Side Effects May Include Anything

A couple of days ago a patient said he’d become depressed after starting Xolair, a new asthma drug I know nothing about.

On the one hand, lots of things that mess with the immune system can cause depression. On the other, patients are notorious for blaming drugs for any random thing that happens around the same time they started taking them. So I did what any highly-trained competent medical professional would: I typed “does xolair cause depression?” into Google.

The results seemed promising. The first site was called “Can Xolair cause depression?”. The second was “Is depression a side effect of Xolair?”. Also on the front page were “Could Xolair cause major depression?” and “Xolair depression side effects”. Clearly this is a well-researched topic that lots of people cared about, right?

Let’s look closer at one of those sites, It says: “Major depression is found among people who take Xolair, especially for people who are female, 40-49 old, also take medication Singulair, and have Asthma. We study 11,502 people who have side effects while taking Xolair from FDA and social media. Among them, 14 have Major depression. Find out below who they are, when they have Major depression and more.” Then it offers a link: “Join a support group for people who take Xolair and have Major depression”.

First things first: if there were actually 11502 people taking Xolair, and only 14 of them had major depression, that would be a rate of 0.1%, compared to 6.9% in the general population. In other words, Xolair would be the most effective antidepressant on Earth. But of course nobody has ever done an n=11502 study on whether a random asthma medication causes depression, and EHealthMe is just scraping the FDA databases to see how many people reported depression as a side effect to the FDA. But only a tiny percent of people who get depression report it, and depression sometimes strikes at random times whether you’re taking Xolair or not. So this tells us nothing.

And yet a patient who worries that Xolair might be causing their depression will Google “can xolair cause depression?”, and she will end up on this site that says “major depression is found among people who take Xolair”, which is one of the worst examples of weasel words I’ve ever heard. Then she will read that there are entire support groups for depressed Xolair sufferers. She will find all sorts of scary-looking information like that Xolair-related depression has been increasing since 2008. And this is above and beyond just the implications of somebody bothering to write an entire report about the Xolair-depression connection!

In case you haven’t guessed the twist – no one’s ever investigated whether Xolair causes depression. EHealthMe’s business model is to make an automated program that runs through every single drug and every possible side effect, scrapes the FDA database for examples, then autopublishes an ad-filled web page titled “COULD $DRUG CAUSE $SIDE_EFFECT?”. It populates the page by spewing random FDA data all over it, concludes “$SIDE_EFFECT is found among people who take $DRUG”, and offers a link to a support group for $DRUG patients suffering from $SIDE_EFFECT. Needless to say, the support group is an automatically-generated forum with no posts in it.

And it’s not just EHealthMe. This is a whole market, with competitors elbowing their way past one another to the top of the Google search results. Somebody who doubts EHealthMe and seeks an online second opinion will probably just end up at PatientsVille, whose page is called “Xolair Depression Side Effects”, which contains the same FDA data, and which gets the Google description text “This opens a possibility that Xolair could cause Depression”. Or Treato, whose page claims to contain 56 reader comments on Xolair and depression, but which has actually just searched the Web for every single paragraph that contains “Xolair” and “depression” together and then posted garbled excerpts in its comment section. For example, one of their comments – and this is not at all clear from Treato’s garbled excerpt – is from a tennis forum, where a user with the handle Xolair talks about how his tennis serve is getting worse with age; another user replies “Xolair, I read this and get depressed, I just turned 49.” But if you don’t check whether it came from a tennis forum or not, 56 reports of a connection between a drug and a side effect sounds convincing!

This is really scummy. Maybe it’s not the most devious of traps for you or me, but what about for your grandmother? What about for those people who send money to Nigerian princes? The law is usually pretty strict about who can and can’t provide medical information – so much so that it cracks down on 23andMe just for reading off the genome in a way that uneducated people might misinterpret. Yet somehow sites like EHealthMe are allowed to continue, because they just very strongly imply fake medical information instead of saying it outright.

Remember, only about 50% of people who are prescribed medication take it. Sometimes it’s personal choice or simple forgetfulness. But a lot of the time they stop because of side effects. I had a patient a few months ago who was really depressed. I started her on an antidepressant and she got much better. Then she stopped the medication cold turkey and got a lot worse again. I asked her why she’d stopped. She said her shoulder started hurting, she’d Googled whether antidepressants could cause shoulder pain, and read that they could. She couldn’t remember what site she was reading, but I bet it was EHealthMe or Treato or some of the others just like them.

One day, somebody’s going to Google “can penicillin cause cancer?”, read a report with a link to a support group for penicillin-induced-cancer survivors, stop taking antibiotics, and die. And when that happens, I hope it’s in America, so I can be sure their family will sue the company involved for more money than exists in the entire world.

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286 Responses to Side Effects May Include Anything

  1. Peter Gerdes says:

    Actually, far from being harmful, this kind of can X cause Y spamming is a serious boon.

    Before this kind of entrepreneurship there was no shortage of poorly justified claims about drug X causing side effect Y. Indeed, plenty of people avoid drugs just because the package lists certain (very rare) side effects and they aren’t able to place those risks in context.

    Now that virtually every drug and side effect combo will turn up people will place less unjustified credence in the claimed sideeffects than they did before. Like “This building contains chemicals known to the state of california to cause cancer” it will fade into the background like reminders to drive safely.

  2. Deiseach says:

    O/T but I genuinely need to ask this.

    There are a lot of you young people on here, right? (By which I mean “under forty” at a maximum; “thirty and under” at a minimum).

    Do you read?

    I mean, do you read all of a media piece past the headlines?

    Because I am getting very damn disheartened about this. Yet again, another storm of “OMG, how can Horrible Evil Conservatives Be So Horrible And Evil?” is frothing on Tumblr about a proposed law in Virginia about lavatories and appropriate gender.

    It’s not even a contemplated law, it’s legislation suggested by a Republican party politician and I have no idea if it has a snowball in hell’s chance of ever getting passed.

    But that doesn’t matter, because an LGBT activist made a blog post declaring that this law would require schools to have adults examine children’s genitals in order to ensure the right genders were using the right toilets.

    Need I mention – though, in light of what happened, I think I really do need to mention this – that there is nothing like this in the proposed legislation? That our friend the blogger was using children (and it isn’t only confined to schools but talk about adults touching children’s genitals is always good for whipping up alarm) as an exaggeration in his rhetoric against this? That he even admitted that there isn’t anything like this in the text (but that doesn’t matter because how else are they going to know if a girl is really a girl)?

    UPDATE [January 13, 2016 @ 6:30pm ET]

    Two important items to add:

    (1) Clarification of the legislation and its enforcement mechanisms

    Though we (and many other outlets) made reference to adults literally inspecting children’s genitals, the bill does not specifically call for it. In fact, the legislation offers absolutely no enforcement mechanism as to how complainants, teachers, or courts would determine someone’s “correct anatomical sex.” We focused on the school portion asking exactly how schools would make the determination a complaint is valid (and not bullying or illegal discrimination). How does the complainant know the “correct anatomical sex” beforehand in order to actually make the complaint?

    And needless to say, those who posted and commented on the news report (which only mentions the blog post), have all fallen for the headline “Virginia lawmakers: ‘Adults must check children’s private parts before entering restroom’”

    Er, no, they mustn’t But that doesn’t matter: all the comments are frothing over paedophilia and cis conservatives and you know the song off by heart by now.

    Apparently reading the whole piece and considering “I know I am not a Republican or a conservative, but is it perhaps possible that every single Republican and conservative is not an evil paedophile-enabling hater?” is beyond the scope of the concerned and consciousness-raised progressives of our day.

    I’m depressed about this. I’m not American, but it really seems all you have to do to make anything, no matter how outrageous, sound plausible is stick “Republican” and/or “conservative” on the front, and the Smart Educated Young(er) Folks will swallow it, because if all the good people are on our side thinking the right things and doing the good stuff to give everybody rights and make the world better, then the other side can only be evil horrible people thinking and doing bad, mean things.

    • Loquat says:

      I’m in my early thirties and I’ve seen enough misleading headlines to know you should always read at least part of the article to find out what was actually said/discovered/etc.

      But I think this is less simple failure to read and more a manifestation of the Toxoplasma Of Rage our host posited some time back – the people enjoying an outrage high over this don’t want to find out the actual proposed enforcement mechanism is based on the child’s birth certificate or whatever and only even comes into play if someone actually complains about someone else’s choice of bathroom, they want to feel self-righteous about bashing the other team.

      • onyomi says:

        I do think people have shorter attention spans now. There is just so much competing for our attention, and Candy Crush or Facebook gossip are just a paw at your cellphone away.

        • houseboatonstyx says:

          Otoh, a click or two on Google can bring up an article debunking the first, and more to whatever depth you want to keep clicking, and even the actual text of the bill and bio of the sponsor. So on net, I think “today” is better than broadside posters on lampposts with nothing to click.

    • Devilbunny says:

      The usual aphorism for American politics is that liberals think conservatives are evil, while conservatives think liberals are idiots.

      • onyomi says:

        I don’t disagree with this, yet liberals generally stereotype conservatives as stupid, uneducated rubes, and conservatives stereotype liberals as touchy-feely, out-of-touch idealists (of course, one can have more than one negative stereotype about the opposing tribe).

      • Nornagest says:

        From what I’ve seen, both sides share a remarkably similar stereotypical picture of the other: that their rank-and-file enemies are naive dupes, being told what they want to hear by a small, malicious elite. For liberals, the dupes are uneducated rednecks and the elites are spherical capitalists with cigars and monocles; for conservatives, the dupes are sheltered college kids and their equally sheltered parents, with a side of poor urban minorities, and the elites are literal Communists. But that’s just set dressing, the actual plot is the same either way.

    • JBeshir says:

      If I don’t, it’s because I’ve decided it’s almost certainly outrage porn with no meaningful insights based on the title and source, and am filtering out the entire piece as noise, rather than because I’m taking it at face value.

      In general I figure that if anything worthwhile does come from a dubious source or with dubious presentation, there’s a near-limitless number of people with far lower standards who will read it and let me know one way or the other, so I tend to skip over or filter things fairly aggressively to save the time and blood pressure.

      For what it’s worth, I don’t think in your particular example, the alleged enforcement mechanism is the core of the objection to the bill. So I don’t know that fully reading it would have done much to make people warmer to the bill’s advocates in that case. Just changed the specific criticisms and made them less snappy.

      Edit: This is an absurdly biased sample to ask from, though, in a predictable direction. My impression is that in a more typical sample you’d find that most people in all groups don’t read *anything* unless they’re effectively forced to, and then they hate it. This is a problem in interface design sometimes.

      • Deiseach says:

        I think the law (or rather, proposed legislation, as it’s not even a law yet and I don’t think it has much chance of going through) is bloody stupid as it stands.

        But I’m depressed that (a) somebody thought the best way to raise an objection was to whip up hysteria about paedophilia (do you want a stranger making your child take down their pants in school so they can examine their genitals?) in a quite cynical manner – because the proposal isn’t limited to schools or children and will most likely affect adults in the main – and worse again (b) people are quite happy to read clickbait headline and take it as gospel because The Other Side are obviously Evil and our side never indulges in propaganda, hysteria or deliberate falsehood.

        If one half of the country is convinced the other half is pure badness (and it doesn’t matter much which side is thinking that of which), I begin to understand Trump’s popularity.

        If you’re constantly being considered both an ignorant redneck bigot and a privileged evil hater, you might as well be hung for a sheep as a lamb and go all out for Worst Thing To Happen To America Ever (i.e. support Trump).

    • houseboatonstyx says:

      Just offhand, I recall seeing a tabloid story from your side of the Pond about some UK municipality that wanted to dig up a graveyard for pro-Muslim reasons, and another that was going to do something about toilets for pro-Muslim reasons (or was it the other way around?). On one of them, the journalist admitted he made the whole thing up.

      There is no shortage of Tonypandy on either side.

      PS. Somehow I suspect that on the US story, the teachers would be the first to protest at having to ask a jiggling child to show their birth certificate first.

      • Deiseach says:

        See, this is what is killing me. The activist who wants to get the proposed legislation quashed has very successfully made it about “do teachers want to accompany kids to the bathroom” when that was not the point of the law and it was aimed at adults.

        Oh, well: everything is Tweedle-Dum and Tweedle-Dee, and this is why I’ve pretty much stopped watching the news and only check online news headlines for a quick look. It’s too depressing otherwise.

    • Echo says:

      I stopped reading that kind of thing simply because it makes it much harder to convince myself that some of them are still human beings, rather than a particularly creepy kind of zombie.

      If you check out the accounts of the creatures that post/retumble/retwit progressive propaganda, you find that none of them seem to have any real human interests beyond television and hatred.
      If they ever talk about their personal lives, it’s even worse: screaming at mom, panic attacks going outside, failing out of a sociology major—complete and utter personal dysfunction made inescapable by subhuman living conditions.

      It’s horrifying and depressing. What can you even do when humans turn into that?

      • Nita says:

        What can you even do when humans turn into that?

        It depends on what kind of person you want to be.

        If you’re someone like Scott, you try to help them.

        If you’re someone like Deiseach, you try to help them while grumbling about their various failings.

        And apparently, you can also decide that they’re creepy zombies, not real people, so there’s no need to do anything (except stockpiling food and buying a shotgun, I guess).

        The rest of us simply try not to dwell on it.

        • Echo says:

          Considering what they’d organize to do to people if they ever got over their debilitating Twitter-PTSD, maybe helping them isn’t the best idea in the first place.
          Nice dig at those filthy, stupid rednecks though. You need to keep kicking them, or they might start thinking they’re human beings.

