5 ms·

"Under-dosed" would avoid most of the trouble. If someone said "Maybe the patient isn't an addict, maybe they're under-dosed", anyone could understand this. Nob

"Under-dosed" would avoid most of the trouble. If someone said "Maybe the patient isn't an addict, maybe they're under-dosed", anyone could understand this. Nobody would have philosophical debates about nuances between "under dosed" and "addicted", whereas it's no surprise people are skeptical when contrasting "pseudoaddiction" vs "addiction". The author says "pseudoaddiction is as good [a term] as any other", but I disagree. Most of the trouble he describes could be avoided by using a more descriptive term. "Pseudoaddiction" doesn't even refer to the patient, it's about second-guessing a diagnosis, which makes it really difficult to contrast.

noodlenotes 7y ago
I agree. The prefix "pseudo" implies that there is some normal behavior (addiction) and faked behavior (pseudoaddiction). But it's the other way around. Wanting medication for legitimate reasons should be the normal behavior and faking it (addiction) the pseudo behavior.
- cat199 7y ago
  not defending the term or the pharma behavior, but pseudo can also mean 'similar to' or 'having the appearance of', especially in an academic context
  - ozzmotik 7y ago
    that seems more appropriate for quasi but i could see how pseudo might be used in such a manner
- TheSpiceIsLife 7y ago
  Here in Australia, addiction is a real medical diagnosis.[1] Drug addiction is a real problem that often calls for initial treatment with controlled dosing of a drug in the same class. 1. https://www.healthdirect.gov.au/what-is-addiction https://www.healthdirect.gov.au/what-is-addiction
kelnos 7y ago
A commenter on the post says something similar, and the author replied that it's about more than just dosage: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/#comment-799443 https://slatestarcodex.com/2019/09/16/against-against-pseudo...
- paulsutter 7y ago
  Surely there’s an even better descriptive name than “under-dosed”, I just meant it as an example of a more descriptive name. Pseudo-addiction is a bad bad term. I get my brain into an inception-level loop if I try to contrast pseudo-addiction to addicting, even clearly knowing the definitions.
  - DanBC 7y ago
    The problem for me with "under-dosed" is the assumption that any dosing level is correct. The post linked to by parent talks about a Xanax prescription for anxiety. Prescribing benzos for anxiety causes severe harm. (The linked post doesn't say "a small amount when needed", but talks about "three times a day".) https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance Note that medication is only advised after other treatment has failed, and that the recommendation in 1.2.25 says "Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]" This also applies to many people being given opioids for pain. Obviously, some people really need opioids and we shouldn't restrict access for those people. But many people given opioids are suffering side effects from the opioids, and are still in pain. Of course unethical drug companies want to sell more medications to this patient group, so they tell doctors that these patients are under-dosed. They're not under-dosed, they are simultaneously over-dosed and under-treated.
std_throwaway 7y ago
But the term "under-dosed" suggests an error on the doctor's part. We can't accept that.
- bonoboTP 7y ago
  Yes, if the doctor admits to a mistake, they are open to getting sued.
  - DataGata 7y ago
    Doctors shouldn't ever get sued. The idea of an "individual doctor" is such a 19th century concept. They're gears in a machine- the hospitals. An ideal hospital would never get sued because it performs very well. Instead, hospitals try to never get sued but do not perform very well, because it's cheaper to avoid litigation than it is to improve performance. Improving performance could be incentivized by open transparency, pricing, and competition but they have a local monopoly, so there's no point. It's a ridiculous legacy system.
    - jrace 7y ago
      So then who should be responsible when a Doctor messes up a surgery?
    - austhrow743 7y ago
      Mistakes are always going to happen in medicine. Who do you propose gets sued if not the doctor and if not the hospital?
      - Justcreatednow 7y ago
        My reading of their post is that the hospital should be sued (unless it provides good Healthcare)

noodlenotes 7y ago

I agree. The prefix "pseudo" implies that there is some normal behavior (addiction) and faked behavior (pseudoaddiction). But it's the other way around. Wanting medication for legitimate reasons should be the normal behavior and faking it (addiction) the pseudo behavior.

cat199 7y ago
not defending the term or the pharma behavior, but pseudo can also mean 'similar to' or 'having the appearance of', especially in an academic context
- ozzmotik 7y ago
  that seems more appropriate for quasi but i could see how pseudo might be used in such a manner
TheSpiceIsLife 7y ago
Here in Australia, addiction is a real medical diagnosis.[1] Drug addiction is a real problem that often calls for initial treatment with controlled dosing of a drug in the same class. 1. https://www.healthdirect.gov.au/what-is-addiction https://www.healthdirect.gov.au/what-is-addiction

kelnos 7y ago

A commenter on the post says something similar, and the author replied that it's about more than just dosage: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/#comment-799443 https://slatestarcodex.com/2019/09/16/against-against-pseudo...

paulsutter 7y ago
Surely there’s an even better descriptive name than “under-dosed”, I just meant it as an example of a more descriptive name. Pseudo-addiction is a bad bad term. I get my brain into an inception-level loop if I try to contrast pseudo-addiction to addicting, even clearly knowing the definitions.
- DanBC 7y ago
  The problem for me with "under-dosed" is the assumption that any dosing level is correct. The post linked to by parent talks about a Xanax prescription for anxiety. Prescribing benzos for anxiety causes severe harm. (The linked post doesn't say "a small amount when needed", but talks about "three times a day".) https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance Note that medication is only advised after other treatment has failed, and that the recommendation in 1.2.25 says "Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]" This also applies to many people being given opioids for pain. Obviously, some people really need opioids and we shouldn't restrict access for those people. But many people given opioids are suffering side effects from the opioids, and are still in pain. Of course unethical drug companies want to sell more medications to this patient group, so they tell doctors that these patients are under-dosed. They're not under-dosed, they are simultaneously over-dosed and under-treated.

std_throwaway 7y ago

But the term "under-dosed" suggests an error on the doctor's part. We can't accept that.

bonoboTP 7y ago
Yes, if the doctor admits to a mistake, they are open to getting sued.
- DataGata 7y ago
  Doctors shouldn't ever get sued. The idea of an "individual doctor" is such a 19th century concept. They're gears in a machine- the hospitals. An ideal hospital would never get sued because it performs very well. Instead, hospitals try to never get sued but do not perform very well, because it's cheaper to avoid litigation than it is to improve performance. Improving performance could be incentivized by open transparency, pricing, and competition but they have a local monopoly, so there's no point. It's a ridiculous legacy system.
  - jrace 7y ago
    So then who should be responsible when a Doctor messes up a surgery?
  - austhrow743 7y ago
    Mistakes are always going to happen in medicine. Who do you propose gets sued if not the doctor and if not the hospital?
    - Justcreatednow 7y ago
      My reading of their post is that the hospital should be sued (unless it provides good Healthcare)