The Dangers of Anti-Intellectual Propaganda

[Gryz]

I'm trying to figure out if this is sarcasm or not. Are you suggesting that gender issues, religious issues, immigration issues, racism issues, and global warming issues aren't important? What do you think is important?

Money is important.
Money allows you to do good stuff. Without money, no policy can be implemented. No strategy can be executed. If there is money, anything is possible. If there is no money, it is everyone for themselves. And in that case, the poor lose. After a while, the middle-class will lose too.

Republican leaders don't care about abortion, or religion or gun laws. They don't care about homosexual marriage. They don't care about marijuana or drugs. They don't care any of these moral issue. All they care about is money. All these moral issue are used to distract the general public's attention from what they are doing: stealing money from the tax-payer and give it to their buddies. Republicans will start a war, and kill a million people, if they think someone can make a profit.


This thread is an example of that.
The issue of the post is: Republicans want to create a negative emotion with intellectualism. It's even worse, they don't like science, don't like education. This is intentional. They don't want the general public to be rational. They want the general public to be emotional. Because if you look at it rationally, Republicans only look out for the 1%. Maybe the richest 10% of the population at most. With those numbers, they should never be able to win an election. So the Republicans don't want people to vote with reason. They want to make voting an emotional issue. Because that they can influence.

Look at this thread. Within the first page the subject (intellectualism approach or emotional approach) is changed to the same old subject: an emotional response to a subject that hardly matters.

They're coming to take your guns away !
Think of all those poor babies !
Goddamn commies !
Goddamn terrorist !
Goddamn muslims !
Goddamn atheists !
They took our juuubbbs.
Murica, fuck yeah ! Greatest country in the world.

These (and more of those) are the issues that the majority of americans vote for. Emotional issues. Not rational. And that makes the Republicans win more elections than they should. And the Democrats keep being fooled by this old strategy.

 

[interchange]

Steve Jobs had a pancreatic neuroendocrine tumor. Very different than the much more common and aggressive adenocarcinoma.

 

[Amused]

That number seems to be way off.

http://healthland.time.com/2011/10/05/the-pancreatic-cancer-that-killed-steve-jobs/

"Pancreatic cancer is one of the faster spreading cancers; only about 4% of patients can expect to survive five years after their diagnosis. Each year, about 44,000 new cases are diagnosed in the U.S., and 37,000 people die of the disease."

Once it was clear that Jobs had the rare islet-cell pancreatic cancer, there was an excellent chance of a cure. According to Cleveland Clinic gastroenterologist Maged Rizk, MD, there’s an overall 80% to 90% chance of 5-year survival. In the world of cancer survival, that’s a huge milestone.​

https://blogs.webmd.com/breaking-news/2011/10/steve-jobs-pancreatic-cancer.html

In Job's specific case, the survival rate was 90% at the time he caught it.

I don't pull facts out of my ass.

 

[Jhhnn]

Money is important.
Money allows you to do good stuff. Without money, no policy can be implemented. No strategy can be executed. If there is money, anything is possible. If there is no money, it is everyone for themselves. And in that case, the poor lose. After a while, the middle-class will lose too.

Republican leaders don't care about abortion, or religion or gun laws. They don't care about homosexual marriage. They don't care about marijuana or drugs. They don't care any of these moral issue. All they care about is money. All these moral issue are used to distract the general public's attention from what they are doing: stealing money from the tax-payer and give it to their buddies. Republicans will start a war, and kill a million people, if they think someone can make a profit.


This thread is an example of that.
The issue of the post is: Republicans want to create a negative emotion with intellectualism. It's even worse, they don't like science, don't like education. This is intentional. They don't want the general public to be rational. They want the general public to be emotional. Because if you look at it rationally, Republicans only look out for the 1%. Maybe the richest 10% of the population at most. With those numbers, they should never be able to win an election. So the Republicans don't want people to vote with reason. They want to make voting an emotional issue. Because that they can influence.