          • Nita says:

            Perhaps, if they got better, they’d be less inclined to lash out at others.

            And I’m pretty sure you’re not a “redneck”, Echo.

      • Deiseach says:

        I’m one of the people who has panic attacks going outside. I come by it honestly, my father suffered the same 🙂

        The only upside is that every generation seemingly has been gloomy about the up and coming generation and how the world is going to hell in a handcart.

    • Whatever Happened to Anonymous says:

      >Do you read?
      >I mean, do you read all of a media piece past the headlines?

      I just don’t read at all, it’s easier on the soul.

      • Deiseach says:

        I’m getting into a discussion (I hope to God it’s not a fight, but I’m not sanguine) with the person who put the post up on Tumblr, and here’s part of their rationale for why they did it:

        I get that it was an activist who put forward the ‘genital checking’ idea to discredit the lawmaker through hyperbole. I went along with that hyperbolic sentiment expecting to be understood by the person from whom I reblogged, and ignored by everyone else. I get that the bill doesn’t suggest genital checking, just birth certificate checking, effectively doxxing trans youth in the event that somebody complains

        And here is where I’m banging my head off the wall, because it wasn’t ignored by everyone else; it was reblogged as fact and people were wetting their knickers in alarm over “OMG my kids will be strip-searched by possible paedophiles!”

        Any stick will do to beat the dog. When pure invention is an acceptable target because you’re Doing It For The Cause, the cause goes rotten very fast.

        • Whatever Happened to Anonymous says:

          I don’t think it’s a young people thing, though.

          We have our own version of SJ people vs non-SJ people here (or blue vs red, or whatever) in Argentina: Kirchnerists vs anti-Kirchnerists. Even though the camps don’t map really well to the ones we discuss here on object-level issues, they’re very stylistically similar, and the arguing comes from both people young and old.

          To me the problem is with internet communication in general and social media in particular for making it available for everyone. The people in your tumblr feed who do this probably skew young, but so does the population of tumblr on the whole.

    • stillnotking says:

      I refuse to believe that anyone needs to explain the effects of political polarization to an Irishwoman.

      • Deiseach says:

        I think you lot are having a civilising effect on me, particularly Scott and his damned reasonableness.

        I am trying my bestest to be civil and not start yelling, even though we’re now into classic wiggling out of answering the query made territory.

        (a) My blog isn’t serious politics, it’s just for fun!
        (b) I’m English, not American and besides, I don’t understand what an Irish conservative would care about
        (c) Are you more upset about a sensationalist headline than people being hurt? That’s something I don’t think I can understand!

        Instead of ripping into “Hell yes, I care more about the truth than about your pwecious fwagile feelings”, I tried to be moderate in answering and stuck to my point: that lying is only going to undermine any case you (‘you’ in general, not the Tumblr user in particular) try to make in future; that it’s a case of The Boy Who Cried Wolf and the moderate middle people, the ones you want to persuade over to your side, will not believe any screaming headlines they read in future – even ones about “trans people are at much higher risk of assault/murder/suicide/mental illness than the general public”, even truthful ‘shock, horror’ headlines – if they’ve been burned by fake “schools will have to implement genital exams by possible paedophiles of YOUR tiny children should this become law!” clickbait headlines.

        It doesn’t matter if it’s Irish, English, American or Venusian politics: if you fake your data, your case is not credible. If people think your argument is so weak you have to lie to shore it up, they are not going to get outraged over the lack of trans rights.

        • Deiseach says:

          And now they’re pulling the “people are dead because of this” angle.

          You know, I am a cold, heartless bitch. I admit it. I’m not glad people suffer. But I am not going to be diverted by emotional arm-twisting. I have had people try to gross me out by telling me gory details of bodily decay in drowning (there’s a fishing village about eight miles west of here, given the occupational hazards of fishing we know all about drowned bodies), and I’ve kept a poker face. Because when someone tries to evoke an emotional response out of me, because I’m not reacting sufficiently intensely for their taste, I will not be moved, I will not give them the satisfaction. (I think that sometimes makes me come off as “flatness of affect” but what the hell. I’m not going to jump when my strings are pulled).

          It’s not about “that one activist lied”. It’s not about “not all activists are liars”. It’s about using hysteria and fakery to achieve an aim, in the spirit of “all ends are just when it’s for the cause”, which means that not alone are you leaving yourself open to having every argument you make dismissed on the grounds that “These people are proven liars”, it’s actually diverting attention away from the subject.

          The blogger, and the person who put up the post on Tumblr, wanted to get attention about trans rights and bathroom laws as examples of politically-motivated persecution of trans people in the USA. They’ve now made it about “I don’t want strangers looking at my child’s private parts” and “How can we effectively vet people in schools to make really sure nobody is a paedophile”.

          Because none of the comments on that post were about “This is terrible news for trans people”, everyone was outraged about ‘it will be compulsory for schools to have adults looking at children’s genitals’.

          Which is shooting yourself in the foot, sawing off the branch you are sitting on, cutting off your nose to spite your face, and any other old saying about creating the opposite of what you hoped to achieve.

          • brad says:

            It seems like you are ignoring one half of the equation. What’s the legislator doing except “using hysteria and fakery to achieve an aim”? What problem was he trying to solve, and was it really a problem to begin with?

            I’m mean sure he’s just one politician, and a minor one at that. But that’s still far more relevant an actor than some random tumblr “activist”.

            It sounds like the best response here is a pox on both their houses.

          • Jaskologist says:

            No mystery as to what he’s trying to achieve. It’s a post-emptive strike against being forced to go along the next big moral crusade. The point it forestall things like Houston’s bathroom bill or NYC’s hundred thousand dollar fines for misgendering.

          • Deiseach says:

            brad, that’s my point. It’s demagoguery on both sides, and appeals to emotional panics rather than looking at the facts. And when Tweedle-Dum engages in it, he has no right to point the finger at Tweedle-Dee about using outrage to achieve his ends.

            I’m mostly depressed by the stupidity; a bunch of intelligent (let us assume) adults (some of them had children that they were quoting as being worried about) read a clickbait headline and swallowed bait, hook and all, and immediately started a chain of outraged comments about “not my kids!” and “this is what conservatives are like!”

            They none of them, seemingly, bothered their arses to read the entire piece. They already had their minds made up. They were so easily led by the nose by a sliver of absurd propaganda, so ready to form a mob and Demand Action Now, that it was disheartening. And even the original intent of the piece was lost: it was supposed to whip up outrage over trans rights, instead it managed to create paedophile panic.

            And these, let me remind you, are the Smart People, the progressives, the liberals, the Democrat voters, the Blue Tribe who like to quote the studies about liberals having college educations and higher IQs than conservatives.

            Nobody won in that situation, except whatever Demon Prince is in charge of idiocy.

          • stillnotking says:

            My original comment was just a joke, but seriously: When polarization gets as bad as it is right now, our political rhetoric becomes dominated by conspicuous signaling. If the other side is for X, you have to be against X; you have to shout from the rooftops that being pro-X is a symptom of mental illness if not Satanic malevolence. If X is something actually benign, or your party’s attacks on X are dishonest, then so much the better — like Cortés burning his ships, you are demonstrating that your loyalty and commitment take precedence over common sense.

            The more polarized a polity becomes, the higher the bar for “belonging”, and the greater the imperative to belong. Clearly this vicious circle is regrettable, but it’s perfectly understandable and far from uncommon. (And right now, it’s not nearly as bad as it could be: see e.g. Bleeding Kansas, the John Brown raid, and various other lead-up proxy battles to the American Civil War. Plus, like, the entire history of Ireland.)

    • ChetC3 says:

      Going by my experience with frothing greyish-red outrage mobs, any story that provides confirmation of the audience’s cherished beliefs will always be true in principle, whatever the facts. Perhaps something similar occurs among your own political outgroup.

    • nydwracu says:

      If people can go around believing that the outgroup kills the ingroup’s babies and bakes their blood into their hardtack, people can go around believing that the outgroup wants to hijack the government and turn it into a machine for molesting ingroup children.

      The thing about that, of course, is that their international counterparts do exactly what they’re accusing our tribe of, most infamously in Rotherham.

      It’s ethnic conflict all the way down.

    • Nornagest says:

      “Conservative group in Satanic ritual abuse scandal.”

      “Evangelical preacher eats kitten at pulpit.”

      “2016 Republican platform claims will ‘show them, show them all’.”

      Hot damn, it really does work.

    • BBA says:

      What we have here, as Harry Frankfurt would put it, is bullshit. To lie is to intentionally speak falsehood and conceal the truth, whereas to bullshit is to speak without caring as to the truth of what you’re saying.

      Bullshitting is more dangerous than lying – it undermines the very notion of truth.

  3. David says:

    As a librarian, I am more concerned we have a whole group of people who do not know how to do simple research. For instance, why is the doctor also googling the information needed. They should have been going to the hospital’s library for a quick phone call consult. The librarian should have been able to pull a list of peer reviewed studies on the issue. At the very least they could be making use of Google Scholar. Please make us librarians work for you. We don’t just hide behind desks…and if your librarian does do this and can’t seem to help you in your research – FIRE THEM AND GET ONE WHO WILL HELP YOU WITH YOUR RESEARCH.

  4. Matt M says:

    I’ve always been surprised how terrible Google is for anything medicine related. I guess that’s how WebMD can still be a thing.

    Any time I’ve ever tried to research a medical condition, the first page of results is usually nothing but ten different scam websites all of whom have copy-pasted the same paragraph from some FDA study or diagnostic manual. The quality of results is about on par with what you get when you try to google for illegal software downloads or bizarre fetish porn and stuff like that.

    I’m kind of amazed that Google themselves hasn’t tried to do anything about it.

    • Nornagest says:

      After the 23andMe debacle, I imagine Google’s leery of implementing anything that could be construed as giving medical information. That of course doesn’t deter anyone from searching for “what is this scaly red rash”, it just means that the information returned is much scammier and more alarmist, but that’s Moloch for you.

    • noko says:

      I think google is pretty good for sorting out the clear bullshit. I mean, even psychiatrists can’t really agree on what actually is an anti-depressant. How can the lay person do any better!

      The first “this is bullshit” thing that came to mind was crystal therapy. Rational wiki, first link says its pseudo-science.

      For vaccines and autism, the first link is “vaccines don’t cause autism”

      I just did a google vs bing comparison for “crystal therapy” and google gives *much* better results. RationalWiki is on the first page!

      • Anthony says:

        Your first Google result is RationalWiki. That comes up fourth for me, though the top one is from Wikipedia and quotes “Crystal healing is a pseudoscientific alternative medicine technique that employs stones and crystals.”

        Second is LiveScience, with the quote “Crystal healing is an alternative medical technique in which crystals and other stones are used to cure ailments and protect against disease.” Third, below the image search results, is, quote: “Holistic healers utilize the spiritual and healing properties in gemstones and crystals to bring about balance and wellness for themselves and for their clients.” And the Wikipedia search results is better than the RationalWiki result, since it includes the word “pseudoscience”; RationalWiki does not.

        If I’d spent lots of time looking up various alternative medicine and other woo on sites sympathetic to woo, what sort of results do you think I’d get from Google?

  5. J Mann says:

    Sorry for jumping off topic, but I keep missing the open threads, and it’s at least tangential:

    Does anyone know of a good rationalist comparison of the various self-genetic tests? I was thinking of doing 23andme just to get the raw data, but recent reviews are pretty spotty. There are a bunch of other tests available, but most are targeted for geneology.

    Is there somebody somewhere who breaks down how much raw data I get with each service, and whether it’s likely to be interesting?

    • Nornagest says:

      23andMe gives you quite a lot of raw data — while its coverage isn’t near 100%, it does track most of the more interesting polymorphisms if you know what to look for. Its analysis is lackluster unless you’re one of the lucky ones who got in before the FDA gimped it; while it provides more information than it did a few months ago, it’s still a shadow of its original self.

      The data is still there, though, you just need to do your own legwork. Sites like Promethease or Interpretome can get you part of the way there, but for a lot of things you might end up having to find the site you want on SNPedia or similar and look it up directly.

  6. jane says:

    On the flip side, there are many people who start a new drug, develop a new symptom, and are told by their doctors that it’s surely a coincidence or all in their silly little heads because that drug has not been Scientifically Proven to cause that symptom. Drug companies do not exactly strive to ensure that every possible side effect is made clear in premarketing trials and rare reactions or side effects that take decades to develop, like dementia, probably can’t be identified with certainty until huge numbers of people start using them. People have been saved from “Alzheimer’s” diagnoses by kicking their statin after seeing reports from other individual patients online that, contrary totheir physicians’ assurances of safety, their statins gave them cognitive impairment. You are no doubt correct that such compilations of case reports create needless fear in some patients, but in a climate in which many doctors rarely or never seriously consider the possibility that medicated patients’ new complaints are iatrogenic, they provide an important alternative information source.

    • JBeshir says:

      I think Scott’s point is that these are not, in fact, compilations of case reports; they’re scammy websites automatically creating massive numbers of alarming fake compilations of case reports in order to scare people into giving the website ad revenue.

      And this is awful, and going to get people hurt if they mistake one of these fake compilations of case reports for a real one.

      • Douglas Knight says:

        No, these are real statistics about real case reports. (although Treato is a misleading collection of real things that aren’t case reports)

        • Nornagest says:

          They’re real case reports, but calling them real statistics looks like a stretch to me. There is nothing to suggest that the samples they’re picking up are representative in any way, and information about base rates seems to be rare to nonexistent.

        • JBeshir says:

          I think “fake” is pretty accurate. A “fake compilation of case reports” as opposed to a fake something else, not sure, that I was more rolling with.

