HN user
Scams happen because of humans. Technology makes it easier to pull them off.
It just so happens that a core principle of crypto, "anonymity", allows scams without consequence.
The only force holding us back from hurting each other in the real world is the possibility that our identity can be tied to our actions.
I worked with the homeless for 1.5 years. You need more policing, not less.
Imagine combining this with a deepfake video.
I this this is a good approach that I've used before.
I think it starts to crumble when people start to demand you to do stuff like posting on your social media or showing them donation receipts.
I'm starting a new job soon and I'm trying to figure out how I'll handle these "silence is complicit" characters. My personal policy is to not discuss political/social issues at work.
If you're healthcare, you're taught not to trust results because it was published under a brand-name journal.
YES, you should be skeptical, but mostly not at the journal-level. You need to be skeptical at the article-level. That is why it's so important to be actually TRAINED to interpret the studies.
The abstract of a trial is like an "advertisement" for the study. You quickly scan it to see if the study is worth reading. If it is, you make multiple passes of the article, identifying biases, understanding the study context, calculating ratios and numbers, reading through the lens of your own practice, and a bunch of other things.
People are losing their heads out there because they don't understand how to interpret studies.
The most infuriating offenders are the media, who have been irresponsible with the presentation of clinical study results. They'll take the results of an observational study and herald it as some revolutionary insight, when in reality the doctors, nurses, and pharmacists interpreting these results are saying "hmm okay, well let's be cautious in our approach and wait for other studies to be done".
Clinical practice should never change, and has never changed (to my knowledge) from the whims of a single OBSERVATIONAL study. But outside medical circles, people will see the results they want to see, and never look past the first 10 words of a headline.
A drug on the market for 60 years (and over the counter in many countries) is “extremely dangerous”?
Yes it can, if used in a different context. You can't generalize stuff in medicine. There are hundreds of factors in play: co-morbidities, genetics, interacting drugs, timelines, dosages, dose delivery forms, routes of entry, previous surgical procedures, demographics...
No, you don't understand this.
The Lancet is one of the most impactful journals in medicine, and has played an important role in shaping how medicine is practiced. It is rigorous in its process, but it's not foolproof. So yes, there are some bad studies that come through, but that is why healthcare professionals are TRAINED to interpret studies--we separate all the bullshit from the legitimately useful stuff.
You should see some of the crap that comes through in some of the lower-impact journals.
The combination of preprint servers + twitter has proven far more effective in looking after humanity’s best interests.
This view is incredibly false and dangerous for so many reasons.
To think that all of a sudden it became more dangerous was silly and unreasonable.
This is a dangerous view and not a fair take. Drugs CAN become more dangerous when used in a different context. The sheer permutation of prior/current medical conditions, interacting drugs, demographics, genetics, medical procedures, and a bunch of other factors all play into the equation that determines a drug's safety and efficacy profile. This is why we continue to do research. This is why guidelines are constantly shifting. This is why medicine requires years of study.
The media was so quick to champion it everywhere though.
I definitely agree with this point. The media has caused harm to the population by taking the results of a single observational study, and parading it around like it was some new concrete medical certainty. This is not how professionals operate. We don't flip our practice on the whims of a single OBSERVATIONAL study.
And I emphasize OBSERVATIONAL because most people here don't understand what that entails. Most people here who comment on clinical trials are not even trained to interpret them. Is it randomized/non-randomized? Double-blinded? What did data collection look like? How were results analyzed? What was the patient population? Timelines? Control arm? Placebos? Previous findings? Primary/secondary endpoint? Do you know the difference between a meta-analysis and a systematic review? NNT? Hazards ratios? Odds ratios?
Too many people outside of medicine think they know how to interpret a study, when in reality they have no idea what they're looking at and cherry-pick the interesting sentences that they're looking for.
I know I'm not going to trust the Lancet or the NEJM ever again.
This is not a fair take. The journals are responsible for reviewing and publishing the most influential clinical research in the world. Occasionally a bad study makes its way in due to falsified data or other illegitimate factors. Health care professionals are well-aware of this, which is why we are trained to interpret studies, and be conservative in the face of radical findings like this.
If anyone has a problem with the Lancet or NEJM, they should see some of the mess found in lower-impact journals.
Counterexample: patient has severe pain, is treated in the hospital with opiates, becomes addicted to opiates.
I've met them, and many are not that different from us.
- flight stewardess who lost job from smoking a joint
- lawyer who lost his wealth from poor investments
- former hockey player addicted to opiates from hospital after injury
- elderly man, also became addicted when given opiates at the hospital
- immigrant from Asia who has had no luck finding a job
- war veterans
- artists
- former nurse
- IT professional, now addicted to opiates
- an extremely nice patient who had autism and no family to support him
- various patients with psychosis, mania, schizophrenia
- adolescents born into a family with drugs (we had a father-son pair who were both on methadone and were supporting each other, they both had jobs and were looking to piece together their lives)
... and this is from an inner-city setting. You might even have coworkers who were former "junkies", or who have children struggling with addictions.