Look at this thread. Within the first page the subject (intellectualism approach or emotional approach) is changed to the same old subject: an emotional response to a subject that hardly matters.

They're coming to take your guns away !
Think of all those poor babies !
Goddamn commies !
Goddamn terrorist !
Goddamn muslims !
Goddamn atheists !
They took our juuubbbs.
Murica, fuck yeah ! Greatest country in the world.

These (and more of those) are the issues that the majority of americans vote for. Emotional issues. Not rational. And that makes the Republicans win more elections than they should. And the Democrats keep being fooled by this old strategy.

Not the Democrats. The voters.

 

[realibrad]

Once it was clear that Jobs had the rare islet-cell pancreatic cancer, there was an excellent chance of a cure. According to Cleveland Clinic gastroenterologist Maged Rizk, MD, there’s an overall 80% to 90% chance of 5-year survival. In the world of cancer survival, that’s a huge milestone.​

https://blogs.webmd.com/breaking-news/2011/10/steve-jobs-pancreatic-cancer.html

In Job's specific case, the survival rate was 90% at the time he caught it.

I don't pull facts out of my ass.

I did not say you pulled facts out of your ass, I just said that 90%+ seems high. I can also cite this too.

http://fortune.com/2011/01/18/steve-jobs-went-to-switzerland-in-search-of-cancer-treatment/

A neuroendocrine cancer expert at the University of Iowa Hospitals and Clinics said Monday that recent studies show that “survival rates are improving” due to better treatment. At the time Jobs’s cancer was originally diagnosed in 2004, according to Dr. Thor Halfdanarson, the five-year survival rate for metastatic disease was thought to be less than 20%. Today “the prognosis is getting better,” with the five-year survival rate at 55% to 57%, he said, according to one recent study.

Everything else I read agrees with that. The only person that says 80-90% is that one doctor that has that exact quote in multiple articles. Everything else I find says closer to 50% today and less back then.

https://www.cancercommons.org/knowl...than-adenocarcinomas-but-still-hard-to-treat/

"Pancreatic neuroendocrine tumors (PNETs) constitute only about 3% to 5% of all pancreatic cancers. Compared to the most common pancreatic cancer—adenocarcinoma (aka exocrine tumors), PNETs have a longer disease course and better prognosis; the 5-year survival rate is 42% for PNETs, but only about 5% to 6% for adenocarcinomas. When PNETs are localized, they can usually be removed by surgery. However, PNETs tend to metastasize, most often to the liver, and present a formidable treatment challenge at this stage."

https://www.cancer.net/cancer-types/islet-cell-tumor/statistics

"The 5-year survival rate tells you what percent of people live at least 5 years after the tumor is found. Percent means how many out of 100. In general, the 5-year survival rate of people with an islet cell tumor is about 42%."

I'm sure this can go on and on. I just feel that the number is high.

 

[abj13]

I did not say you pulled facts out of your ass, I just said that 90%+ seems high. I can also cite this too.

http://fortune.com/2011/01/18/steve-jobs-went-to-switzerland-in-search-of-cancer-treatment/


Everything else I read agrees with that. The only person that says 80-90% is that one doctor that has that exact quote in multiple articles. Everything else I find says closer to 50% today and less back then.

https://www.cancercommons.org/knowl...than-adenocarcinomas-but-still-hard-to-treat/

"Pancreatic neuroendocrine tumors (PNETs) constitute only about 3% to 5% of all pancreatic cancers. Compared to the most common pancreatic cancer—adenocarcinoma (aka exocrine tumors), PNETs have a longer disease course and better prognosis; the 5-year survival rate is 42% for PNETs, but only about 5% to 6% for adenocarcinomas. When PNETs are localized, they can usually be removed by surgery. However, PNETs tend to metastasize, most often to the liver, and present a formidable treatment challenge at this stage."

https://www.cancer.net/cancer-types/islet-cell-tumor/statistics

"The 5-year survival rate tells you what percent of people live at least 5 years after the tumor is found. Percent means how many out of 100. In general, the 5-year survival rate of people with an islet cell tumor is about 42%."