          The page claims that the organisation behind it has studied lots of individual people and is summarising the results, saying that someone has taken the time to study the matter in particular (which shunts probability on its own).

          When in reality it’s presenting a number generated an entirely different way with no human having ever studied anything, with that number meaning something different to the limited extent it means anything at all.

          A case report involves a detailed report of a patient. Arguably the thing it’s pretending to be would be a “compilation of case reports”, but the thing it does have, a single integer count of reports of a side effect reported to the FDA spat out unanalysed with no detail and neither an individual description nor anyone having ever looked at one, I don’t think that’d count even if it was presented honestly.

  7. Pam says:

    I did two searches myself, but did not come across these bogus sites in the first 5 Google pages of results.

    It might be helpful if you were to mention some sources of side-effect info that ARE accurate, helpful, informed, non-inflammatory.


  8. Goof says:

    so what’s the right way to find health info online if not google?

  9. Evan Þ says:

    Congratulations, Scott; this post is now at the bottom of page 1 of Google for “does xolair cause depression”!

    If only you could write blog posts about every such spurious association, the internet would be a far better place.

  10. Mike says:

    A couple of observations.

    Murphy: “smart and well paid accountant yet didn’t understand how vaccines work.”

    Charles A. Janeway was one of the foremost immunologists until his death in 2003 – such that the college textbook is still called “Janeway’s Immunology”. He said that adjuvants were “immunologist’s dirty little secret” because nobody yet understood how they worked.

    That was in 1989, long after vaccines had been widely used and promoted. A smart accountant, for all his limitations, could have grasped that proponents of vaccines were talking about something they did not know themselves.

    In a position similar to that accountant, I asked my acquaintance, a professor of immunology, what would one expect to happen if one injected people with multiple doses of adjuvants – mostly aluminum compounds – that are part of modern vaccines, but without actual antigens. It was quite instructive.
    I thought that this anecdote about pretense of knowledge would fit well with the general spirit of this blog.

    Scott Alexander: “doctors and medical regulators don’t really share your priorities here”
    Leaving aside the issues of financial incentives combined with largely-coercive state-directed payment for medical services, indoctrination, etc.
    How many doctors actually think “Helping all those people not to die now will lead to mutational meltdown in not so many generations, so hopefully gene-editing and embryo-selection techniques become cheap and reliable for mass use before we run out of time and resources”?
    Not implying that we should let people die – just surprised that all doctors are not screaming for massive manhattan-project style funding for that vital research.

    • Jason K. says:

      Part of the problem is that I don’t think anyone has a good grasp on the rate that genetic drift could become a problem, if it even will. (Perhaps some evolutionary biologists might?) It isn’t going to be so obvious as ‘there isn’t any selection pressure anymore’. There is still a lot of soft selection pressure as poor genes are expensive/limiting along almost all axes, not just finances. I am almost certain that we are going to see increased variation, but sexual selection is self-reinforcing and might keep the whole thing in relative check.

      • Mike says:

        I was talking about mutational load, not genetic drift. The latter is a change in order, the former is an increase of entropy.

        It does not matter much what areas “poor genes” are limiting in, as long as they are not limiting procreation.

        • Anon says:

          Why wouldn’t they be limiting procreation? Even if they don’t outright kill you, they could still limit your mating options.

        • Jason K. says:

          Where exactly could you have poor genes that wouldn’t likely impair mating to some degree? About the only things I could think of would be ones which invisibly trim off life expectancy like being prone to heart attacks.

          • That may not impair mating, but it reduces the length of time over which you can either produce offspring or help rear offspring.

          • God Damn John Jay says:

            Depends how you define poor genes, the Clinton family are about as successful as you can get, but they only have one grandchild.

          • Samuel Skinner says:

            Then they have low fitness genes.

          • Marc Whipple says:

            Bill and Hillary have only one child, but I’d be slightly surprised if Bill only had one child.

          • Mike says:

            Poor (up to a certain limit) genes would surely impair mating, but are likely to induce procreation – by limiting other options and distractions.

            An overweight, <90 IQ girl with diabetes and drug addiction will not be able to snatch a hedge-fund executive for a husband for a mate, but would have no problem to produce 3-4-5 kids from multiple daddies, all of whom would survive to maturity despite a diet of junk food – at a significant public expence. Her life expectancy hardly matters – she will certainly live long enough to become a grandmother in her mid-30s.

        • Deiseach says:

          Contraception and abortion are doing a heck of a lot more to limit procreation than one’s mating options being limited.

          Unless the worry is that “mutational load” is going to increase amongst the very types that are having children (seeing as how we’ve discussed that increasing levels of educational attainment correlate to having fewer children), I think this is a problem that you don’t have to worry about, except if you’re worrying about things like “the association of brains and wearing glasses being due to smart kids needing to wear glasses because of poor eyesight so we’re going to have lots of smart people with bad eyes and other health problems”?

          • Mike says:

            Mutation load is increasing among all people who suffer low child mortality rates – every generation of children is going to be less healthy, carry more defects than the previous one.
            It will hurt upper classes more, because the burden of a sickly child tends to prevent such people from having more children.

            In the past, even the elites had high child mortality rates, so it was not primatily the problem of nutrition, lack of care, etc.

          • “Mutation load is increasing among all people who suffer low child mortality rates – every generation of children is going to be less healthy, carry more defects than the previous one.”

            Child mortality tends to eliminate genes that lead to child mortality—not defects in general. A gene that leads to child mortality in a world where food is scarce and modern medicine has not yet been invented is a defect in that environment but not necessarily in the environment of the modern world.

            So what you are saying is that low child mortality in the modern world means that we are no longer filtering out genes that would have been defects a few hundred years ago but may no longer be defects in our current environment.

          • Mike says:

            “Child mortality tends to eliminate genes that lead to child mortality—not defects in general.”

            Genetic Load consists of numerous (hundreds?) mutations that are slightly-detrimental (not individually subject to severe adverse selection) but cumulatively reduce the fitness.

            Impairments to childhood survivability due to GL would necessarily correlate to impairments in other traits for the same reason, so the other defects get eliminated by proxy.

            There are good reasons to believe that the relation of decrease in fitness to cumulative GL is super-linear.

            “So what you are saying is that low child mortality in the modern world means that we are no longer filtering out genes that would have been defects a few hundred years ago but may no longer be defects in our current environment.”

            For a western professional family, a sickly child would drastically impair the lifestyle and procreative choices of the parents compared to a child that is healthy.
            So it’s not a binary live/die kind of defect that I have in mind but more of eventual group extinction kind.

    • Aegeus says:

      First off, how many doctors actually expect “mutational meltdown in not so many generations”? Even around here (a very pro-genetic-engineering crowd), I don’t know anyone predicting a meltdown.

      There are a couple of people who say “gene-tweaked babies are going to be awesome so we should totally invent them,” and a couple of people who say “If we don’t get gene-tweaked babies, the Chinese and Russians will,” but I don’t think there’s many people who are expecting the world to end if we don’t launch the Genetic Manhattan Project.

    • JBeshir says:

      While on the margin, I’d love it if people had higher regard for the less capable, I think we’re in no danger of the unhealthy or incompetent being viewed as being just as attractive as the healthy and competent. You don’t need to kill people for them to be evolutionarily disfavoured; you just need them to be less attractive. And we got that.

      While the selective pressure might not be exactly on where we humans would put it, likely favouring impulsiveness and other things since contraception came into play, it hasn’t ever been too great, and although contraception may have made it less good at selecting for intelligence in some ways recently, it’s also likely gotten better at selecting for intelligence recently in other ways.

      We’ve just taken a huge selective pressure for reduced caloric needs out, for instance. I’m no expert either, but my best guess would be that caloric needs would have probably been the main reason we aren’t just bigger overall, with correspondingly bigger brains, and bam, that’s gone. By eliminating the occurrence of a lot of situations which are rough on the body, like periods of starvation or extreme exercise under life-threatening conditions, we permit any compromises to other things made to help cope in them be undone. By treating disease, we remove compromises in other functions that were there to help us cope with them- no more selective pressure for sickle cell disease. And while intelligence probably increases odds of reliable use of contraception, the social success it permits increases odds of relationships, and that game continues to be a runaway competition.

      My expectation is that we probably couldn’t *stop* genetic manipulation becoming common place within the next 300 years or so if we tried, but even if we didn’t develop it I don’t think that I’d expect humanity to degrade into infirmity and idiocy. That said, if in a century things look to be going downhill and genetic manipulation isn’t on the horizon I think we can and should act then. We get some time delay after noticing the decline to act, so we can act when we see one.

      Right now we’ve only just stopped (in the West) after a continual rise, and we’ve no need to make choices which involve more suffering in the name of Humanity’s Future, though.

      • One further point you missed … . Modern obstetrics make large headed babies less of a risk to the mother.

        • God Damn John Jay says:

          Interestingly, there was a case of a hydrocephalic man whose brains was diminished to 5% of its size having an IQ of 126. This creates a wrinkle in the theory that humans need huge heads, huge hips and miscarriages in order to perform higher logic functions. I have no idea what could cause it then, but its certainly a weird concept.

          On a more esoteric note, some people the writer of the article dubs the “religious nut jobs” cite this as evidence for an Cartesian brand soul. Especially since person walks around without a brain seems to be bigger than half the biblical miracles. I am reminded of Scott’s old post where he said that there is a fish with the word Allah on it, which seems like a pretty clever “proof” of god’s existence. I think Scott has a long and interesting set of posts where he writes about a topic that is pretty far fringe with a engagement beyond the typical {lol-Horus-lol-Baldr-lol-Mithras-lol}.

          • Murphy says:

            thing is, there’s no reason to believe that he had that void in his head his whole life.

            If it’s the case I think it is the patient ended up in hospital after a traffic accident, people presenting with less severe Hydrocephalus often do so in a similar manner, they’ll be driving then black out or have a fit, crash and the abnormality shows up on brain scans when they end up in hospital.

            They don’t notice it until the very slowly expanding void finally presses on or damages something that can’t be compensated for and they have a blackout or accident.

            So this kid was likely born with a pretty normal brain which gradually got crushed against the inside of his skull by the growing void.

            A great deal of our brain cells die as we age, to a large extent it’s essential that they do so as it optimises various pathways but you need that larger initial mass to learn and adapt at a young age. It’s entirely possible that a large brain mass is essential for learning effectively in the early stages of life while at the same time it being possible for an intelligent adult to live with a fraction of the brain matter once the most essential pathways have been laid down.

  11. “Maybe it’s not the most devious of traps for you or me, but what about for your grandmother?”

    I’m 62. I’m not a grandmother because I didn’t have children, but I’m old enough to be a grandmother. And old enough for long enough that I’m tired of “your grandmother” being shorthand for “an ignorant person who isn’t reading this”.

    I’m not sure what would be a more polite and accurate way of expressing the concept. Possibly “a naive person”? This does have the problem that “your grandmother” implies that you’d like her to be safe, while there are all too many people who think ignorance deserves to be punished.

    • Who wouldn't want to be anonymous says:

      You are old enough to be a grandmother, but not old enough to be the grandmother of someone who would be reading this site. Add a few years and a double dose of dementia.

      I see your anecdote and raise you one: if my grandmother knew what the internet was, she would have mortgaged the house for a Nigerian Prince ten times over by now.

      • Not all old people (including those who are a good bit older than I am) have dementia in the range where they’re vulnerable to scams (um, more vulnerable than the general population) but still in good enough shape to get ripped off.

        Also, while I don’t know the percentages, it’s at least possible for generations to be 20 years long, so a 20 year old reading the site with a 40 year old mother and a 60 year old grandmother.

        • Who wouldn't want to be anonymous says:

          Maybe I should point out I was being a little tongue in cheek? I do get the point you’re making.

          That being said!

          If you’re interested in the percentages, you can check out the National Vital Statistics Report. [1] The number the news likes to harp on is the average age at first birth, which they love to tell us how it has moved from around 20 to the mid/high 20’s somewhere. This is an interesting number to know for vital statistics reasons, but isn’t very helpful for us: women have more than one child. We’re more interested in average age for all births. Skimming through the report I didn’t see it spelled out anywhere, and I have way too much of a headache right now to try figuring it out from the tables. It is probably a lot closer to 30 than 20.

          Figuring that out is step one. Step two is that SSC tends to skew strongly on the educated side. And educational attainment is, iirc, strongly correlated with the educational attainment of the mother, and educational attainment of the mother is strongly correlated with older age at birth. [Citation needed]. So if you close your eyes and believe! it looks am awful lot like SSC should have older mothers than the general population. (And if you are really, really committed you could say the intergenerational educational attainment correlation may extend across more than one generation, so SSC’s grandmothers might’ve been older at birth than the general population.)

          So I’ll maintain that you are very unlikely to be old enough to be the grandmother of any meaningful portion of the SSC readership.

          [1] The filter apparently ate my link, but the NVSR should be easy to find.

      • I am a grandfather, and I wouldn’t be surprised if my ten year old grandson reads the site–his father does. I was past thirty when his father was born, so if I had produced a child on the early end of the normal range I could have a twenty year old grandson.

        • God Damn John Jay says:

          Admittedly the Agnatic line of the house of Friedman is probably smarter than most, but I would be shocked if a ten year old would be able to understand, appreciate and enjoy this blog. There is a pretty good intersection of following the minutia of current events reporting and relatively insular events of internet culture. Additionally I think a lot of the writing on the blog is of a revisionism of revisionism nature, all of which are things that very few ten year olds would follow with any degree. My family made a token effort to keep the news off around my sibling and I to prevent issues where we would see dead bodies or hear horror stories.

