4 ms·

Probably will get downvoted for this, but a bunch of my family members are pharmacists. Their quiet opinion is that most pharmaceuticals don’t work. Even the on

Probably will get downvoted for this, but a bunch of my family members are pharmacists. Their quiet opinion is that most pharmaceuticals don’t work. Even the ones that are thought effective. The data is anecdotal, but is over 15 years of watching people come in for prescriptions. The other aspect, is they say it’s mind boggling to see what kind of drugs people are on.

kstrauser 3y ago
I’d like to think you’ve heard them grousing about specific things like this and misinterpreting that as a general mistrust. Every medicine I’ve ever taken had an objective, quantifiable effect on me. Except for phenylephrine, of course, which only served to teach me how to ask the pharmacist for the good stuff.
- jrockway 3y ago
  I think that people are hoping for larger effects. I have been a lifelong allergy sufferer. Many years ago, my doctor gave me an intranasal antihistamine. It came with a piece of paper about the studies done on it. Patients rated their symptoms on a 1-5 scale, and the study observed the ratings with and without. The placebo group rated their symptoms, say, 4.0. The people on the drug rated them 3.5. I would say that's exactly the effect I got from the medication, an improvement, but not a complete elimination of symptoms. Certainly some people are going to go to their pharmacist and say "this does nothing", and that might lead them to believe it's all a scam. It's not really a scam, it's just that expectations were not set correctly. People want "this will cure you and you'll get a gold metal in the Olympics!" but all we have is "this will make life slightly less miserable". It's probably the same for many conditions and medications. Antidepressants don't turn you into someone who is always happy. Painkillers don't make recovering from surgery a joy. I think that people even had the same feelings about COVID vaccines; they wanted "one shot and you'll never be sick again", but all we got was being 90% less likely to get COVID or whatever. None of this makes these things a scam. Rather, they are imperfect technologies that we work to improve. Silver bullets are rare, but they do exist. Just not all the time. (Have you died from strep throat or polio recently? People used to all the time!)
  - kstrauser 3y ago
    Huh, that’s an interesting point and I bet there’s something to it. I’m taking OTC allergy meds right now but still have some symptoms; it’s not an instant and complete cure. Anyone who expects an instant improvement from most kinds of medicines is going to be sorely disappointed, and doctors need to diligently explain that such-and-such will help a problem, not immediately fix it altogether.
    - jrockway 3y ago
      Yup, exactly. OTC allergy meds are often an improvement; I certainly notice if I forget to take them. But it's not like my nose turns into the air-intake equivalent of one of those helicopters that sucks up water for fighting forest fires. Such a technology may not exist ;) (That said, pseudoephedrine is pretty good for me on the worst days.)
nradov 3y ago
We now know that most published medical research findings are false. That likely includes many of the studies that the FDA relied upon to approve certain drugs. https://doi.org/10.1371/journal.pmed.0020124 https://doi.org/10.1371/journal.pmed.0020124 My impression is that the situation has been improving in recent years. Between study pre-registration, larger subject groups, and greater statistical rigor I have a lot more confidence that drugs getting approved now actually do what they say on the label. Of course, this is also part of the reason why it now costs >$1B to bring a new drug to market.
- scarface_74 3y ago
  It’s been known for years that Phenylephrine is useless and was just kept on the market because of lobbying.
flarg 3y ago
Pharmacist here. Most pharmaceuticals do actually work but finding the right one for a patient can sometimes be harder than you would think. I suspect your family members are quiet about their opinions for a very good reason.
adriand 3y ago
It’s really difficult to untangle the placebo and nocebo effects. I was recently surprised to learn there are studies showing placebos can be effective even when people are told they are taking a placebo. Ie literally telling people, “take this pill every day, but please understand it’s a placebo and has no active ingredients whatsoever”. And yet, their symptoms improve. The theory is that the subconscious mind acts on some information (white-coated professional giving me a medicine) without being fully affected by the conscious mind’s knowledge that the pill ought to do nothing. It’s even possible that the negative attitudes of your pharmacist family members toward the medications their patients are taking are affecting their efficacy!
- jtriangle 3y ago
  You're missing the part where they told participants what the placebo effect was, and that taking the placebo would make them feel better in spite of it having no active ingredients, and it did indeed do so.
- cheald 3y ago