I'm sure this can go on and on. I just feel that the number is high.

Sigh. You are being pedantic and unfortunately quoting data that you are misinterpreting. Have you actually read how that data is derived and what those values represent? Have you actually looked at the citations? Those are survival numbers for all patients, all tumor types, all backgrounds. Unfortunately, those values can overgeneralize chances of survival for individual patients, this is often why oncologists will explain survival using more meaningful data. Patient age matters. The type of tumor matters. The spread of the tumor matters. Sex and race matters. All of the values you are quoting represent all comers with the tumor (all ages, all tumor type, all tumor locations etc) and do not accurately depict the likelihood of survival for Steve Jobs.

Better insight can be provided from:

Garcia-Carbonero R1, Capdevila J, Crespo-Herrero G, Díaz-Pérez JA, Martínez Del Prado MP, Alonso Orduña V, Sevilla-García I, Villabona-Artero C, Beguiristain-Gómez A, Llanos-Muñoz M, Marazuela M, Alvarez-Escola C, Castellano D, Vilar E, Jiménez-Fonseca P, Teulé A, Sastre-Valera J, Benavent-Viñuelas M, Monleon A, Salazar R. Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann Oncol. 2010 Sep;21(9):1794-803.

This study analyzes survivability in Spain (yes different region) in the same time frame that Steve Jobs was diagnosed. How do some of the variables matter?

Age (years) 5yr % Survival
<30 100
31–60 88.0
>60 79.6

Hormonal syndrome (most are hormonal/functional now)
Yes 87.1
No 71.2

Primary tumor site Pancreas

Local 89.7
Regional 87.0
Distant 60.9
All 78.9

Obviously we don't have all the data on Steve Job's tumor type, but based on his age, he already has a high likelihood of survival, and if we presume he had a functional tumor that was local or regional, he had much higher odds than 50% survival at 5 years.

Another reference:

Halfdanarson TR1, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008 Oct;19(10):1727-33.

Here's data from the US from 1973-2000 (time period prior to Job's diagnosis)

What's the survival of all patients from that time period who had a functional, regionally located tumor (the most likely tumor type in Jobs)?
86.7%

And that includes patients diagnosed with this tumor 40 years ago, relying on medical interventions of 40 years ago.

They also include factors that include likelihood of survival. What are some of them? White, aged <50, localized or regionally advanced... all of which Steve Jobs had. Plus, if we presume he had the most common type, functional tumors, it further increases the likelihood of survival.

 

[realibrad]

Sigh. You are being pedantic and unfortunately quoting data that you are misinterpreting. Have you actually read how that data is derived and what those values represent? Have you actually looked at the citations? Those are survival numbers for all patients, all tumor types, all backgrounds. Unfortunately, those values can overgeneralize chances of survival for individual patients, this is often why oncologists will explain survival using more meaningful data. Patient age matters. The type of tumor matters. The spread of the tumor matters. Sex and race matters. All of the values you are quoting represent all comers with the tumor (all ages, all tumor type, all tumor locations etc) and do not accurately depict the likelihood of survival for Steve Jobs.

Better insight can be provided from:

Garcia-Carbonero R1, Capdevila J, Crespo-Herrero G, Díaz-Pérez JA, Martínez Del Prado MP, Alonso Orduña V, Sevilla-García I, Villabona-Artero C, Beguiristain-Gómez A, Llanos-Muñoz M, Marazuela M, Alvarez-Escola C, Castellano D, Vilar E, Jiménez-Fonseca P, Teulé A, Sastre-Valera J, Benavent-Viñuelas M, Monleon A, Salazar R. Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann Oncol. 2010 Sep;21(9):1794-803.

This study analyzes survivability in Spain (yes different region) in the same time frame that Steve Jobs was diagnosed. How do some of the variables matter?