    • Scott Alexander says:

      I’m not suggesting older people are stupid. I’m suggesting that they’re not familiar with the Internet and don’t have a good eye for scams.

      I’ll give an example. I have a professor in his fifties or sixties. He recently got a few thousand dollars stolen from his credit card because a popup said he had a virus and needed to call Apple Support Staff, and the number went to a scammer who claimed to be from Apple and asked for his credit card number. While I’m sure some people my age would fall for that, and I’m sure there are some really savvy 60 year olds who wouldn’t, I think in general it’s more common among the over-60 population.

      My own grandmother asks me for help with the Internet all the time. She’s very smart, she’s just not a “digital native”, and she admits it.

    • Saint Fiasco says:

      When I was a child I used to be annoyed by phrases like “this appliance is so easy to use that even a child could handle it”.

      I’m not sure I grew out of it in the sense that that kind of thing doesn’t bother me anymore in a general sense, or if I just literally grew up and those phrases no longer apply to me.

    • “I’m not suggesting older people are stupid.”

      Scott, I said “ignorant”, not “stupid”.

      • Scott Alexander says:

        I think old people are very specifically ignorant about technology and about the number of scams on the Internet.

        • Who wouldn't want to be anonymous says:

          Starting from the observation that the elderly make up a very disproportionate fraction of fraud victims, it may seem reasonable to infer that they must be unusually vulnerable, either from stupidity or ignorance.

          But it may be instructive to look at the situation from a different angle. Instead of the victim, consider the perpetrator: “Because that’s where the money is.” Whether out not Willie said it about banks, it also happens to be true about the elderly. They have all the money.

          Whether because they are vulnerable; because they have the money; because perpetrators think they are more vulnerable, or have an the money; or all of the above; dutiful grandchildren worrying about elderly fraud is probably reasonable. Playing on that worry may even be a reasonable rhetorical device in the right circumstances. Ascribing a reason may be a step to far.

          And because one link is never enough, try this article which attempts to correlate potential risk factors with vulnerability. The link carries no warranty, express or implied. (But if you head down the rabbit hole, keep in mind there is basically no area of research that wouldn’t be interesting to hear you report on.)

    • Elissa says:

      Grandmothers, and people old enough to be grandmothers, are often very awesome people and underestimated by young men in particular. I don’t think Scott meant to cast any aspersions, but I feel where you’re coming from.

    • Echo says:

      Hey, at least you’re not the Racist Grandfather, right?

    • Murphy says:

      Randomly sampling from different demographics who would you guess would have the higher proportion of people who, when tested, will fall victim to the most internet scams:

      Single women with no children.


      Keeping in mind that the majority of the former are young and grew up with the internet.

      If the question was who would be most likely to be able to work a library file card system the grandmothers are likely to win.

      It’s silly to pretend that every demographic is equal.

      There’s a reason that Elderly people make up 80% of fraud victims

      • Echo says:


        “…a woman in her 70s was instructed by a group (who described themselves as police officers) on the phone to get dressed up for a funeral and go to a bank and withdraw money…
        The scheme worked. She withdrew ¥22 million, met one of the men and handed it to him in person. The suspects are still at large.”

        You’re conflating “can’t into internet” with “vulnerable to all kinds of fraud and abuse that have nothing to do with the internet”.
        The 12 year olds spending $1200 on microtransactions with their parents’ credit cards aren’t even included in those statistics, and they sure “grew up on the internet”.

    • Error says:

      Isn’t the canonical internet-illiterate user Aunt Tillie?

      Not sure if that’s an improvement or not.

  12. ryan says:

    A subconscious BS filter is probably a necessary adaptive trait for the internet age.

    I have a good deal of experience researching drug side effects online. When the only google results are the automated EHealthMe type sites, you can be very confident there is not a known association between the drug and the side effect you’re interested in. If there is any legitimate evidence of a relationship, google will find that website and rank it above the scams.

  13. Julia says:

    I’m not too pleased with the people running TV ads for lawsuits about Risperdal and gynecomastia, because now a lot of my male clients are afraid to take Risperdal no matter how rare the side effect is. Thanks, folks, this was exactly what people with paranoia needed to see.

    • Scott Alexander says:

      Psssst…Invega is almost exactly the same and it’s gone generic now. No one will ever have to know.

    • Jeremy says:

      Is it common for doctors to prescribe Risperidone and say it’s a sleep aid when they secretly want the antipsychotic effects as well?

  14. TomA says:

    Once upon a time, our ancient ancestors lived in an environment of significant existential hazard. During an encounter with an existential threat (think saber tooth tiger), they would either die, be seriously injured, or have the shit scared out of them as they fled. This was good for the robustness of the species.

    We now live in a time of unprecedented technological advance and great affluence, and what passes for existential threat is the odd encounter with a bogus information website. Something tells me that evolution isn’t what it used to be.

    • Scott Alexander says:

      Banned, on the grounds that being banned from a blog is less bad than being eaten by a sabertooth tiger so there’s nothing to complain about.

  15. Jordan D. says:

    I’m not super familiar with the legal principles involved in suing an online medical advice dispensory, but I expect it would be pretty tough to win a case like that unless there was either clear malice or incredible recklessness (like telling diabetics that insulin will kill them or something). This is probably a case where at some point somebody will die, there will be an outcry and Congress or the FDA will regulate.

    More important to me is how much more money than exists in the whole world they get sued for. As far as I know, the current record-holder is Purisima v. Au Bon Pain Store, which famously demanded more than the defendant could repay even if it enslaved the human race and put us all to work until the stars guttered and perished from the heavens.

    (The obvious solution being to design an Unfriendly AI which converts all matter in the universe to dollar bills. Or letting the Fed up inflation by a few sextillion times. Depending on whether you’re one of the people who fears the Fed more than a malevolent robot god.)

    Obviously Au Bon Pain’s misdeeds are rather less malicious than some of these online sites. I won’t truly feel that justice has been done if there are fewer than a hundred zeroes behind the number in this hypothetical suit!

    • God Damn John Jay says:

      There are very strict laws about medical advertising in the United States, as well as a large number of libel policies, I would be shocked if this doesn’t break at least *one* law.

      • Marc Whipple says:

        It’s impossible to go about the daily affairs of living without committing several serious crimes a day. The mere fact that something could be a serious crime has almost no bearing on whether a) anybody knows, b) anybody cares, or c) anybody will do anything about it.

        • Jordan D. says:

          I’m a little skeptical of this claim: I started hearing ‘you commit multiple crimes every day’ right after the book Three Felonies a Day came out, but I’ve never seen anyone actually identify these felonies. I’ve only skimmed excerpts from that book but a lot of them seemed to be one-off examples of prosecutorial overreach or events from cases which led to unfair convictions due to rare circumstances.

          The two most convincing examples I’ve heard are the Computer Fraud and Securities Act, which could theoretically criminalize a public employee browsing Facebook, and the law against obstructing a federal employee (i.e., ‘accidentally lying to a park ranger’). At least one of those laws is regularly abused by prosecutors, but I’d imagine that most people actually don’t violate either very often.

          I would be interested in more prolific examples of frequent felonies!

          (This isn’t to say that I don’t think we have too many broad laws. It just seems like there’s a lot of hyperbole.)

          • Murphy says:

            This guy runs though some examples as part of explaining why you should keep your mouth shut if you’re ever involved with the police.


            “[James Duane] Here is one of those ten thousand federal criminal statutes on the book, that you probably never heard about. It’s called the Lacy Act. Sixteen U.S.C. section 3370 says “It’s a federal offense for any person to import, export, transport, sell, receive, acquire, or purchase any fish or wildlife or plant taken, possessed, transported, or sold in the violation of any law, treaty, or regulation of the United States or any Indian tribal law, or any state law or any foreign law.”

            People have been convicted in federal court for violating this statute because they brought back a Bony Fish from Honduras, not knowing that Honduran law, not American but Honduran law, forbade the possession of the Bony Fish. People have been convicted under this law because they were found in possession of what’s called a short lobster, a lobster that is under a certain size. Some states forbid you from possessing a lobster if he’s under a certain length. It doesn’t matter if he’s dead or alive. It doesn’t matter if you killed it, or if it died of natural causes. It doesn’t even matter if you acted in self defense. Did you know that? Did you know it could be a federal offense to be in possession of a lobster? Admit it, raise you hand if you did not know that.”

            One of the reasons I decided to give this talk. I recently received a phone call from a former student of mine. A Regent law school graduate, who may be watching this online, we’re putting it on the Internet. And he told me “hey, I’ve been approached by the Internal Revenue Service. They want to ask me a couple of questions. They asked if I’d be willing to. Uh, but they say that I’m not a suspect, and I know in my heart I don’t I’ve done anything wrong in violation of the Internal Revenue Service provisions.” Lord have mercy. There’s no man on earth, there’s no woman in this country who can honestly say with complete confidence “I know I have never violated any provisions of the Internal Revenue Code.” He said, “but they say I’m not a suspect, and I know I’ve done nothing wrong. It’s OK if I talk to him?” I said “No. No, you tell them you will not talk to them without immunity.” I explained to him why that was true and they never, he never heard from them again.

          • Scott Alexander says:

            But most of us don’t import weird fish from Honduras three times a day. This isn’t very convincing.

          • Deiseach says:

            Well, I can see the reason for the lobster one. Lobsters under a certain size are likely to be immature, and this would be a case of over-fishing. Same way that we are constantly having lawsuits over here about salmon fishing/salmon poaching and who has the rights to the river etc., and there are fishery protection vessels on the seas policing trawlers.

            Because you allow people to fish lobster and sell them on to restaurants etc. with no conditions and you’ll end up with no lobsters since they’ll be fished into extinction (look at cod for an example of something that was once a cheap, plentiful food and stocks are now at such a low that frozen food manufacturers are trying to get the public to buy hoki fillets from New Zealand).

            Short/undersized lobsters are immature lobsters are lobsters which haven’t spawned are lobsters that haven’t created the next generation of lobsters are no new baby lobsters are no lobsters in this region anymore.

            And allowing people to get away with “I didn’t kill it” or “It was already dead when I found it” and the like means you might as well let your law be tissue paper. Since most people will not be innocent tourists or kids out for a day on the beach with grandpa, but will be commercial fishers and selling on those lobsters, you have to be finicky about the execution of the law, even if you do catch a few genuinely did not know and are not doing it for money people in the net.

            Besides, I thought there was a principle that “ignorance of the law is no excuse”?

            Laws about importation/movement of crops and animals, like the examples quoted, are there for a good reason: Australia for one is very strict on this because they’ve had experience with people introducing new species that were not native, and it didn’t go well.

            The Colorado Potato Beetle is taken seriously as a pest over here, even if it sounds funny; specimens can be accidentally imported on farm produce from outside the British Isles, so people sending crops, plants, animals, etc. to family and friends, or bringing exotic specimens home with them, could create a serious problem without intending to do so or knowing that there was a risk of germs, bugs, or invasive plant species.

            Rhododendrons have spread over mountainsides in Ireland as escapees into the wild from gardens where they were introduced in the 19th century as exotic foreign show pieces. They look very lovely but they are killing off and displacing native plants and they are horribly difficult to eradicate and you very quickly end up with an entire hillside covered in rhodendron from a starting point of one bush.

            So yeah, these are bad examples of “The government is sticking its beak in for no good reason and turning ordinary people into criminals”.

          • keranih says:

            Do you go on a walk outside in the woods, and pick up feathers when you do? Most birds in the USA are covered under Migratory Bird Act, and in particular the possession of raptor (hawk and falcon) feathers can get really expensive, really fast. Same same with many turtle bones.

            It’s not that any one law is so bad – it’s that there are so very very many of them.

          • Echo says:

            Scott, many of us do equally odd things on a regular basis as part of our jobs, knowing that some federal prosecutor’s interpretation of a foreign law that isn’t even applied there could send us to prison for ten years.

            You know, if our company donated to the wrong presidential campaign, which seems to determine whether Gibson or C.F. Martin gets the book thrown at them for the same activity.

          • Jason K. says:

            “Besides, I thought there was a principle that “ignorance of the law is no excuse”?” – This is a pet peeve of mine. Sure, it is a fine principle if it is in any way shape or form a reasonable request to know the entirety of the law that might ever apply to you. We are waaaay past that point now.

            Besides, that principle is only ever applied one way. It is only applied by the state and their enforcers towards the proles, not the other way around. When the state screws it up, there is almost always some excuse that they avail themselves of. Usually in the form of: ‘The state only had good and pure intentions and should be forgiven because they meant well.’

          • Murphy says:

            @Jason K

            personally I think it’s a crying shame that the constitution never included criminal penalties for violating it.

            Imagine a world where if a law gets struck down as grossly unconstitutional then every lawmaker who voted for it could, in theory, be criminally liable depending on their level of involvement and likely level of good faith that it was constitutional.

            Try to bring in a law to execute unpatriotic journalists ignoring objections that it’s obviously unconstitutional? Locked up for a long time.

            Try to bring in a law codifying the regulations on the sale of lettuce that you ran past constitutional lawyers and made an effort to make sure was constitutional but where clause 122 on page 67 gets struck down after a long court battle over a subtle constitutional problem? Misdemeanor.

            Some say that it might have a chilling effect on lawmakers, making them unwilling to bring in laws that are merely likely to be unconstitutional or force them to put effort into trying to make sure that laws are constitutional: I say mission fucking accomplished.