  "Suggestible You" by Erik Vance explores this phenomenon, and really turned me around on placebos. I'm, generally speaking, not particularly susceptible to placebo effects, and always kind of (arrogantly) chalked placebo effects up to people just being gullible and wanting to see something that wasn't there. It turns out there are actually genes that might be responsible for the physical impact of the placebo effect in the brain. There's an enzyme - catechol-O-methyltransferase - which is coded for by the COMT gene. This enzyme catalyzes the metabolism of dopamine in the brain. COMT has three common variations - AA/AG/GG - which substantially alters how effective the enzyme is at metabolizing dopamine. AA results in significantly reduced enzyme activity, which can result in dopamine built-up in the brain, which results in increased sensitivity to stress, anxiety, and pain, but comes with the bonus of enhanced cognition, motor skills, and memory. AA genotypes also tend to be "placebo responders", while GG genotypes tend to be non-responders. This tends to imply that placebo responsiveness isn't purely psychological, but physical - and indeed, it turns out that in AA "responders" you can turn off the placebo effect by administrating naloxone (which works by binding to opioid receptors)! This has really interesting implications for pharmacological research, too - if there are people who are genotypically predisposed towards or against placebo effects, then a drug trial that stacks responders in the trial group and non-responders in the placebo group which would produce a drug efficacy signal that could be just the placebo effect.
m463 3y ago
I think american medicine just chooses prescribing medication first. Patients are definitely more likely to take a medication than change their behavior. Patients also ask for medication. And then there's the whole pharmaceutical system. My personal experience is that many older people I've known have a startling number of bottles of medication they take every day. I also know some older people that have exercise and eating right as part of their regimen and rarely take any medication.
- 303uru 3y ago
  >I also know some older people that have exercise and eating right as part of their regimen and rarely take any medication. Not to be pedantic, well actually let's be. But this is pretty poor medical thinking. Are patient's not on meds at advanced age because they exercise? Or are they able to exercise because they're otherwise healthy and feel good? This kind of simplifying causes a lot of harm in medicine and a lot of patient blaming.
  - m463 3y ago
    My observation seems to be two broad groups. Maybe the fit ones eventually become the bottle ones? Maybe the no-bottle ones are resisting medicine? One thing is for certain - it makes me uncomfortable how many different medications some people take every day.
jonnycoder 3y ago
Anecdotally the most useful drugs are antibiotics and corticosteroids. Other remedies I found truly impactful are neti pot usage everyday if needed and zone 2 daily exercise.
h2odragon 3y ago
Placebo effect is strong. "Medicine" never wandered that far from religion, after all.
scarface_74 3y ago
Of course you are going to get downvoted and you should. I know my blood pressure medicine works for instance because every time I talk to my doctor about reducing it or getting off it, I monitor my blood pressure and it spikes. I know psuedophredrine works. And your data is just that, “anecdotal”, it’s no better than the people doing “research” by watching YouTube on the toilet.
- onco 3y ago
  Ehh. Your experience is similarly anecdotal. You ignore that there is a placebo effect, blood pressure is a surrogate marker for cardiac events, and drugs can have adverse effects. It’s best to look at all cause mortality in your example. Many studies have looked at that endpoint if you are curious.
  - scarface_74 3y ago
    It’s “anecdotal” that I can measure with a machine that gives a number and that I track over a period time? It’s not like I said “I feel better” when taking it. So my blood pressure just magically comes down after I’m taking it?
    - MockObject 3y ago
      What did you think "anecdote" means? Why wouldn't your individual report of your meter measurements count? You haven't shown us the data, shown that you've controlled for confounding factors, or anything. You posted an anecdote.
      - scarface_74 3y ago
        https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000103632.19915.0E https://www.ahajournals.org/doi/full/10.1161/01.HYP.00001036...
    - bee_rider 3y ago
      I mean it is technically anecdotal evidence; it is just a story about you and wasn’t collected in any systemic way, we have no way to abstract it. But there’s also lots of clinically collected evidence behind blood pressure medicine, right? I don’t see why anyone would have reason to doubt you.
ShamelessC 3y ago
This is a really bad take. I hope you or your family members reconsider. Also maybe they shouldn't hold negative judgemental views on the customers that make their job possible?
- GuB-42 3y ago
  This is also a bad take. GP specifically mentioned prescriptions, so the customer/patient is not at fault here, if there is a judgment here, it is toward the doctors. And just because something earns you money doesn't mean it is above criticism. I still don't share GP's opinion in that most medicine don't work. I think some don't work, and some is misused or used preemptively, therefore showing no effect. And I am also dubious about a lot of comfort medicine, but for most people I know who are under proper prescription, it is obvious that it works, it includes psychatric medicine.
matwood 3y ago
I don't take many medicines and then only ones that I have found to work for me. Pseudoephedrine absolutely does work, phenylephrine does not.
303uru 3y ago
As a pharmacist, I can't help but laugh. I'm guessing they're quiet because their peers see them as quacks. Most don't work huh? Cancer death and morbidity rates are falling like a rock. Antibiotics? Antifungals? Hep C cured? HIV/AIDs guaranteed death turned to decades of symptom free life? Hell, we wouldn't have an opioid crisis if the damn things didn't work. The premise is just laughably silly. It seems some people see that placebo's can have effects in a select few paradigms of care and extrapolate that to "all drugs must be placebos." Which is just smooth brain conspiracy talk.
bee_rider 3y ago
It seems like a wild breach of professional ethics to sell medical treatments that they don’t believe will help their patients. Did they mistake themselves for cashiers or something?