Age (years) 5yr % Survival
<30 100
31–60 88.0
>60 79.6

Hormonal syndrome (most are hormonal/functional now)
Yes 87.1
No 71.2

Primary tumor site Pancreas

Local 89.7
Regional 87.0
Distant 60.9
All 78.9

Obviously we don't have all the data on Steve Job's tumor type, but based on his age, he already has a high likelihood of survival, and if we presume he had a functional tumor that was local or regional, he had much higher odds than 50% survival at 5 years.

Another reference:

Halfdanarson TR1, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008 Oct;19(10):1727-33.

Here's data from the US from 1973-2000 (time period prior to Job's diagnosis)

What's the survival of all patients from that time period who had a functional, regionally located tumor (the most likely tumor type in Jobs)?
86.7%

And that includes patients diagnosed with this tumor 40 years ago, relying on medical interventions of 40 years ago.

They also include factors that include likelihood of survival. What are some of them? White, aged <50, localized or regionally advanced... all of which Steve Jobs had. Plus, if we presume he had the most common type, functional tumors, it further increases the likelihood of survival.

Jesus. All I said was that the number seemed high from what I remembered.

That said, some spoke of the cancer having metastasized.

A neuroendocrine cancer expert at the University of Iowa Hospitals and Clinics said Monday that recent studies show that “survival rates are improving” due to better treatment. At the time Jobs’s cancer was originally diagnosed in 2004, according to Dr. Thor Halfdanarson, the five-year survival rate for metastatic disease was thought to be less than 20%. Today “the prognosis is getting better,” with the five-year survival rate at 55% to 57%, he said, according to one recent study.

That changes things greatly. This is old like you said, so I cant recall where I am remembering my numbers from, but this fits far better with what I remember.

 

[abj13]

Jesus. All I said was that the number seemed high from what I remembered.

That said, some spoke of the cancer having metastasized.

That changes things greatly. This is old like you said, so I cant recall where I am remembering my numbers from, but this fits far better with what I remember.

??? Why does talking about metastatic disease matter? If Steve Jobs had metastatic disease at the time of diagnosis, he would not have been offered surgery (unless he was having an acute bowel obstruction or some other direct complication of the tumor, which clearly he did not have).

And again, quoting percentages about survival of all comers with the tumor type is inaccurate to extrapolate for Steve Job's chances of survival.

 

[realibrad]

??? Why does talking about metastatic disease matter? If Steve Jobs had metastatic disease at the time of diagnosis, he would not have been offered surgery (unless he was having an acute bowel obstruction or some other direct complication of the tumor, which clearly he did not have).

He did wait 9 months which is stupid. I agree with the OP on that. When they did go in to do surgery it had spread. It seems it is not known for sure, but they suspect that it may have spread in that time. I do not disagree that it was a stupid thing to do.

And again, quoting percentages about survival of all comers with the tumor type is inaccurate to extrapolate for Steve Job's chances of survival.

I remember the number differently. All of this started with me saying that the number presented seemed off. I then did a search and found that many others were saying that his survival rate was closer to 50%ish. I was not quoting them to say what the number is, I quoted them to explain why I remember it being different.

 

[mect]

Money is important.
Money allows you to do good stuff. Without money, no policy can be implemented. No strategy can be executed. If there is money, anything is possible. If there is no money, it is everyone for themselves. And in that case, the poor lose. After a while, the middle-class will lose too.

Republican leaders don't care about abortion, or religion or gun laws. They don't care about homosexual marriage. They don't care about marijuana or drugs. They don't care any of these moral issue. All they care about is money. All these moral issue are used to distract the general public's attention from what they are doing: stealing money from the tax-payer and give it to their buddies. Republicans will start a war, and kill a million people, if they think someone can make a profit.


This thread is an example of that.
The issue of the post is: Republicans want to create a negative emotion with intellectualism. It's even worse, they don't like science, don't like education. This is intentional. They don't want the general public to be rational. They want the general public to be emotional. Because if you look at it rationally, Republicans only look out for the 1%. Maybe the richest 10% of the population at most. With those numbers, they should never be able to win an election. So the Republicans don't want people to vote with reason. They want to make voting an emotional issue. Because that they can influence.