  16. Abel says:

    Wow, that’s really scummy, didn’t know this was behind that kind of page. Funnily enough, now that I think about, I don’t remember seeing it in the Internet in Spanish (many possible reasons for this, of course)…

  17. >The law is usually pretty strict about who can and can’t provide medical information – so much so that it cracks down on 23andMe just for reading off the genome in a way that uneducated people might misinterpret. Yet somehow sites like EHealthMe are allowed to continue

    Law? The law of which country? It could be hosted on anywhere on Earth and we are not too far from hosting a site OFF Earth, IMHO. Or you mean it in the sense that US ISP’s could be ordered to filter out sites that break US law? Technically doable but the next time you find out the whole world have read an extremely interesting article but you and other Americans could not because it also included two lines of quoting someone whose speech was deemed hate speech, you will be pissed.

    When I need a plumber I won’t look up one from Yellow Pages, rather I ask my friends to recommend a reliable one. The same way, people could learn to not google random shit about things like their health but got sites who were promised to be reliable by someone they trust. This is not sci-fi, not too much to expect, real actual humans, even not very bright ones, really do understand that some things work better by referrals, you don’t have to be very smart and educated to not look up a plumber from Yellow Pages, you just need to be a bit paranoid. Which means, I figure your grandma usually ask her grandma friends to recommend a plumber too.

    On the Internet, this trust and referral could also be automatized. Something better than asking your friends or doc about what a good medical site is. Urbit is trying to solve it, but I think there are other projects as well, the problem is well understood amongst programmers.

    • TeMPOraL says:

      What is also well understood amongst programmers is that referral systems are always going to be gamed. There are whole subfields of marketing devoted to exactly that. Even personal relationships can be gamed that way – that’s exactly what all those MLM schemes are doing! They’re promising great rewards if you only sell your soul and advertise a particular product to your friends while pretending you actually care about their best interest.

      I’m generally used to managing my peresonal “web of trust” and I tend to recommend nice and competent people a lot. But I keep wondering if it can actually scale. Not everyone has a high-energy laser support equipment operator in their circle of friends. We can try and expand the reach of the referral network through tools like social media, but the further down the network you go, the more likely it is that you’ll get attacked by advertisers who are poisoning the network. So it still seems prudent to raise the *base* level of competency you can expect from any random, legitimate company.

      Also, I really dislike the “appeals to life experience”, i.e. “it’s ok to have evil agents X, you need to learn to recognize them”. No, it’s not ok – each evil agent you have to learn to avoid is more cognitive burden for everyone, and with enough evil agents, you’re bound to fall prey to at least one at some point. Evil agents should be opposed.

      • I don’t think I wanted to tell people they need to recognize evil agents. I basically just wanted to tell people to use referral systems, and this is precisely what everybody does in a low-trust situation. So basically just telling people to treat the web as a low-trust situation. Precisely because people cannot detect evil agents, they should use ones someone they trust says are not-evil.

        I think “evil agents should be opposed” is too utopian. “find ways to reduce the damage done by evil agents” is better, and one of the ways could be automating / improving referrals by tech. I mean, it is something similar as dreaming about ending crime so that nobody needs self-defense or living in nice areas or anything. Won’t happen.

        Besides, this even has advantages. Street muggings have no advantages for anyone but the mugger. But low-trust, scammy environments have the advantage that they push people to use referrals and thus to use their friends/community for something else than hanging out and shooting the shit. I mean, the primary reason there is so much alienation and atomization is that people don’t really need each others help anymore, life is too comfortable. In this sense, it is good. Maybe grandma wants to talk to you but needs an excuse for it, because she fears otherwise it would be inconvient for you. This is a good excuse.

        Who was it who discovered if you ask people to do favors to you, and they comply, they will like you more? To justify it? This means, if you want people to like each other more, it is not bad if they live in an environment where many small favors are needed. Such as referrals.

        • Randy M says:

          “Who was it who discovered if you ask people to do favors to you, and they comply, they will like you more?”
          Ben Franklin, iirc.

    • brad says:

      The problem with referrals is that in a lot of fields the customer has no idea whether or not the professional did a good for them. You see it all the time in the legal profession — some clients unreasonably impressed with their lawyers for routine work on an easy case and other clients unreasonably unimpressed with their lawyer for good results on very difficult cases.

      I think it boils down to personality compatibility and/or bedside manner.

      • Perhaps, if doing routine work on easy cases is easy, there is enough capacity left in actually impressing the client, like being all friendly and nice. While working hard on a tough case can make a lawyer snappy and curt and all that, not much energy left for niceties.

        I mean, this is why in software the programmers who can fix bugs are usually not allowed direct customer contact, only through support people. (In my experience.) Dealing with both the customer rage and the difficulty of an elusive bug is too much for one person, they will get snappy and so on. Support people can be nice and calming to customers knowing they don’t actually have to solve hard problems, just escalate them. And programmers can rage if they want to, their rage stays in-house. As the saying goes, lock then in a back room, slide specs, bug reports and pizza in under the door 🙂

        • I’d model it more transactionally, I think. People don’t like dealing with annoying users, and few people can program. If you can program well, you don’t have to make nice with annoying users. If you can’t, but have enough technical knowledge to interface with programmers, you can be a BSA and deal with users.

          If you have the patience and the ability to do both, then you can go into independent consulting and make a lot of money, however. I’d say it’s more that people, once they hit a career with duties and pay they’re comfortable with, don’t tend to branch out into other areas unless forced to.

          • >If you have the patience and the ability to do both, then you can go into independent consulting and make a lot of money

            I wish. Here in Europe, being a freelancing SAP or Oracle Financials or similar accounting software consultant, or maybe a CRM software consultant or data warehousing consultant suchlike is not such a good move, even though it requires three skillsets (people, software, accounting/business/how users like to slice data etc.) not just two. They get to charge roughly 50% of what consulting companies charge, so about €600 a day, so if they get to charge every workday, 22, a month, €13200 a month would be indeed an excellent pay. That would make $170K a year. By working as a senior consultant employee at a consulting company, they would make about 40% of that. In other words in order to make freelancing worthwhile, they must be able to charge for about 8 workdays a month. And this, is hard to find that much demand, find that many customers, and to be able to actually charge that much, instead of the freebies like spending time on writing countless sales offers, sitting in sales meetings, or doing a million kind of unpaid work like the customer saying “you misunderstood my requirements so fix it for free”.

            I am actually very good in my field and only rarely tell users to get fucked by a team of horses which I figure counts as people skills, but I haven’t even an idea how I would start selling myself. Start randomly calling the IT dept of various corporations, hey peasants let me improve your data warehouse, I won’t even tell you how much it will cost, I bill per time, €600 a day, deal? I am afraid it would tell me to get a blowjob from a shivering shark. Working as an employee is safer, although much lower pay, because basically every productive, billable consultant must earn not only his own salary but the salary of one full-time salesman who does cold calls and suchlike in order to generate work for him.

          • Heh. Here in Charlotte, NC where I live, there are multiple banks and financial companies that are all going “OMG Hadoop big data whaargbl!” at once. I would not be surprised if you did get a bite based on exactly that sales pitch as a cold-call.

            Then once you’re in the door somewhere, you use those nebulous social skills to make contacts with other people at other IT departments, find out what they’ll need in a year, tailor your work at stepping stone company N to look really awesome for company N+1, then leave before company N notices your work is only marginally for their benefit.

            And of course as you say, working for one of the aforementioned big banks or financial companies is much safer (and is in fact my preferred choice), but I’ve seen people leverage Talking to Users (both in sales and in requirements / project management) into quite princely salaries.

        • brad says:

          I mean, this is why in software the programmers who can fix bugs are usually not allowed direct customer contact, only through support people.

          The problem is that people, or at least Americans, get very upset when they have to talk to a paralegal or nurse practitioner. They very much want to have an actual expert waste his time listening to their inane babbling and reassuring them. Also they have very specific ideas about what said expert should look and sound like. In law it isn’t too terrible because at least the client is generally paying for the hand holding so there’s a feedback mechanism. In health care it is an utter disaster because there are all these entitled demands and no counterbalancing cost signal.

  18. Moloch cleanup brigade says:

    Scott, meet Moloch:
    * Google still puts a lot of signal value into incoming links from other highly reputable sites
    * You’ve just cross-linked half the scummy Internet
    * Google will import this as an implicit *trust signal* between your site, and these sites.
    * We’d really like to optimize the other way
    * Quick fix for this is mark all these links as rel=”nofollow”

    • Scott Alexander says:

      I was hoping it wouldn’t matter because it should be very rare that anyone searchers for Xolair and depression specifically, but since I’m not sure that’s how it works and you’ve presented a good solution, I’ve done that.

      • Nestor says:

        Google does manually nuke sites for egregious behaviour like this, you’re likely read by someone who is or can tell someone in google who is in a position to do something about this. I would not be surprised if this site gets nuked from the search results in short order. If you actually do know someone in or in the orbit of google and actively tell them it could probably happen even quicker.

        • TeMPOraL says:

          I’m posting it to Hacker News just in case – some Google folks responsible for search results tend to hang out there.

          • Echo says:

            Boy, I sure love living in a world where tiny cliques of people with too much time on their hands get to decide what I’m able to look up on the internet.
            Reckon they’ll start tackling “hate facts” next?

          • Anon says:

            Just so y’all know, this blog post was reported to Google and there’s an internal conversation going on about it.

          • Other Anon says:

            This post was also reported to Bing, and it’s getting a response there too.

          • CatCube says:


            If you use a search engine from a company, there’s going to be a relatively small number of software programmers that decide how they rank their results. I don’t know how you get around that.

  19. Kaj Sotala says:

    OTOH, I like that you’re giving us a link to the page so that we can verify what you’re saying about them, but at the same time, linking to them gives them more views, which is what they’re after. Maybe replace the link with a screenshot of the page?

  20. Anonymous says:

    Even legit medical advice sites tend to do more harm than good. I’m a person who rarely can keep my head calm and rational when it comes to my health. Whenever my body has any out-of-ordinary behavior, I google it and find that it’s probably cancer or at least a liver failure or something and I should really see my doctor. My doctor gives me a very superficial examination, says it’s probably nothing and sends me home. I spend the next one or two weeks as a nervous wreck because I probably have only a few months to live. Then the symptoms slowly disappear because it was actually nothing and I just forget about the whole thing.

    At least every site that lists causes of weird symptoms should list: 1) the conditional probability for each sickness given the symptoms and 2) the probability of getting these symptoms without having any serious condition. I don’t know if such numbers are usually known for different symptoms and diseases, but if not, it would be better to not say anything about them.

  21. drethelin says:

    It’s too bad it’s not reliable to crowdsource medical and scientific data. We need an Uber for Metamed.

  22. One possible approach to the problem would be to create a web site that rates and reviews medical advice web sites. Obviously you have to find some way of getting readers to trust it–perhaps sponsorship by some reputable medical authority, perhaps just the quality of its contents.

    • Anonymous says:

      There should be a system that automatically rates sites on various angles, such as trustworthiness. Neal Stephenson’s Anathem has one, because there’s so much automatically-generated spam and malware on their version of the internet.

      • Nornagest says:

        There are several such systems. If you have a modern browser you’re probably filtering everything through one right now, and if you’re behind a corporate proxy you almost definitely are.

        For better or worse, most of them are concerned with malware and (for corporations or paranoid parents) porn rather than with quackery and clickbait.

    • I think you can always count on the human revenge instinct. That means, if a site pisses people off, and it is fairly easy to send them a fuck-you, enraged people will. They are FAR more likely to do this than the opposite and give a favorable review to a good one. Zuck got it wrong – human nature is that we’d usually far more likely to click on a Dislike than on a Like button. And then track this…

      • Noumenon72 says:

        I have almost never arrived at a YouTube video with more dislikes than likes. I’m sure some are suppressed by the search results and many are sought out by people who like it, but I don’t think there’s any video with 15 million dislikes. Which is weird to me because I dislike frequently, but I am one of under a thousand every time.

    • Tibor says:

      I use a similar website, although it only rates various consumer goods (ranging from cosmetics to cars), insurance and a few other things. It is entirely subscription based (i.e. ads), it costs about 40 US dollars a year, so it is pretty cheap (they only test the products on the Czech market and obviously not all those available…so in a given year they test some 25-30 fridges or 40 bicycle helmets for example). I think that people who use it trust it simply because the information they provide is very good (way better than anything you can read from amazon reviews). I bought several home appliances using their website (they don’t actually sell it or link to shops, although they do mention an average price of the product at the time of the test), choosing always one of the top three products (with the specifications that I was looking for) they list and I was always extremely satisfied (and managed to get something comparable to the highest priced products for something like half the price…or at occasions even something better than them for half the price). They do get some government subsidies, but those are for counseling and other services they also provide, not for the product testing so they would be able to do that without the government. They also trade the info with similar organizations in other countries which reduces their costs. I would definitely be willing to get a subscription to a medical advice rating site of similar quality. Not everyone can afford personal medical consultation with the best doctors* but most people could afford more general medical advice/rating of advice elsewhere from the best doctors from a subscription based website.

      *and in many countries in Europe, maybe most, you won’t get to the best doctor because all of them have to charge the same and so the best just won’t take any new patients, and for an operation in the hospital you just get whoever is available…unless you know the doctor or someone who knows the doctor personally and can convince him to arrange it to operate you, which might also sometimes include bribes I think…those would not be bribes in the US where paying for a better doctor is not illegal).

  23. Rith says:

    Asthma and depression have a high co-morbidity ( If the patient was not depressed before and he is now, it seems very unlikely that the final straw was taking an igE blocker, which is an anti-inflammatory and would probably have at most a slight anti-depressant effect.

    My hypothesis would be that whatever life-change motivated the person to start getting xolair shots (and my impression is that is the normal mode of administration) A) exacerbated the asthma and then a little later B) triggered depression.

    • Calico says:

      I think having sever asthma and the life-style effects that go along with it really suck, so people get depressed.