I understand your mindset (I had similar views when I was a teenager). Others may secretly have the same views as well. But I think it is a naive one.
Wrong attitude. I think you would benefit from meeting more people from different socioeconomic backgrounds.
This is absolutely terrible.
I worked in an inner-city setting servicing the addictions and psychiatry population as the fentanyl crisis started evolving several years ago. I would see the usual patient every day with no signs of instability, until they suddenly disappeared for a few days and were later found to have overdosed. Perfectly ordinary, pleasant people.
We try to prevent these events by sending teams around to check up on them daily. However, resources are limited and we couldn't closely monitor everyone. One of our patients had come across multiple close calls, but no amount of persuasion would entice him to use his drugs in one of those public injection sites, or to invest more heavily in drug therapy.
I have some hope for injectable hydromorphone programs being offered in pharmacies. Patients would come into a private room with a dose already measured out by the pharmacist. Pharmacies can already offer an unparalleled degree of monitoring since they see their patients on a daily basis.
Pharmacist & software dev here -- my goodness please do, the technology infrastructure supporting pharmacy is massively outdated and I've had to fight against it to do my job properly. Among many other problems, explore what can be done in compounding.
I have a running hypothesis on human behavior: people form self-serving opinions first and foremost, then scrounge around for the supporting evidence afterwards.
It is so hard for adults to admit they are wrong. Even harder if someone has been advocating for their own side at length. To change opinions, they need to have some acceptable exit strategy (e.g. "company A doesn't make vaccines with dangerous component X anymore, vaccines are safe now thank goodness!").
Waste of time. I won't entertain this any further.
Context change was implied as soon as the respondent began with the words "on the flip side...". The topic in this sub-tree is now about that "flip side". Discussion has expanded into new areas.
I was referring to your reply to outside1234's comment. His answer was in the scope of the "obviously mentally ill" population. And I addressed your reply to that.
It is incorrect to take my response outside of its intended context and attempt to attack it there.
This is a complicated issue. I've seen this happen in practice. As long as the process remains conservative and respectful of the patient, it results in better outcomes for the patient and a more peaceful society.
The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia.
Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
I'm a pharmacist, and I completely agree with your assessment. People are waaaaay over-estimating their abilities here.
I think there's a bit of Dunning-Kruger at play here. People think they can make their own judgements based on the drug monograph and simply checklist over the contraindications/interactions and call it a day. And there are others who share their pills with relatives/family members because "its worked for me before". There's another special group of people who think that piecing together a pharmacological narrative will bring about a clinically meaningful result (it works in theory, so it must work in practice!). Others think statistical significance == clinical significance.
The typical community pharmacist is absolutely not equipped with the tools, incentives, and workplace conditions to assume the role of a GP. We are trained in evidence-based drug therapy management, not diagnosis. I'm also deeply concerned about how retail pharmacy corporations will adapt to this. I imagine that there will be a new metric: prescriptions sold/visit that regional directors will be optimizing for. If not a prescription, then you need to sell an OTC product.
A lot of people think they can DIY medicine. It will be a disaster. I've worked in a very high-income area with a very professional clientele (business owners, health care workers, lawyers, finance), and many are completely swayed by false information or "studies" they read online (because they are intelligent professionals, after all).
We need better access to high-quality healthcare, but not through DIY medicine. This proposal is the result of people running out of ideas and giving up.
In the majority of cases, online interaction checkers might be OK. But please be aware that there's more to drug interactions than using online checkers.
You can have a drug interaction that is red-flagged but can be deemed harmless depending the patient's medical background (QT prolongation). In other cases the interaction can be undocumented, and relies on the instinct and knowledge of the medical professional to piece together the pharmacology and make a judgement of the risk to the patient (co-sedating drugs, drugs that are processed by CYP2C19 vs CYP3A4 enzymes -- there's a big difference).
Also need to take into consideration the timeline of administration. Some drugs clear very slowly from the body, and simply taking one drug after the other is discontinued can be a dangerous assumption to make (antipsychotics).
There are a lot of other interactions that are flagged, but after careful appraisal of the evidence, they're not that much of a concern to the patient.
Also consider route of administration. Does taking a transdermal patch interact with an oral medication? What about eyedrops and inhalers? What are the absorption/distribution/metabolic/excretion characteristics of the drug? Peak drug concentration levels?
Some of these details are picked up online. But you need to be aware of fundamental gaps in your understanding of medicine. It's like being a self-taught developer. Sure you can learn enough on your own to be useful, but without the years of theory and fundamentals, you will hit a roadblock which can be costly.