Look at this thread. Within the first page the subject (intellectualism approach or emotional approach) is changed to the same old subject: an emotional response to a subject that hardly matters.

They're coming to take your guns away !
Think of all those poor babies !
Goddamn commies !
Goddamn terrorist !
Goddamn muslims !
Goddamn atheists !
They took our juuubbbs.
Murica, fuck yeah ! Greatest country in the world.

These (and more of those) are the issues that the majority of americans vote for. Emotional issues. Not rational. And that makes the Republicans win more elections than they should. And the Democrats keep being fooled by this old strategy.

You seem to be contradicting yourself. Do republicans win elections because they campaign on money or because they campaign on emotional issues? The fact that money is important doesn't make other issues unimportant. And considering this thread is about the anti-intellectualism of the right, it seems logical that people would talk about these other important issues.

 

[woolfe9998]

Once it was clear that Jobs had the rare islet-cell pancreatic cancer, there was an excellent chance of a cure. According to Cleveland Clinic gastroenterologist Maged Rizk, MD, there’s an overall 80% to 90% chance of 5-year survival. In the world of cancer survival, that’s a huge milestone.​

https://blogs.webmd.com/breaking-news/2011/10/steve-jobs-pancreatic-cancer.html

In Job's specific case, the survival rate was 90% at the time he caught it.

I don't pull facts out of my ass.

Personal anecdote: my maternal grandmother, who to be honest I never knew very well because she died when I was young, was diagnosed with cervical cancer. Instead of getting surgery and chemo like her doctor recommended, she went down to a "clinic" in Mexico where she was given herbal "medicine" including some kind of herbal tea which she douched with. A year later she was having trouble breathing and finally came to my parents for help. They took her to an oncologist - turned out the cancer had metastasized to her lungs and brain.

Irrationality kills. And unfortunately, as shown by your example of Steve Jobs, even highly intelligent people aren't immune to it.

 

[Amused]

That is just so sad.

I'm sorry.

 

[realibrad]

Personal anecdote: my maternal grandmother, who to be honest I never knew very well because she died when I was young, was diagnosed with cervical cancer. Instead of getting surgery and chemo like her doctor recommended, she went down to a "clinic" in Mexico where she was given herbal "medicine" including some kind of herbal tea which she douched with. A year later she was having trouble breathing and finally came to my parents for help. They took her to an oncologist - turned out the cancer had metastasized to her lungs and brain.

Irrationality kills. And unfortunately, as shown by your example of Steve Jobs, even highly intelligent people aren't immune to it.

Was she afraid of doctors, or was it more about a belief system?

 

[woolfe9998]

Was she afraid of doctors, or was it more about a belief system?

I didn't know her well enough. I do recall my parents saying that she believed the herbal "medicine" would work. Perhaps she convinced herself of that because of fear of doctors. However, it wouldn't change the fact that it's a bad idea to ignore science and modern medicine for emotional reasons.

 

[interchange]

To be fair, a large deal of modern medicine is either placebo or not a whole lot better than placebo. The efficacy of medical care is highly linked to the ritual, the institution, the training, the perceived power of it, and the provider's confidence in what they are doing. Confidence in all of those things has been eroding in society in favor of alternative treatments whose basic premise is to provide all the same placebo benefits of modern medicine with the addition of a big middle finger to authority. Lots of people benefit more from that placebo than from modern medical placebo.

Still, there are areas of modern medicine which placebo just won't do. Things like bacterial infection and aggressive cancers are pretty high on that list.

 

[woolfe9998]

To be fair, a large deal of modern medicine is either placebo or not a whole lot better than placebo. The efficacy of medical care is highly linked to the ritual, the institution, the training, the perceived power of it, and the provider's confidence in what they are doing. Confidence in all of those things has been eroding in society in favor of alternative treatments whose basic premise is to provide all the same placebo benefits of modern medicine with the addition of a big middle finger to authority. Lots of people benefit more from that placebo than from modern medical placebo.