  24. Max says:

    To be fair first thing which jumped at me from Ehealthme page is “Among them, 14 people (0.12%) have Major Depression”. 0.12% !!!! That screams to me that its probably does not cause depression (even though I did not make connection that this rate is lower than depression rates among general population like Scott did)

    I mean seriously it does provide sufficient information to conclude that it probably does not cause depression for a layperson like me. Can it mislead somebody else? – probably, but then that person could be mislead in myriad ways. If you are mislead by honest facts -well its your own damn problem !

  25. Professor Frink says:

    Regarding the last line, it’s really, really hard to win that sort of lawsuit in America. “Tort reform” of the 80s/90s made it really hard to sue and win.

    The whole “America is a litigious society” is a media myth pumped up by insurance companies. Tort reform means payouts go down (good for insurance!), and because of all the media play about “frivolous” lawsuits no one minds when their insurance rates go up (good for insurance!).

    • Max says:

      No its not. America is insanely litigious society. You should investigate how much malpractice insurance cost for doctors . And then insane amount of paperwork, tests and sometimes useless procedures staff in hospital has to do just to cover their asses. American health care cost are driven to stratosphere by two factors: regulation and litigation

      • Professor Frink says:

        I used to work for one of largest malpractice insurers in the US. When I left a few years ago, our payouts had been steadily falling since at least the early 80s largely because of new laws limiting damages.

        Here is a question- do you think we charged less in states where non-economic damages were capped? Of course we didn’t!

        Your assertion that malpractice is a cost driver also doesn’t pass the smell test- throughout the 80s and 90s all sorts of caps were put in place for damages, and health care didn’t trend down in those states with strong tort reform laws (caps, mandatory arbitration,etc). Some hospitals may practice defensive medicine but it’s more their own fear than a rational response to serious liability. Less than 2% of “incidents” (surgical error, hospital acquired infection,etc) lead to a lawsuit.

        My current healthcare provider is an HMO, Kaiser Permanente, and like several HMOs nation wide, they require all their customers to sign away their right to a trial (mandatory arbitration clauses). I can’t sue my provider, if something goes wrong Kaiser appoints someone to run the arbitration to decide how much I get. This is becoming increasingly common.

        • Max says:

          When I left a few years ago, our payouts had been steadily falling since at least the early 80s largely because of new laws limiting damages.

          throughout the 80s and 90s all sorts of caps were put in place for damages, and health care didn’t trend down in those states with strong tort reform laws (caps, mandatory arbitration,etc).

          Erm… You just proved my point. Imagine if laws were saner first place! or no laws for a change. So you know visit to doctor could be paid entirely out of pocket without any regulation/insurance companies involvement.

          Like it used to be. Yeah I know its a shock, but doctors visits used to be not much more expensive than oil change today. Before the licensing/govt stepped in

          p.s. And regulation does not prevent malpractice/errors/bad drugs.

          • nil says:

            Other things that didn’t exist in the good old days:
            – dialysis
            – useful diagnostic equipment that costs 6-8 figures
            – chemotherapy
            – life expectancies over 70

            There’s no magic bullet for medical costs, nor, if you think about it a little, is there any reason to go looking for one. The answer is easy, and can be found through asking oneself a simple question: how much money would you spend to save your own life?

          • God Damn John Jay says:

            The thing about Chemotherapy is that chemicals are surprisingly cheap as has been demonstrated by the Daraprim controversy. Similarly a lot of equipment winds up being superannuated over the lifetime of a hospital, and could potentially wind up being cheaper per visit if we increased the rate at which we pushed people through the doors, I used to work at a pharmaceutical firm that re-purposed its reactors for fish oil supplements during the recession because anything was better than letting equipment sit idle. Factories make people work in shifts for this very reason. I wouldn’t be surprised if a lot of the price increase of medical care is due to doctors taking family leave / working less demanding specialties / retiring early.

            (For the record I graduated with a computer science degree but was in engineering and did a coop shift early in college, for anyone who cares enough about my posts to catch me in a contradiction)

          • AlexL says:

            In other more civilized countries (e.g. Mexico) all that expensive stuff is covered by – drumroll – INSURANCE. Regular doctor visits are not and you pay them. You treat insurance like actual insurance (i.e. for catastrophic events) and lots of the current economic disincentives in the U.S. system disappear. I’m not saying it’s a panacea, but that would probably be a good first step.

          • Professor Frink says:

            No Max, I did not “prove your point,” your point seems to have morphed. You claimed malpractice insurance was a cost driver for health care, I said that if that were the case, the massive wave of tort reforms more than 20 years ago would have had big impacts on the cost curves (and neighboring states with and without caps give us lots of natural experiments). That was not the case.

            Now you seem to be talking about generic regulation, and yes, some regulations do push costs up (and some push costs down), but that is far different than what we started this conversation on.

          • Thomas Jørgensen says:

            No, the post is implying-without-outright-stating that malpractice insurance firms are very successful rent extractors, and are making bank on the difference in perception between malpractice lawsuits and the actuality thereof. This, would of course, be a major market failure, but I don’t actually find it hard to believe that starting up a new malpractice insurance company to undercut the existing players is difficult.

          • Careless says:

            Why do you think it’s difficult? There are hundreds of hospitals that self-insure. And they don’t have cheap rates. My wife was an accountant who had to deal with that for one of them

          • Professor Frink says:

            @Careless The hospitals that self insure do save money over hospitals that do not. In the last year I have industry data for (2009), with self-insured hospitals, the average loss rate per physician was < $6,000. That is just a few % of the physician salary, and it is actually quite cheap as far as risk pools go.

            These aren't the numbers you'd expect if malpractice were a cost driver.

        • Anthony says:

          The issue isn’t that much the “non-economic damages” as the economic damages assessed when the doctor/hospital/drug company isn’t actually at fault.

          On the other hand, the easiest way for a health care provider to lower malpractice suits is to not be an asshole about billing disputes.

          (I did this once – I was treated very poorly at Alta Bates Hospital in Berkeley. It was only after they’d threatened to turn my $50 copay over to a collection agency that I threatened them with a malpractice lawsuit. I detailed how they’d fucked up in my first letter. The next correspondence I got was a notice that they’d waive the copay. They probably got to keep the $900ish they’d gotten from my insurance, because I didn’t bother to file a complaint with the insurance.)

          • Professor Frink says:

            Economic damages tend to be naturally capped (which isn’t to say they aren’t high, just that they are predictable). It’s non economic damages that provide the “wild-card” in malpractice lawsuits.

            And malpractice lawsuits, especially after the 80s-90s are actually pretty hard to win. Even if you do win, odds are very high that the reward will be overturned on appeal. One of the results of the Chamber of Commerce push to pour money into local judicial elections is that many states have very hospital/doctor friendly appellate courts.

            And this is if you can sue, many HMO groups force you to sign away your right to sue as a condition of being insured.

      • America is something that looks sort of like an insanely litigious society, but we don’t actually have a snappy phrase for our quite serious problem.

        What we’ve got is a legal system which is much too expensive for an average (or even somewhat above average person) to use. The result is that the mere threat of being sued is terrifying for most people and they can’t afford to sue, so they put up with a lot of injustice. And those who can afford it put a lot of effort and money into avoiding being sued.

        • Professor Frink says:

          Which is sort of the opposite of an insanely litiguous society- it’s a society where we’ve made it damn near impossible to use the tort system for what it’s supposed to do. This was basically my point.

    • Murphy says:

      The insurance companies are the ones doing most of the suing.

      Almost always if you have insurance you sign over the right to recover costs from third parties. If you have medical insurance and your kid breaks their head open in a village playground, even if you don’t sue the owner of the playground your medical insurance company likely will without you ever knowing.

      A great deal of the time you get insurance companies suing insurance companies.

      The only ones who win are lawyers.

      • Max says:

        The insurance companies are the ones doing most of the suing.
        A great deal of the time you get insurance companies suing insurance companies.
        The only ones who win are lawyers.

        Which are all consequences of regulation by govt. You know who also wins? – govt agencies doing licensing endless checks everybody (doctors, hospitals and insurance companies). Paying with taxpayers moneys too

        • Murphy says:

          We could live in a lawless ancap world with no tort law of any kind but I don’t find that world terribly appealing.

          • Jon says:

            As well you shouldn’t. The default method of solving disputes in areas without tort law involves one or both sides grabbing weaponry.

            Part of the purpose of Tort law is to solve disputes, but another part is to create a system in which solving disputes can be done without resorting to violence.

            If that system disappears, people will take alternative measures to solve a dispute.

            There are problems with the modern legal system, but it’s still much, much better than the alternative.

          • Alex Welk says:

            An ancap society would neither be lawless nor without tort. If you are interested in learning about what ancaps actually propose instead of strawmanning, I’d be happy to walk you through the basics and suggesting people who can explain it much better than I.

          • anon says:

            I forget if this is one of these quotes misattributed to some famous statesman or something, but here it goes:

            In the system with lawyers, guy with most money wins most of time; in the system with no lawyers, guy with most guns wins all the time.

          • John Schilling says:

            Witty, catchy, and false. At the micro scale, there’s no getting around the golden BB – no matter how skilled you are and how superlative your gear, one lucky shot by an amateur with a POS revolver ends your career as a gunfighter, permanently. At the macro scale, number of people willing to kill or die for your cause usually counts more than number or quality of guns.

          • Saint Fiasco says:

            At the macro scale, number of people willing to kill or die for your cause usually counts more than number or quality of guns.

            That is what people mean when they say “the most guns”. It’s a synecdoche.

          • Vox Imperatoris says:

            @ Saint Fiasco:


            The actual meaning is that, with no laws, a dictator gets in charge and does whatever he wants. Until someone schemes to kill and usurp him.

            And this situation is pretty much intolerable for everyone, including the potential dictators, which is why we have laws.

            @ Alex Welk:

            This is why I find it very misleading to describe anarcho-capitalism as being “no government”. There is a system of government. It’s even a very powerful government which exerts a big influence on people’s lives (in the form of protecting property rights, etc.). It’s just a very decentralized system.

            Canada and the U.S. exist in a state of “anarchy” with regard to one another. It doesn’t mean there is no international law governing their relations, or that Canada could just confiscate American property and expect to get away with it. Or even that America could expect to do the same, despite being far more powerful.

          • Murphy says:

            @Vox Imperatoris

            Are you sure you’re not thinking of some of the somewhat similar libertarian style systems?

            An-cap is pretty big on elimination of the state.

            Unless you have an extremely broad definition of “government” including any organization capable of projecting significant force.

          • @Vox I:

            The question is what are the defining characteristics of a government. I don’t think there is anything that governments do that has not, in some time and place, been done by mechanisms we don’t usually think of as governments.

            Consider the protection of property rights. Territorial animals do it via a mechanism of mutually recognized commitment to fight more and more desperately the farther into the claimed territory the trespasser comes. A fight to the death is usually a loss for both participants, so if the commitment is recognized the trespasser usually retreats. I don’t think you would call that a government, yet it is one way in which what a lot of people think of as a core function of government gets done.

            For my answer to the question, see:


      • Anonymous says:

        > If you have medical insurance and your kid breaks their head open in a village playground, even if you don’t sue the owner of the playground your medical insurance company likely will without you ever knowing.

        This is a big part of why I have insurance for things. Part of the value I derive from insurance is being able to recoup my losses in the case of catastrophe. The other part is that it lets me offload much of the legal work to others who have dedicated resources and expertise in that area. If they behave well wrt me, then I go about my life happy. If not, then I have to get a lawyer and deal with them (…and then immediately get a new insurance company).

      • God Damn John Jay says:

        Popehat had a funny post on this where a woman sued her nephew over breaking her arm when hugging her. He predicted she sued him in court and went out to for ice-cream later, (I think it turned out she bought him an action figure instead).

        • nil says:

          That was driven by the insurance company:

          • Professor Frink says:

            Well, sort of. Almost certainly what happened is the homeowner’s policy had some terms around pay for people accidentally injured on the property (like the classic slip-and-fall on ice in front of the house).

            They probably initially refused a pay-out to the aunt for her medical costs (whether they were in the right probably depends on the terms), so the only way to try to force the insurer to pay is to sue someone the policy covered.

          • God Damn John Jay says:

            Sorry, thats what I meant, the Insurance company made her sue.

          • Deiseach says:

            Okay. I Googled a Connecticut insurance company and looked at their website; quick extract on home insurance policies (and I haven’t read the fine print, so it’s probably festooned with qualifications about what can be claimed) says:

            Guest medical protection
            What it does: Helps pay medical bills for those injured on your property.

            Coverage offered: Up to $5,000.

            Going to the news story, it says “Jennifer Connell filed a lawsuit against the boy seeking $127,000 in damages, CNN affiliate WFSB reported.”

            So she sued for $120,000 over the insurance claim limit.

            It may be that her medical expenses were indeed that high, but blame it on my cynicism from working with the public, sounds to me like “auntie” was trying to make a fast buck off the fracture by claiming against her cousin’s insurance and the jury didn’t believe she would need future medical treatment or that her quality of life was permanently affected as per her claim.

            Or maybe it wasn’t a fast buck, it could be we are so inured nowadays to the idea that “someone must pay” she felt the insurance company owed her for what, in former days, would have been seen as an unlucky domestic accident but nobody’s fault. Either the insurance company refused to pay, or she thought $5,000 wasn’t enough and she deserved more (because media accounts of insurance payouts always are in the big figures and that gave her an inflated expectation of what an injury was worth).

        • Deiseach says:

          We don’t have all the facts in that case. It seems that the woman was suing under homeowner’s insurance, not medical insurance (so presumably her medical insurance did cover the costs of the surgery she claimed to need for her fracture).

