risk of premature mortality in 10% of the population, easily shaving off 10-40 years in life expectancy in that 10%, depending on the severity of their reaction to the drug.

The company could find absolutely no way to tell the two populations apart prior to administering the pill. Most critically, once the 10% took the pill for a short period of time, they almost always ended up suffering the adverse effects.

Do you think the FDA would approve that pill? Do you think any sane doctor would prescribe that pill to his/her patients?

So absolutely, if you are sure you don't have any alcoholic tendencies (and if you have to ask, you aren't sure), then drink a glass or two of red wine a day (depending on your body mass). It will almost certainly improve your cardiovascular health.

But don't expect medical or public health professionals to go singing its praises from the rooftops to a partially at-risk population.

Are you really sure about that? Do you know Isotretinoin? You may want to do a little search about it. Look at the serious adverse effects and harms it cause [0].

Despite that, a huge numbers of doctors (in many countries around the world) do administer it. Why? Because it makes money for the pharmaceutical industry.

So the answer: Yes, the FDA will approve that magical pill.

*[0]: http://en.wikipedia.org/wiki/Isotretinoin#Adverse_effects

Criticizing Isotretinoin can only come from someone who doesn't understand what big of a deal acne can be. That drug saves millions of human lives from suicide.

Millions of lives from suicide? Only ~800k people successfully commit suicide annually, and somehow many people survived quite bad acne before this drug.

I'm not saying severe acne or associated scaring can't cause mental health issues, but the list of side effects includes suicidal ideation, suicide, birth defects (it's a teratogen), depression (notably at the rate of between one in 1k and one in 10k), etc. This list [1] is quite extensive, and I'm glad I didn't have to sit on the fda council that decided this list of side effects was ok in a drug that, after all, just prevents some cosmetic scaring.

[1] http://en.wikipedia.org/wiki/Isotretinoin

Did you go through the treatment? I was a victim of Isotretinoin, and at some point I might have lost my sight.

>Do you know Isotretinoin? You may want to do a little search about it

Yes, I know all about Isotretinoin. I took 3 courses of it as a teenager with severe, painful scarring acne. It improved my life a great deal, both from a health and social perspective.

Want to make any more assumptions about me?

If you know all about Isotretinoin, then we don't you speak to that instead of some perceived personal attack?

I think it's perfectly acceptable to assume someone may not know about something when it may heavily affect their argument and they haven't mentioned it.

The reason I was pissed off was the patronizing "you may want to do a little research". Not that he/she didn't know I had been on Isotreninoin.

I still think you are interpreting the statement as being far more condescending than it possibly is. You didn't mention it, it seemed relevant, so someone pointed it out, assumed you didn't know about it because you didn't mention it, and suggested you look it up.

I read it as trying to be informative, not condescending. More than a few upvotes on my response leads me to believe others interpreted it similarly. Maybe the subject is charged enough for you to create a bias for how you interpreted the response?

>Maybe the subject is charged enough for you to create a bias for how you interpreted the response?

Sure, it's possible. In fact, I'd say it's definite. I would never deny that I'm biased because of my life experiences with isotretinoin (which I knew as Accutane).

But by the same token, csomar is equally biased because of his/her negative life experiences with isotreninoin, as he mentions elsewhere [1].

And I don't know how else to interpret "You may want to do a little research" except as condescension. I guess if csomar is not a native English speaker, it's possible that's not how it was intended. But no native English speaker would write a statement like that without the desire to be arrogant, condescending and superior.

So the smart person will discount what we're both saying and do his/her own research, paying particular attention to published peer-reviewed research by neutral researchers.

But I think a thoughtful person with some numeric literacy will quickly see that the issue is not as black/white as csomar has painted it.

1. https://news.ycombinator.com/item?id=8280603

EDIT: I've already spent far too much time on this, so I can't respond to anymore replies. If someone makes a particularly good point against me, then I concede the argument.

And yet opiates are both approved by the FDA, and widely prescribed by doctors. As far as I know they carry a much higher addiction risk and increase mortality quite a bit more than alcohol does.

Benzos, amphetamines, SSRIs, etc etc. There are plenty of pills both approved and prescribed that have a worse effect and/or affect a higher percentage of people.

Opiates, benzos, and amphetamines are all highly controlled substances -- and most physicians only prescribe them long-term under very rare circumstances.

And actually, long-term opiate abuse is much less likely to result in organ failure and other chronic health conditions than alcohol is.

That's not the case with benzos or amphetamines, but I don't see anyone this side of Hunter S. Thomson arguing that more people should take amphetamines.

Finally, can you explain what you mean by "and/or affect a higher percentage of people"? You mean more people take SSRIs than abuse alcohol? I don't understand what you're suggesting.

Opioid[1] and Amphetamine[2] over-prescription is certainly not rare. Anecdotally, I know plenty of people that got sent home with a bottle of hydrocodone after dental surgery, which is not a rare case. There is an entire market based on prescribing these "highly controlled" substances to people who don't actually need them.[3][4][5]

While long term use of opiates isn't in itself harmful, long term abuse carries a high risk of overdose due to tolerance.

By "and/or affect a higher percentage of people", I mean that a higher percentage of people who take certain prescribed substances (like amphetamines or opioids) are at risk for addiction to those substances than those who drink alcohol.[6]

Edit: All of which is ultimately irrelevant, as your argument was "Do you think the FDA would approve that pill? Do you think any sane doctor would prescribe that pill to his/her patients?" and we both seem to agree that pills that have fewer benefits and just as bad if not worse consequences that your hypothetical drug are both approved by the FDA and prescribed by doctors.

[1] http://www.ncbi.nlm.nih.gov/pubmed/22786464

[2] http://www.gwlr.org/2014/02/03/cohen-2/

[3] http://www.northjersey.com/news/north-jersey-pill-mills-cash...

[4] http://www.tampabay.com/news/politics/stateroundup/after-pil...

[5] http://fox8.com/2013/04/18/doctor-pleads-guilty-to-running-p...

[6] http://commons.wikimedia.org/wiki/File:Rational_scale_to_ass...

Opiate abuse doesn't, but the bundled acetaminophen kills livers.

I think the previous posters' point was that becoming dependent on opiates happens more often than dependency on alcohol. I agree -- except in cases where there is genetic predisposition to alcoholism.

Two glasses of wine per day is not a healthy amount to drink. You get the cardio vascular benefits from much smaller amounts than that.

That depends entirely on body mass since the effect is dose dependent (one of the few things we understand well about the positive effects of alcohol).

> drink a glass or two of red wine a day

The red wine thing is bullshit, as mentioned in the article. Wine and beer actually have problematic amounts of estrogen. If you're going to drink, quality clear spirits are best.

If there's anything special about red wine it's probably the small dose of salicylate. Might as well just take a baby aspirin if you buy into that.

I don't buy the idea that alcohol itself is particularly biologically medicinal; I think the benefits are entirely by way of psycho-social well being. At a simple biological level alcohol, at even pretty high amounts, is merely benign. That said, problems like fatty liver disease appear to be often be the result of the interaction between alcohol metabolism and stored polyunsaturated fats. So if you're going to drink a lot, eat a low PUFA diet.

Reply on news.ycombinator.com