Still, there are areas of modern medicine which placebo just won't do. Things like bacterial infection and aggressive cancers are pretty high on that list.

I can think of countless other areas where a placebo won't do. Get a compound or worse, comminuted bone fracture, you're going to need surgery to fix it. Get appendicitis, the inflamed appendix needs to be removed. Get a deep laceration, someone needs to stitch it up. Get clogged arteries, you'll need some procedure to reduce of remove the arterial plaque or you just might have a heart attack. I could probably come up with 50 other examples if I had the time.

Which areas of medical practice do you think the efficacy is mainly tied the placebo effect?

 

[Amused]

To be fair, a large deal of modern medicine is either placebo or not a whole lot better than placebo. The efficacy of medical care is highly linked to the ritual, the institution, the training, the perceived power of it, and the provider's confidence in what they are doing. Confidence in all of those things has been eroding in society in favor of alternative treatments whose basic premise is to provide all the same placebo benefits of modern medicine with the addition of a big middle finger to authority. Lots of people benefit more from that placebo than from modern medical placebo.

Still, there are areas of modern medicine which placebo just won't do. Things like bacterial infection and aggressive cancers are pretty high on that list.

I think you've confused alt-med "integrative" medicine with science based medicine.

 

[senseamp]

Conservatives, name one great anti-intellectual society. I'll wait.

 

[pmv]

I think you've confused alt-med "integrative" medicine with science based medicine.

Personally, I think the problem with 'science based medicine' is that it hasn't, for most of it's history, lived up to that description. It's not that I would support 'alternative' medicine, not at all, but conventional medicine isn't as far from the 'alternative' as people sometimes seem to believe. It's only quite recently that it's started to become a bit scientific, and still it appears to be full of anecdote and artisanship. The fact that they had to specifically start a project for 'evidence-based medicine' surely says something? A lot of things doctors have done, up till very recently, have then turned out to not have much basis in proven science. They just believed it because it had become part of their 'craft'.

I think, funnily enough, the alleged efficacy of the placebo effect appears to be one of those theories that didn't get a close enough examination and when looked at more carefully turned out to be much more questionable than previously thought.

Personally I think it (placebo) is mainly about a patient's desire to please their doctor - causing them to report positive effects even when there really aren't any. Nobody wants to tell a doctor that their treatment had no effect. Hence it works best for self-reported conditions, and tends to wear off.

 

[interchange]

I can think of countless other areas where a placebo won't do. Get a compound or worse, comminuted bone fracture, you're going to need surgery to fix it. Get appendicitis, the inflamed appendix needs to be removed. Get a deep laceration, someone needs to stitch it up. Get clogged arteries, you'll need some procedure to reduce of remove the arterial plaque or you just might have a heart attack. I could probably come up with 50 other examples if I had the time.

Which areas of medical practice do you think the efficacy is mainly tied the placebo effect?

Let's see here...