          She had an accident at home or in her cousin’s home, tried to claim on the insurance to make money out of it, the insurance company wouldn’t wear it, so she went to a lawyer who advised her to sue the family member ‘responsible’ for her injury and the jury told her no dice either.

          I don’t see anything about the insurance company “forcing” her to sue; it seems to have been all her own idea.

          Working in local government, I can tell you that you have no idea of the scams people try when it comes to insurance. Members of the same extended family regularly tripping and injuring themselves on pavements, suing the council, and getting payouts for it. Fake or dubious claims are a cottage industry, not helped by the ambulance chasers who advertise “Had an injury at work? You could be due $$$$$$$ in damages!”

  26. You left out a word. “Then she will that there are entire support groups” should be “Then she will see that” or “Then she will read that”.

  27. Could aspirin cause Down Syndrome?

    You know, I won’t favor them with another link. But yes, this page exists. As do several other genetic diseases I checked.

    I was disappointed that “placebo” isn’t in their drug set. That also has some great possibilities.

    • Murphy says:

      Actual pages from ehealthme:

      Review: could Paracetamol cause Ebola hemorrhagic fever?

      Review: could Paracetamol cause Ebola disease?

      “join a support group for people who take Paracetamol and have Ebola disease”

      “Paracetamol and Ebola Disease – from FDA and social media

      A study of people who take Paracetamol and have Ebola Disease, conducted by eHealthMe with data from FDA and social media ( The study analyzes who these people are, when they have Ebola Disease and how. eHealthMe updates the study periodically.”

      Review: could Paracetamol cause Cleft palate?

      Review: could Paracetamol cause Septic shock?

      Review: could Paracetamol cause Toxic shock syndrome?

      Review: could Paracetamol cause Microcephaly?

      Review: could Paracetamol cause Fall?

      Review: could Paracetamol cause Contraception (Birth control)?

      Review: could Paracetamol cause Deep heating rubs overdose (Methyl salicylate overdose)?

      Review: could Paracetamol cause Excessive masturbation?

      Review: could Paracetamol cause Soda ash (Sodium carbonate poisoning)?

      Review: could Paracetamol cause Baking soda overdose?

      Review: could Paracetamol cause Tb (Pulmonary tuberculosis)?

      Review: could Paracetamol cause Lupus (Systemic lupus erythematosus)?

      “Oh my god! It really is Lupus! Call Dr House!”

      Review: could Paracetamol cause Chikungunya virus infection?

      Review: could Paracetamol cause Removal of warts (Wart removal)?

      Review: could Paracetamol cause Seafood contamination (Poisoning – fish and shellfish)?

      Review: could Paracetamol cause Bananas and upset stomach?

      “join a support group for people who take Paracetamol and have Bananas and upset stomach”

      I really want this support group to exist. “Hello, I take Paracetamol and have Bananas and upset stomach, I’m not sure how to cope”

      Review: could Paracetamol cause Steam iron cleaner?

      “Yesterday I took Paracetamol and now I’m suffering from the worst case of Steam iron cleaner of my life. Please help!”

      Review: could Paracetamol cause Homosexuality?

      I’m really hoping that this post eventually gets scraped and posted to these pages.

      • FJ says:

        “Review: could Paracetamol cause Excessive masturbation?”

        I mean, paracetamol does help relieve soreness…

        I’ll show myself out.

  28. AnonBosch says:

    I would bet that most of these scam sites are hosted offshore, so there’s only so much the FDA/FTC can do short of throwing up a full-on Great Firewall to filter out scams.

    • xtmar says:

      Not necessarily. Google just needs to voluntarily change their algorithm to make that sort of SEO more difficult. They’ve done it before to try to kill off some of the content farms, and the regular nature of these sites seems like they would be easy to filter. If you could get Bing, Google, and Yahoo to filter them out, you could probably kill 85% of the problem.

      • Virbie says:

        Google doesn’t need to be told to do stuff like this, it’s already one of their highest priorities in ranking. Sites like these (specifically auto generated content farms) already tend to be heavily penalized by Google. If they’re still showing up high up in the results, it’s likely because they don’t have a principled algorithmic way to exclude them (in this case, probably because there are no real pages discussing the _lack_ of a Xolair/depression connection).

        Note that I specified “principled algorithmic way”, since the easy solution (a tailor made solution) is something they explicitly don’t do, since that would kill the Golden goose of “reputation for not manually choosing organic search results”

        • Anonymous says:

          Could that mean the solution is something like the suggested above? A *different* content farm cross referencing drugs, side effects, and frequencies, with explanations in very simple language of what the frequencies actually mean using relative risk? If someone made that, would Google then have an incentive to tweak their algorithm to bring that higher up the search results than the alarmist sites?

          • Thomas Jørgensen says:

            Their already existing algorithms would probably push it to the top pretty darn quick just on the basis of things like repeat visits and links to it.
            The shit sites are on top because there is currently no good sites to push them down. Of course, making a good site that covered a sufficient breath of drugs to be useful would be.. a lot of work

    • And if they aren’t, they would be, if there was pressure on ones hosted in the U.S.

  29. Vox Imperatoris says:

    This is really scummy. Maybe it’s not the most devious of traps for you or me, but what about for your grandmother? What about for those people who send money to Nigerian princes? The law is usually pretty strict about who can and can’t provide medical information – so much so that it cracks down on 23andMe just for reading off the genome in a way that uneducated people might misinterpret. Yet somehow sites like EHealthMe are allowed to continue, because they just very strongly imply fake medical information instead of saying it outright.

    It seems to me that government intervention intensifies this problem.

    If you try to ban all quackery, you give people the impression that whatever is allowed is not quackery. But if the government is in fact not able to catch all the quacks, this gives people a false sense of security.

    If you ban the guy who says “Can Xolair cause depression?”, you just get him to move to something else like “Can homeopathy cure depression?” And if the government lets people sell homeopathic remedies in the drug store, there must be something to it, right? Or should they ban that, too? If so, where do they stop? Are we going to get to the point where whenever you want to develop a new drug, you have to go through some kind of multi-billion-dollar process of bureaucratic approval? Oh wait, somehow we already managed to do that while allowing homeopathy at the same time…

    If you know that all medical advice you read on the internet is not being watched by the careful eyes of the government and could be nonsense, maybe you will actually learn to tell the difference on your own. Or at least speak to someone like a doctor who can.

    I always liked George Reisman’s quote that under a free market, “Stupidity of choice is its own punishment, which tends to reduce the amount of it.”

    • MichaelM says:

      The terror of a quote like that is that sometimes ‘reduce the amount of it’ means ‘people die’.

      • Vox Imperatoris says:

        Almost none of the reduction comes through killing the sort of people who make bad choices.

        Choosing not to breathe is its own punishment, and that tends to reduce the amount of it. But there aren’t too many people who have to actually pass out from not breathing in order to get the message that you have to breathe.

        If you’re conscious of the fact that you would be harmed if you made a bad choice, that is enough to discourage it.

        But yes, if you have a free society, some people will die because they did something stupid. If you have an unfree society, people will also die. And it might very well be because someone else did something stupid, such as creating a cartelized system of doctors. Or delaying in approving lifesaving medication. Or imposing costs sufficient to discourage certain medicines from being developed in the first place.

        The problem is that when your stupidity of choice is someone else’s punishment, it doesn’t tend to reduce the amount of it.

        • vV_Vv says:

          In an unregulated market, how do you distinguish legitimate medical advice from quackery? Sure, recognizing automated crap aggregator websites like is easy if your Internet-fu is strong, but can you do it in general, without having a medical degree?

          Hell, even if you have got a medical degree, how do you know whether your degree is actually based on sound science rather than pseudo-scientific bullshit?

          Seems like you would need some sort of certification authority.

          What, private certification firms working with a reputation-based system, you say? Yeah, what could be possibly go wrong?

          • Matthias says:

            The financial crisis is perhaps not the best comparison here: government insists on minimum standards for banks balance sheets, and gives explicit (and implicit) guarantees that banks don’t default on you.

            The alternative would be only requiring balance sheets to be public (perhaps even with a six month delay, if you want to financial institutions to be able to keep some secrets for a while), and letting some banks go bankrupt every once in a while to keep people on their toes about where they put their money.

          • Addict says:

            I’d say the alternative is for banks to not loan more money than they have. In a society with intelligent consumers and no banking regulation, there woule be ‘money-storing’ banks and ‘money-investing’ banks and they’d probably have very little to do with each other.

      • I second everything Vox said. But in addition, so what if people die? Sometimes people die from their own stupid decisions, and we shouldn’t attempt to stop them. I’d wager that the pathologies engendered by trying to save people from their own stupidity across society are far worse that the relatively small number of problems that would come from letting people know that there is no safety net.

        • Scott Alexander says:

          “But in addition, so what if people die?”

          I hope you won’t be surprised to learn that doctors and medical regulators don’t really share your priorities here.

        • Murphy says:

          Practically speaking? people dying, even stupid people dying is very costly for everyone around the stupid person and stupidity can be very domain-specific.

          I know an accountant who’s a good, smart and well paid accountant yet didn’t understand how vaccines work.

          If she dies because she doesn’t understand biochemistry as well as a biochemist then society loses most of the money that’s been invested in training her to read, write and be an accountant. Her children will likely have significantly worse life outcomes and her bank will have to charge everyone slightly more for mortgages because the cost of her being unable to pay it back either gets spread over people getting loans or people buying insurance.

          Do you feel confident that you’re smart enough in every domain to not be stupid in many of them?

          Also, people don’t just kill themselves with their own stupid decisions, a big part of why the US requires that drugs be tested before they’re given to people is because of incidents like a stupid chemist who’d been quietly providing perfectly good drugs to people for years decided to use a highly toxic substance as a solvent for cough-medicine without testing it in any way first and killed a whole mess of children who’s only sin was having parents who trusted an expert.

          • TeMPOraL says:

            Not only that, but let’s not forget that there’s a whole industry employing highly-trained specialists whose only job is to *make* you chose against your own self-interest. The very concept of professional specialization means that in most domains you’ll end up choosing stupid (and, in Reisman’s wold, die).

            That Reisman’s quote makes sense only in a theoretical free market where both parties have perfect information. Which is totally unlike real-life markets – they’re all about information asymmetry.

        • Deiseach says:

          There’s a case for “let stupid people suffer the consequences of their own stupidity” when it comes to things like drinking to excess etc.

          But when it’s “my doctor put me on this drug and I had such a bad reaction but he said it couldn’t possibly be the drug but I looked up the Internet and there are sites saying it’s fine and sites saying it’s dangerous in certain cases”, then sure, maybe you’d be stupid to believe the quack site over your doctor, but how can you tell it’s a quack site?

          Especially given that some people do have bad reactions, idiosyncratic reactions, and doctors and hospitals do pooh-pooh patient concerns until it kills the person?

          Saying “let the stupid suffer the consequences of their behaviour” in those instances is a bit of a blunt instrument.

          • Nornagest says:

            how can you tell it’s a quack site?

            Reading like it was written by a fourteen-year-old or a Web spider, or a web spider written by a fourteen-year-old, for a start. People are generally pretty good at spotting this sort of thing. Even grandparents — what they lack in Web savvy, in my experience, they make up for in (very rational under the circumstances) distrust of the Web in general.

            Now, “pretty good” doesn’t cover everyone, to be sure. People give money to Nigerian princes, people sign up for that solar cell scam that keeps robodialing me no matter how many of their numbers I block. But how many people? They still need to get past a gatekeeper — somebody in the medical profession — and those gatekeepers deal with plain old hypochondriacs all the time.

      • alaska3636 says:

        It is funny to watch a discussion of the “unregulated free market” turn into an exclamation of “What about the kids!” Allowing for the fact that people of all levels of intelligence will kill themselves by stupid decisions in a given year, we become so worried about the problem becoming endemic that we decide that making stupid decisions should be illegal because of the costs imposed on society. There problem solved.

        I don’t often see it discussed, but a decadent society really seems to pride itself on lowering the bar for basic survival skills and rational thought every instance it gets. I can’t be bothered with cost-benefit analysis, the Kardashians are doing stuff. Cheetos, pepsi, doritos, done.

        The problem with well-meaning, intelligent people prescribing deterrents to the world’s idiot population from killing themselves is that only first-order consequences are considered. The real benefit of people spouting free-market analysis is that they often understand the “unseen” second-order consequences of consolidating power for benevolent solutions is often the corruption of those same institutions by a type of people who are not idiots and who are not well-meaning. Maybe the FDA and EPA are great institutions but they have no competition and the general population trusts them because they are ubiquitous. That seems like a big opportunity for tomfoolery. Very few are the solutions that remove rather than add. Is lowering the bar over and over again really the direction for a robust society or a doomed one?

        • xtmar says:

          This is quite thoughtful!

        • Masebrock says:

          The world of medicine is hardly “basic survival skills” and “rational thought”. Even primitive herbalism takes years of training and vast expertise. Extend this line of thinking to surgery. Should we just let anyone with a knife and a falsified diploma perform it? And if you get killed, well maybe you should have taken his diploma under a microscope to see how the ink was printed first?

          I think many of us who support the FDA, medical licensing, ect. are well aware of the dangers of consolidating power into monopoly. A small number of people may even will die because of the bureaucracy. It’s just that is a tradeoff we are willing to make, the danger on the other direction seems so much greater.

          • It’s worth considering the distinction between licensing and certifying. You can have a regime where the FDA certifies drugs and any uncertified drug has to have a large notice on it “this drug has not been approved by the FDA.” One could deal with physician licensing in the same way.

