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According to the FDA itself (1), adverse drug reactions (ADRs) "are one of the leading causes of morbidity and mortality in health care" and may be the fourth l

According to the FDA itself (1), adverse drug reactions (ADRs) "are one of the leading causes of morbidity and mortality in health care" and may be the fourth leading cause of death. We need people willing to speak up and be skeptical. And whatever small reward they may obtain by doing so is trivial in comparison to the billions that pharma and their sponsored scientists stand to gain by unjustified cheerleading. It's laughable to question the motives and incentives of skeptics like Prasad while ignoring the immeasurably greater perverse incentives in favor of approving drugs too quickly. I can understand the desire, the hope, that a new drug might be the miracle we've been waiting for. But precisely because we so desperately want new drugs to be helpful, it's crucial to remain rational and evaluate new drugs based on what they actually do, not based on our hopes or on the claims made by pharma companies. 1: https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions https://www.fda.gov/drugs/drug-interactions-labeling/prevent...

roenxi 7y ago
But the statistic you cite might just as likely be evidence that the system is working very well. If the drugs being approved are 99.999% perfectly efficacious and 0.001% deadly then nearly all the deaths would be attributable to when the drugs fail. We aren't going to do better than that. The better the system works and the more effective the medicines, the more deaths will be attributed mainly to adverse drug reactions. That is why we must tolerate them. We can't work towards a system where nobody dies in hospitals; but we can work to one where the leading cause of death is failure of medical care as opposed to natural causes. The better our healthcare gets, the more likely the leading cause of death will be "nurse didn't follow the checklist", "the machine broke" or "the drugs made their body go haywire" and similar. Something has to be the leading cause of death. As we become gods unto our own bodies that cause will be human factors and mistakes.
- leereeves 7y ago
  In that hypothetical world, life expectancy would be rising. In fact, it is falling.
  - roenxi 7y ago
    I promise I'll stop being argumentative after this, but in the meantime - not necessarily. Simpson's Paradox might get triggered where better healthcare encourages more marginal people to have children/migrate to the better healthcare/whatever. There is no single statistic or even a small batch that is safe to make uninformed decisions on. This is optimising a complex system. It needs to be done slowly, holistically and with statistics and science. Just because one part is failing doesn't mean that the system is out of control. It might be out of control, but the evidence needs to be quite deep to conclude that because the system is very complicated. A response powered by emotions, anecdotes or silver bullet stats probably feels right but is likely to do more damage than good. This is a field where high-functioning sociopaths should be given a lot of room to make decisions; they are the ones who can make hard decisions and get to a greatest-good-greatest-number style outcomes despite that fact that gut-wrenchingly unfair and tragic thing happen every day in the world of healthcare. What it comes down to is people die and often suffer. The fact that people are observed to die in the hospital system is not evidence. Even aggregate stats getting worse is not necessarily a problem. Arguments have to talk thoroughly about what the costs and benefits of any change is likely to be and we have to accept that death is a cost that the healthcare system is going to pay whether we like it or not; because that really is an elephant in the room with these sort of decisions.
    - leereeves 7y ago
      What I don't understand is why you'd want to shut down the discussion. Why object, not merely to a specific statement a "medical conservative" made, but to their very existence? Why should we trust the system to high-functioning sociopaths, as you said, and not listen to both sides and have a vigorous and ongoing debate? You're right that people die, and will continue to die, in medical care. And it's a difficult and emotional subject. And people don't always make the best decisions. But I'd still rather have public discussion about every little detail rather than trust insiders (with their own, sometimes perverse, motivations) implicitly.
      - DoreenMichele 7y ago

roenxi 7y ago

But the statistic you cite might just as likely be evidence that the system is working very well. If the drugs being approved are 99.999% perfectly efficacious and 0.001% deadly then nearly all the deaths would be attributable to when the drugs fail. We aren't going to do better than that. The better the system works and the more effective the medicines, the more deaths will be attributed mainly to adverse drug reactions. That is why we must tolerate them. We can't work towards a system where nobody dies in hospitals; but we can work to one where the leading cause of death is failure of medical care as opposed to natural causes. The better our healthcare gets, the more likely the leading cause of death will be "nurse didn't follow the checklist", "the machine broke" or "the drugs made their body go haywire" and similar. Something has to be the leading cause of death. As we become gods unto our own bodies that cause will be human factors and mistakes.

leereeves 7y ago
In that hypothetical world, life expectancy would be rising. In fact, it is falling.
- roenxi 7y ago
  I promise I'll stop being argumentative after this, but in the meantime - not necessarily. Simpson's Paradox might get triggered where better healthcare encourages more marginal people to have children/migrate to the better healthcare/whatever. There is no single statistic or even a small batch that is safe to make uninformed decisions on. This is optimising a complex system. It needs to be done slowly, holistically and with statistics and science. Just because one part is failing doesn't mean that the system is out of control. It might be out of control, but the evidence needs to be quite deep to conclude that because the system is very complicated. A response powered by emotions, anecdotes or silver bullet stats probably feels right but is likely to do more damage than good. This is a field where high-functioning sociopaths should be given a lot of room to make decisions; they are the ones who can make hard decisions and get to a greatest-good-greatest-number style outcomes despite that fact that gut-wrenchingly unfair and tragic thing happen every day in the world of healthcare. What it comes down to is people die and often suffer. The fact that people are observed to die in the hospital system is not evidence. Even aggregate stats getting worse is not necessarily a problem. Arguments have to talk thoroughly about what the costs and benefits of any change is likely to be and we have to accept that death is a cost that the healthcare system is going to pay whether we like it or not; because that really is an elephant in the room with these sort of decisions.
  - leereeves 7y ago
    What I don't understand is why you'd want to shut down the discussion. Why object, not merely to a specific statement a "medical conservative" made, but to their very existence? Why should we trust the system to high-functioning sociopaths, as you said, and not listen to both sides and have a vigorous and ongoing debate? You're right that people die, and will continue to die, in medical care. And it's a difficult and emotional subject. And people don't always make the best decisions. But I'd still rather have public discussion about every little detail rather than trust insiders (with their own, sometimes perverse, motivations) implicitly.
    - DoreenMichele 7y ago