Top 30 prescribed drugs in 2017:
1 Lisinopril 115,508,573 --> actually does worse than placebo for all-cause mortality
2 Levothyroxine 99,992,248 --> not a placebo; synthetically produced biologically equivalent to natural T4 hormone
3 Metformin Hydrochloride 86,125,658 --> one of the best drugs, definitely not a placebo
4 Simvastatin 81,518,801 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
5 Atorvastatin 74,227,208 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
6 Metoprolol 72,320,918 --> effective for heart failure and rate control in AFib; not a placebo
7 Omeprazole 71,929,303 --> about twice as effective as placebo for GERD
8 Acetaminophen/Hydrocodone Bitartrate 68,756,036 --> there is no study that shows long-term opioid treatment is better than placebo; opioids are the best placebo ever
9 Amlodipine Besylate 63,722,510 --> about 45% of the blood pressure lowering effects matched with placebo
10 Hydrochlorothiazide 50,428,398 --> about 40% of the blood pressure lowering effects matched with placebo
11 Albuterol 48,189,599 --> 50% subjective improvement vs 45% subjective improvement from placebo inhaler; does have measurable difference in pulmonary function tests
12 Gabapentin 39,361,473 --> many different indications, but for most pain indications it beats placebo by about 40% benefit to 25% benefit, so more than half of benefit is placebo effect
13 Sertraline Hydrochloride 37,723,879 --> about 80% of antidepressant response is seen in placebo
14 Losartan Potassium 37,330,149 --> about half of BP lowering effect is matched with placebo
15 Furosemide 37,104,417 --> not gonna look it up; it definitely works as a diuretic, but not sure about any mortality outcome/etc.
16 Azithromycin 31,988,786 --> not a placebo but about 1 in 3 antibiotic prescriptions are not indicated
17 Acetaminophen 31,926,190 --> effective in acute dental/operative pain; no better for back pain or osteoarthritis than placebo
18 Atenolol 30,837,679 --> gonna skip this one; all antihypertensives have similar efficacy; not usually used for CHF so not sure its efficacy there
19 Insulin Human 30,588,285 --> not a placebo
20 Fluticasone 30,573,156 --> many outcomes I'm looking at, but about 65% of efficacy seen in placebo
21 Citalopram 29,737,921 --> about 80% of antidepressant response is seen in placebo
22 Pravastatin Sodium 29,717,750 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
23 Alprazolam 28,897,888 --> about 50% difference from placebo, but possibly the worst drug in existence
24 Potassium 28,365,609 --> not a placebo, but mostly prescribed as replacement for side effects of diuretics
25 Amoxicillin 27,585,663 --> not a placebo but about 1 in 3 antibiotic prescriptions are not indicated
26 Tramadol Hydrochloride 25,809,738 --> there is no study that shows long-term opioid treatment is better than placebo; opioids are the best placebo ever
27 Montelukast 25,670,394 --> not a placebo, not a great deal of efficacy either
28 Trazodone Hydrochloride 25,521,675 --> about 80% of antidepressant response is seen in placebo
29 Bupropion 25,061,016 --> about 80% of antidepressant response is seen in placebo
30 Rosuvastatin Calcium 24,760,853 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death

 

[sandorski]

Let's see here...

Top 30 prescribed drugs in 2017:
1 Lisinopril 115,508,573 --> actually does worse than placebo for all-cause mortality
2 Levothyroxine 99,992,248 --> not a placebo; synthetically produced biologically equivalent to natural T4 hormone
3 Metformin Hydrochloride 86,125,658 --> one of the best drugs, definitely not a placebo
4 Simvastatin 81,518,801 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
5 Atorvastatin 74,227,208 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
6 Metoprolol 72,320,918 --> effective for heart failure and rate control in AFib; not a placebo
7 Omeprazole 71,929,303 --> about twice as effective as placebo for GERD
8 Acetaminophen/Hydrocodone Bitartrate 68,756,036 --> there is no study that shows long-term opioid treatment is better than placebo; opioids are the best placebo ever
9 Amlodipine Besylate 63,722,510 --> about 45% of the blood pressure lowering effects matched with placebo
10 Hydrochlorothiazide 50,428,398 --> about 40% of the blood pressure lowering effects matched with placebo
11 Albuterol 48,189,599 --> 50% subjective improvement vs 45% subjective improvement from placebo inhaler; does have measurable difference in pulmonary function tests
12 Gabapentin 39,361,473 --> many different indications, but for most pain indications it beats placebo by about 40% benefit to 25% benefit, so more than half of benefit is placebo effect
13 Sertraline Hydrochloride 37,723,879 --> about 80% of antidepressant response is seen in placebo
14 Losartan Potassium 37,330,149 --> about half of BP lowering effect is matched with placebo
15 Furosemide 37,104,417 --> not gonna look it up; it definitely works as a diuretic, but not sure about any mortality outcome/etc.
16 Azithromycin 31,988,786 --> not a placebo but about 1 in 3 antibiotic prescriptions are not indicated
17 Acetaminophen 31,926,190 --> effective in acute dental/operative pain; no better for back pain or osteoarthritis than placebo
18 Atenolol 30,837,679 --> gonna skip this one; all antihypertensives have similar efficacy; not usually used for CHF so not sure its efficacy there
19 Insulin Human 30,588,285 --> not a placebo
20 Fluticasone 30,573,156 --> many outcomes I'm looking at, but about 65% of efficacy seen in placebo
21 Citalopram 29,737,921 --> about 80% of antidepressant response is seen in placebo
22 Pravastatin Sodium 29,717,750 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
23 Alprazolam 28,897,888 --> about 50% difference from placebo, but possibly the worst drug in existence
24 Potassium 28,365,609 --> not a placebo, but mostly prescribed as replacement for side effects of diuretics
25 Amoxicillin 27,585,663 --> not a placebo but about 1 in 3 antibiotic prescriptions are not indicated
26 Tramadol Hydrochloride 25,809,738 --> there is no study that shows long-term opioid treatment is better than placebo; opioids are the best placebo ever
27 Montelukast 25,670,394 --> not a placebo, not a great deal of efficacy either
28 Trazodone Hydrochloride 25,521,675 --> about 80% of antidepressant response is seen in placebo
29 Bupropion 25,061,016 --> about 80% of antidepressant response is seen in placebo
30 Rosuvastatin Calcium 24,760,853 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death

