meew0

Metamizole is an amazing drug, I'm always grateful that I work and live in an area where it is available.

But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole).

I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.

Sorry if this is too specific/personal, but I've been wondering, why does the treatment timeline include antibiotics (dalbavancin)? Does dalbavancin have any suspected antitumor effects, or was it simply to treat complications of surgery / catheter infections?

(edit: actually now that I checked the treatment timeline again it seems to be gone now. It was there 2 weeks ago!)

Cysteine proteases are named after their reaction mechanism, which involves a key cysteine residue within the enzyme. It doesn't have anything to do with the amino acids in the cleaved proteins.

The problem is that N-acetylcysteine tastes and smells awful (like farts/rotten eggs) and often causes nausea and vomiting as a side effect.

The vast majority of people use acetaminophen in a safe way, and acetaminophen doesn't really have many side effects by itself, so you'd make life more unpleasant for a large number of people in order to prevent a tiny number of acute poisonings.

Probably if this were implemented, most acetaminophen users would switch to e.g. ibuprofen which is less acutely toxic in overdose but has much more chronic toxicity (to the stomach and the kidneys) when used over a long period of time, even at a normal dose. I'd wager this change might even be a net negative on the whole.

Reading about this process always makes me wonder: in a particular round, was an elector allowed to choose someone who had already been chosen in a previous round? And if yes, to what extent was this done in practice?

Depending on this detail, the character of this election process changes completely, since if repeats are allowed, it could easily degenerate into an oligarchy of ~50 people consistently choosing candidates from among their ranks.

Once drugs lose patent protection, it's difficult for them to gain approval for new indications, because drug approval procedures are extremely expensive and there's no patent holder left for whom it would make economic sense to spend all that money.

So in cases like valproate for migraine, those drugs usually stay off-label long term. That makes them unattractive for doctors to prescribe, since they assume more liability if something goes wrong, and insurance companies are less likely to cover the drugs.

The way information about off-label uses gets communicated is basically the same way as elsewhere in science: through scientific papers, conferences, textbooks, and the like. A doctor who discovers that their migraine patient does well on valproate might publish this as a case report. If there are many such reports, someone might do a randomized trial. Once there are many randomized trials, meta-analyses can be performed, and eventually, the information will end up in textbooks and medical school curricula.

It takes a certain amount of agency for a doctor to stay up to date on the latest research; while medical boards tend to have certification requirements for CME (continuing medical education), these are usually quite lax, and a truly lazy doctor can probably just live their years without really learning anything new.

At the same time, reading all new research that comes out is basically impossible, and even just trying to do this would risk always following the latest fads that later evidence might show to, in fact, be harmful. Every doctor needs to find their own middle ground here, and you as a patient must find a doctor that suits your own preferences.

The screenshot feature is easily accessible in Firefox using the right-click context menu on any webpage

I feel like you could do even better than chilies/ginger for replicating the burn. The burn from chilies feels completely different than the burn from alcohol, because ethanol is much more volatile than capsaicin. Plausibly, using a more volatile TRPV1 agonist such as allyl isothiocyanate (from horseradish/mustard) would produce an even closer effect.

I wish there was a version of this for proportional fonts as well. I never use monospace fonts for coding anymore if I can avoid it, but I'm still in search of the “perfect” proportional coding font.