kstrauser 3y ago

I’d like to think you’ve heard them grousing about specific things like this and misinterpreting that as a general mistrust. Every medicine I’ve ever taken had an objective, quantifiable effect on me. Except for phenylephrine, of course, which only served to teach me how to ask the pharmacist for the good stuff.

jrockway 3y ago
I think that people are hoping for larger effects. I have been a lifelong allergy sufferer. Many years ago, my doctor gave me an intranasal antihistamine. It came with a piece of paper about the studies done on it. Patients rated their symptoms on a 1-5 scale, and the study observed the ratings with and without. The placebo group rated their symptoms, say, 4.0. The people on the drug rated them 3.5. I would say that's exactly the effect I got from the medication, an improvement, but not a complete elimination of symptoms. Certainly some people are going to go to their pharmacist and say "this does nothing", and that might lead them to believe it's all a scam. It's not really a scam, it's just that expectations were not set correctly. People want "this will cure you and you'll get a gold metal in the Olympics!" but all we have is "this will make life slightly less miserable". It's probably the same for many conditions and medications. Antidepressants don't turn you into someone who is always happy. Painkillers don't make recovering from surgery a joy. I think that people even had the same feelings about COVID vaccines; they wanted "one shot and you'll never be sick again", but all we got was being 90% less likely to get COVID or whatever. None of this makes these things a scam. Rather, they are imperfect technologies that we work to improve. Silver bullets are rare, but they do exist. Just not all the time. (Have you died from strep throat or polio recently? People used to all the time!)
- kstrauser 3y ago
  Huh, that’s an interesting point and I bet there’s something to it. I’m taking OTC allergy meds right now but still have some symptoms; it’s not an instant and complete cure. Anyone who expects an instant improvement from most kinds of medicines is going to be sorely disappointed, and doctors need to diligently explain that such-and-such will help a problem, not immediately fix it altogether.
  - jrockway 3y ago
    Yup, exactly. OTC allergy meds are often an improvement; I certainly notice if I forget to take them. But it's not like my nose turns into the air-intake equivalent of one of those helicopters that sucks up water for fighting forest fires. Such a technology may not exist ;) (That said, pseudoephedrine is pretty good for me on the worst days.)

nradov 3y ago

We now know that most published medical research findings are false. That likely includes many of the studies that the FDA relied upon to approve certain drugs. https://doi.org/10.1371/journal.pmed.0020124 https://doi.org/10.1371/journal.pmed.0020124 My impression is that the situation has been improving in recent years. Between study pre-registration, larger subject groups, and greater statistical rigor I have a lot more confidence that drugs getting approved now actually do what they say on the label. Of course, this is also part of the reason why it now costs >$1B to bring a new drug to market.

scarface_74 3y ago
It’s been known for years that Phenylephrine is useless and was just kept on the market because of lobbying.

flarg 3y ago

Pharmacist here. Most pharmaceuticals do actually work but finding the right one for a patient can sometimes be harder than you would think. I suspect your family members are quiet about their opinions for a very good reason.

adriand 3y ago

It’s really difficult to untangle the placebo and nocebo effects. I was recently surprised to learn there are studies showing placebos can be effective even when people are told they are taking a placebo. Ie literally telling people, “take this pill every day, but please understand it’s a placebo and has no active ingredients whatsoever”. And yet, their symptoms improve. The theory is that the subconscious mind acts on some information (white-coated professional giving me a medicine) without being fully affected by the conscious mind’s knowledge that the pill ought to do nothing. It’s even possible that the negative attitudes of your pharmacist family members toward the medications their patients are taking are affecting their efficacy!

jtriangle 3y ago
You're missing the part where they told participants what the placebo effect was, and that taking the placebo would make them feel better in spite of it having no active ingredients, and it did indeed do so.
cheald 3y ago
"Suggestible You" by Erik Vance explores this phenomenon, and really turned me around on placebos. I'm, generally speaking, not particularly susceptible to placebo effects, and always kind of (arrogantly) chalked placebo effects up to people just being gullible and wanting to see something that wasn't there. It turns out there are actually genes that might be responsible for the physical impact of the placebo effect in the brain. There's an enzyme - catechol-O-methyltransferase - which is coded for by the COMT gene. This enzyme catalyzes the metabolism of dopamine in the brain. COMT has three common variations - AA/AG/GG - which substantially alters how effective the enzyme is at metabolizing dopamine. AA results in significantly reduced enzyme activity, which can result in dopamine built-up in the brain, which results in increased sensitivity to stress, anxiety, and pain, but comes with the bonus of enhanced cognition, motor skills, and memory. AA genotypes also tend to be "placebo responders", while GG genotypes tend to be non-responders. This tends to imply that placebo responsiveness isn't purely psychological, but physical - and indeed, it turns out that in AA "responders" you can turn off the placebo effect by administrating naloxone (which works by binding to opioid receptors)! This has really interesting implications for pharmacological research, too - if there are people who are genotypically predisposed towards or against placebo effects, then a drug trial that stacks responders in the trial group and non-responders in the placebo group which would produce a drug efficacy signal that could be just the placebo effect.