That list doesn't support your argument.

 

[interchange]

That list doesn't support your argument.

It doesn't? How?

 

[sandorski]

It doesn't? How?

Read what it says.

 

[abj13]

Let's see here...

Top 30 prescribed drugs in 2017:
1 Lisinopril 115,508,573 --> actually does worse than placebo for all-cause mortality
4 Simvastatin 81,518,801 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death
5 Atorvastatin 74,227,208 --> statins as a class have a number needed to treat of 167 patients over 4.1 years to prevent 1 death

I think your analysis is rather short-sighted. Death isn't the only beneficial outcome for many of those medications. Lisinopril has many indications, not just as an anti-hypertensive. It has benefits in congestive heart failure, diabetes, etc. Reducing the progression of CHF or reducing the incidence of end-stage kidney disease by lisinopril is a significant benefit to the patient and the medical system, which you do not quantify in your analysis. Likewise, statins have major benefits outside of mortality. Reducing the number of myocardial infarctions and stroke are significant benefits that you didn't quantify.

So I would be careful using that list in examples for your argument. Your analysis barely scratches the surface of many of those medications (while others I would agree are vastly overprescribed).

 

[interchange]

Read what it says.

I think your analysis is rather short-sighted. Death isn't the only beneficial outcome for many of those medications. Lisinopril has many indications, not just as an anti-hypertensive. It has benefits in congestive heart failure, diabetes, etc. Reducing the progression of CHF or reducing the incidence of end-stage kidney disease by lisinopril is a significant benefit to the patient and the medical system, which you do not quantify in your analysis. Likewise, statins have major benefits outside of mortality. Reducing the number of myocardial infarctions and stroke are significant benefits that you didn't quantify.

So I would be careful using that list in examples for your argument. Your analysis barely scratches the surface of many of those medications (while others I would agree are vastly overprescribed).

You guys realize I wrote the list, right? By doing a very cursory set of pubmed searches. As far as, for example, lisinopril and statins go, sure there's a big range of indications or potential benefits and a whole bunch of outcomes. But are they clinically meaningful? It's not like a lower creatinine or a higher HDL are things that a person feels. Certainly, not having an MI or stroke or needing dialysis are clinically meaningful, but the point of the (cursory) data representation here is that, while they do clearly produce benefits, for many of these drugs, they are not likely to really do anything meaningful for the people you give them to. I still give plenty of them. I know the list is highly flawed. I could do much better but that's a whole lot of effort for very little benefit. It's put together just to illustrate a point.

As far as some of them being overprescribed, well, placebos work to. I see no problem with prescribing a safe medication whose benefit is only a little better than placebo if the benefit itself is worth having compared to the risk.