m463 3y ago

I think american medicine just chooses prescribing medication first. Patients are definitely more likely to take a medication than change their behavior. Patients also ask for medication. And then there's the whole pharmaceutical system. My personal experience is that many older people I've known have a startling number of bottles of medication they take every day. I also know some older people that have exercise and eating right as part of their regimen and rarely take any medication.

303uru 3y ago
>I also know some older people that have exercise and eating right as part of their regimen and rarely take any medication. Not to be pedantic, well actually let's be. But this is pretty poor medical thinking. Are patient's not on meds at advanced age because they exercise? Or are they able to exercise because they're otherwise healthy and feel good? This kind of simplifying causes a lot of harm in medicine and a lot of patient blaming.
- m463 3y ago
  My observation seems to be two broad groups. Maybe the fit ones eventually become the bottle ones? Maybe the no-bottle ones are resisting medicine? One thing is for certain - it makes me uncomfortable how many different medications some people take every day.

jonnycoder 3y ago

Anecdotally the most useful drugs are antibiotics and corticosteroids. Other remedies I found truly impactful are neti pot usage everyday if needed and zone 2 daily exercise.

h2odragon 3y ago

Placebo effect is strong. "Medicine" never wandered that far from religion, after all.

scarface_74 3y ago

Of course you are going to get downvoted and you should. I know my blood pressure medicine works for instance because every time I talk to my doctor about reducing it or getting off it, I monitor my blood pressure and it spikes. I know psuedophredrine works. And your data is just that, “anecdotal”, it’s no better than the people doing “research” by watching YouTube on the toilet.

onco 3y ago
Ehh. Your experience is similarly anecdotal. You ignore that there is a placebo effect, blood pressure is a surrogate marker for cardiac events, and drugs can have adverse effects. It’s best to look at all cause mortality in your example. Many studies have looked at that endpoint if you are curious.
- scarface_74 3y ago
  It’s “anecdotal” that I can measure with a machine that gives a number and that I track over a period time? It’s not like I said “I feel better” when taking it. So my blood pressure just magically comes down after I’m taking it?
  - MockObject 3y ago
    What did you think "anecdote" means? Why wouldn't your individual report of your meter measurements count? You haven't shown us the data, shown that you've controlled for confounding factors, or anything. You posted an anecdote.
    - scarface_74 3y ago
      https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000103632.19915.0E https://www.ahajournals.org/doi/full/10.1161/01.HYP.00001036...
  - bee_rider 3y ago
    I mean it is technically anecdotal evidence; it is just a story about you and wasn’t collected in any systemic way, we have no way to abstract it. But there’s also lots of clinically collected evidence behind blood pressure medicine, right? I don’t see why anyone would have reason to doubt you.

ShamelessC 3y ago

This is a really bad take. I hope you or your family members reconsider. Also maybe they shouldn't hold negative judgemental views on the customers that make their job possible?

GuB-42 3y ago
This is also a bad take. GP specifically mentioned prescriptions, so the customer/patient is not at fault here, if there is a judgment here, it is toward the doctors. And just because something earns you money doesn't mean it is above criticism. I still don't share GP's opinion in that most medicine don't work. I think some don't work, and some is misused or used preemptively, therefore showing no effect. And I am also dubious about a lot of comfort medicine, but for most people I know who are under proper prescription, it is obvious that it works, it includes psychatric medicine.

matwood 3y ago

I don't take many medicines and then only ones that I have found to work for me. Pseudoephedrine absolutely does work, phenylephrine does not.

303uru 3y ago

As a pharmacist, I can't help but laugh. I'm guessing they're quiet because their peers see them as quacks. Most don't work huh? Cancer death and morbidity rates are falling like a rock. Antibiotics? Antifungals? Hep C cured? HIV/AIDs guaranteed death turned to decades of symptom free life? Hell, we wouldn't have an opioid crisis if the damn things didn't work. The premise is just laughably silly. It seems some people see that placebo's can have effects in a select few paradigms of care and extrapolate that to "all drugs must be placebos." Which is just smooth brain conspiracy talk.

bee_rider 3y ago

It seems like a wild breach of professional ethics to sell medical treatments that they don’t believe will help their patients. Did they mistake themselves for cashiers or something?