            At that point, information costs for those who trust the FDA’s judgement have been reduced to near zero. And those who do not trust the FDA’s judgement have the option of relying on whatever other sources of information they prefer.

          • alaska3636 says:

            Here’s an article that seems to show that the biggest achievements in death reduction since 1900 are related to tuberculosis, pneumonia, influenza and gastrointestinal infections.

            The other big decrease is in infant-mortality rates.

            I’ve seen it argued, and it seems compelling, that penicillin and advanced obstetrics account for the great and prolonged extension of life. So what are the regulators regulating, for whom, and to what purpose?

            Also, I doubt that removing medical licensing would result in “anyone with a knife” performing surgeries.

          • Samedi says:

            I think you are forgetting malpractice insurance. There is no reason to think it would go away if medicine were deregulated. In fact, it would probably become more important.

    • Masebrock says:

      If you know that all medical advice you read on the internet is not being watched by the careful eyes of the government and could be nonsense, maybe you will actually learn to tell the difference on your own.

      It is already the case that all medical advice isn’t watched by the eyes of the government, and people haven’t learned to tell the difference between medial truth and medial lies. The correlation between increasing medical deception and increasing people being hurt seems fairly obvious, why would you think it would run backwards?

    • FooQuuxman says:

      There is also the problem that the same laws that let a hypothetical Perfect Government effectively silence the quacks, also let the Not Actually Perfect Bureaucrat silence the person who is helped by [not yet vetted treatment], because they are “giving medical advice”.

    • Jiro says:

      Are we going to get to the point where whenever you want to develop a new drug, you have to go through some kind of multi-billion-dollar process of bureaucratic approval? Oh wait, somehow we already managed to do that while allowing homeopathy at the same time…

      Homeopathy is a special case because the law that created the FDA (actually Wikipedia says it “empowered” the FDA) was sponsored by a homeopath, so he wrote in an exception for homeopathy. So the fact that the FDA allows homeopathy doesn’t prove anything about the process in general.

      • Jaskologist says:

        I think that says a lot about the process in general.

        • Jiro says:

          What does it say about the process in general? “Sponsoring the act that created the FDA” is something that only happens once. Quirks in it inherently don’t reflect on the process in general.

          • Echo says:

            Because whenever a law or institution is created, it’s being created by real people with whatever really stupid beliefs are popular at the time.
            Especially in a democracy, where a relatively small number of “wi-fi causes cancer!” activists can can an outsized influence on government.

    • I’m surprised no one has mentioned that the authorities can be stupid– or at least wrong– as well as the general public, with the fear of animal fats being a notable example. When the authorities are wrong, they have the potential to be wrong on a grand scale.

      • FooQuuxman says:

        Not just wrong on a grand scale. They can force everyone else to be just as wrong as them or else.

      • Echo says:

        Not to mention it giving authorities a very strong incentive to never appear to have been wrong, blocking attempts to fix the problem.

        Some people think Lysenko’s methods are causing the famine? They’re obviously reactionary wreckers causing the famine themselves to undermine the state!

    • cypher says:

      Most of that stuff actually has a “warning label” of sorts – it says something like “these claims have not been evaluated by the Food and Drug Administration, this product is not intended to cure or treat any disease.”

      Anyhow, the difference with the government intervention is that generally these things won’t kill you, except if you replace actual medicine with homeopathy. I also doubt removing the state’s intervention would result in an environment where it is easier, and not harder, to fight through all of the constant misinformation that quacks produce.

      Remember, quacks get paid a lot of money to fool you – they are economically specialized in scamming – and they can take in people that are smart in other domains. If the system allows a certain amount of quacks now, when quacks get thrown in jail from time to time, wouldn’t there be more if they weren’t?

  30. AnthonyC says:

    On the one hand, I agree that the fact that companies like that exist and cause these kinds of issues, and really the fact that the FDA-reported drug info includes all possible reported side effects with no attempt to determine causality or report frequency, are upsetting and frustrating.

    On the other hand, my sleep neurologist (after about 2 years of tracking down various contributing factors and confounders to my sleep issues) told me that one of the most important lessons he has learned is that “any drug can have any effect” in the right person under the right conditions. Apparently I can take Claritin for years, switch to Zyrtec and do better allergy-wise for a year, only to find that for me over time the drowsiness effects of that antihistamine build up to the point that I become a zombie at risk of falling asleep mid-day at work or behind the wheel even though I was taking 200 mg of modafinil each morning and getting as much sleep as my body wanted at night.

    Example 2, a few years ago a coworker of mine developed a life-threatening allergy that she eventually realized was triggered by just about any food with added vitamins (primarily enriched flour). She thinks it is caused by some additive or binder that companies add along with the vitamins. Whatever it is, she has the same reaction to some pills (presumably the problem agent is among the inactive ingredients?). Including Benadryl – yes, taking a Benadryl once sent her to the ER for an allergic reaction.

    …But obviously adding such things to warning labels would be insane. No idea what the solution is here.

    • Scott Alexander says:

      I agree that almost any drug can have almost any effect.

      • alaska3636 says:

        Don’t you think that it is dubious to advertise a drug for the preferred effect and call all the other effects “side-effects”. It’s not like you’re ordering a skirt steak with the chimichurri on the side. If you want to try the chimichurri, it is next to the fries but I’m just gonna eat this delicious steak first while I think about it…

        • Furslid says:

          Not really. They come as a package, some are desired others aren’t. It makes perfect sense to call the ones that aren’t desired something else. Sometimes when I get stuffed up I take an antihistamine, knowing that I’ll get tired but considering the tiredness worth it.

          Also one effect may be a side effect sometimes and the desired effect at other times. Using the antihistamine example, the active ingredient in Benadryl is also approved for use as a sleep aid (according to Wikipedia.) The sleep aid probably lists “reduced nasal congestion” as a side effect.

          It’s not that side effects are different than other effects. It’s just that they’re part of the package with something you want. This doesn’t seem dubious to me.

        • drethelin says:

          One might call this an Artifact of how the FDA approves drugs, but because it generally approves them for specific clinical uses that means that every other effect from their point of view is a side effect.

    • Error says:

      I once had an allergic reaction to Depomedrol, a steroid, bad enough to end up in the ER. This regularly gets me funny looks when reporting my allergies to doctors, because apparently you’re not supposed to be able to have allergic reactions to steroids.

      General consensus is that it was actually one of the inactive ingredients, but who knows which one.

      • Devilbunny says:

        My personal favorite was an allergy to normal saline. It was in fact real, but turned out to be a reaction to a plasticizer in the IV tubing.

    • cypher says:

      Long-term the solution is to keep teching up and either patch up human genetics or become cyborgs or something along those lines.

      I’m only half-joking. There are too many random biological “quirks” and they just seem to be getting worse, in addition to ordinary diseases. It would be best to just do away with all of them.

      In the meantime, a massive database would be nice to manage these sorts of things, and could be accessed from smartphones, but it’s unclear who would maintain it.

      • Echo says:

        They seem to be getting worse, so let’s start doing what we already are twice as hard?
        That’ll get the “Time To Dalek” counter sped up a bit.

      • Mary says:

        They are probably “getting worse” because quirks that used to be life are now quirks.

        Also because diagnosing these things tends to multiply them. Discovering antibiotics meant discovering a good number of diseases that were not, after all, tuberculous.

  31. Peter Scott says:

    So, where can you find the real information about drug side-effects? Someone reputable has to have studied this, right?

    Currently my default approach is to look up the drug on Wikipedia, which I’m sure is the worst possible answer except for all the others I’ve tried.

    • Cadie says:

      At least there, they tell you which side effects are common, which are rare, etc. with approximate percentages – at least on the better med articles. That adds useful information. If 26% of patients taking the drug experience nausea, then nausea when you start taking it is very likely to be a drug side effect. If it’s 1%, then look more closely at other potential causes, because that’s probably close to how many people feel really nauseated regardless of whether or not they’re taking that medication.

    • Scott Alexander says:

      Wikipedia is always a good default option.

      • vV_Vv says:

        Is it? What stops pharmaceutical companies from editing it to make their drugs look better and talk shit on their competitors’ drugs?

        After the “reproductive ant” controversy, I lost any faith in Wikipedia being able to present unbiased and accurate information when material interests are at stake.

        • HeelBearCub says:

          Because drug companies have deep pockets and teams of lawyers, would be my guess.

          Eventually you get caught doing that. It’s not like GSK is not keeping tabs on Wiki articles for their product.

          • vV_Vv says:

            Two large pharma companies will probably avoid an all out propaganda war on Wikipedia, but what about a large company and a small one? Or a large company vs the Indian manufactures of a drug whose patent expired?

          • HeelBearCub says:

            A large company has deep pockets.

            Lawyers will take claims on spec to go after companies with deep pockets.

            Companies with deep pockets will avoid doing these sorts of things based on the direct downside of losing a case, and the side effect of the case becoming public.

            I’m not saying these things never happen (see VW) but usually the sleazy things big companies due are technically legal and minimized in civil risk.

            It’s one thing to pay a third party to post individual positive or negative reviews of your company or a competitor. You just ask the third party to recruit people with positive or negative claims (which then may be completely spurious, but that is on the 3rd party). I’m pretty sure that actually happens on the regular.

            I think it’s another thing altogether to actively manage inserting untrue claims into a Wikipedia article. I am not a lawyer nor a corporate marketer, so I’m sure someone will come in and tell me in what way this contention is wrong…

        • TeMPOraL says:

          What stops it is other people reverting those edits. There’s lot of people who hate misinformation and want stuff to be as accurate as possible. Wikipedia is not a perfect place, but it’s much better than almost everything else out there. You at least get to review the changes and read discussions on them. Contrast that with your typical source, whether on-line or in print, which pushes the agenda of a particular person/group and has no way to be corrected by the readers if it’s wrong.

          • vV_Vv says:

            What stops it is other people reverting those edits.

            What stops them from reverting these reverts? They can pay people to do this all day, and as long as the information they put is not blatantly false, they have a good chance that everybody else eventually give up without taking the issue to arbitration (which is a slow, complicated and bureaucratic process, something that the vast majority of Wikipedia users don’t want to deal with).

          • Urstoff says:

            Possible; it just doesn’t seem very plausible.

          • Anthony says:

            vV_Vv – it’s actually simpler than that. I occasionally check in at Wikipedia’s “Adminsitrator’s Noticeboards”, and if someone with no track record of editing Wikipedia on a variety of topics kept reverting to insert dodgy-looking information about a particular product, Wikipedia’s admins would block the account, and possibly block the range of IP addresses the account was editing from. And if that admin noticed that the range of IPs belonged to GlaxoRocheBayer, they might even make a public stink about it.

          • Marc Whipple says:

            Yep. I have had the experience of having the employee of a client make, shall we say, somewhat overzealous modifications to the client’s Wikipedia page. The response was that after a few “knock it offs” which the employee claimed never to have seen, the client’s IP range was blocked.

            We got it straightened out, but it was nothing if not efficient from the “prevent persistent proxy from providing and promoting puffery” point of view.

        • Rainmount says:

          “What stops pharmaceutical companies from…”

          No idea, but I think Scott mostly likes Wikipedia for outside-view reasons.

        • Deiseach says:

          Yeah, but you’re likely to get the chemical formula and structure on Wikipedia and you can look that up and see what effects such molecules tend to have, so if the Wikipedia page says “turns you yellow” and you see on a different website that this does indeed happen with that family of molecules, you can gauge if the rest of the article is or isn’t applesauce.

        • I don’t know what stops the companies from editing the articles but Scott can look at the articles and see if they’re accurate. I’m much more confident in Scott’s recommendation than I am in my ability to figure out the social, economic, and legal dynamics behind Wikipedia edits.

          • Deiseach says:

            I suppose it’s one’s own area of expertise. I know a bit about Irish history and politics, so when I look up a Wikipedia article and don’t see blatant lies (or at least what I’d identify as blatant lies or misrepresentation) then I say “Okay, I will take it that the articles I don’t know about are generally okay”. Same thing with religion, at least as far as Catholicism goes, though again, it’s easy if you know that a statement has to be partial or biased or plain wrong because you’re one of the Offler the Crocodile God worshippers and you don’t do that at services, but an outsider has no idea if it’s right or wrong and takes it on trust.

            Speaking of which, I have to share with you all something that popped up on my Tumblr dash; it’s one of those “Humans of New York” things and was quoted by someone boggling at a line in it.

            In which our respondent talks about how, now that his husband is at a seminary, he (the respondent) is studying Christianity and when you step away from the Bible you see that it was written in a time of survival and “When I step back from that, I see a book that attempts to use symbols and stories to understand the source of life. And that source is depicted as completely loving. And I think that’s beautiful.”

            Yadda yadda yadda, typical progressive liberal mainline Protestant bafflegab (though I have no idea if our respondent is actually a Christian or just married to one of the type).

            But the real jewel of the piece is this, which drew all the comment from those who left notes on it:

            “Homosexuality was forbidden because it didn’t lead to reproduction. For the same reason, if you had sex during your wife’s period, you had to sacrifice a hamster in the temple.”

            Now, I make no pretensions to being a Torah scholar, but from my memories of readings from the Lectionary at Mass, generally the sacrifices were “two turtle-doves or young pigeons”. I don’t recall a line in there about “Or, y’know, if you can’t afford or find a turtle-dove, a hamster will do”. What makes it particularly piquant is that someone pointed out that hamsters are treyf so as animals for Temple sacrifices – no, not really.

            Something leads me to think perhaps the particular translation of the Bible this gentleman is reading is rather lacking. Or it could be one of those new, inclusive-language, gender-neutral ones, who knows? Perhaps the translators are birds’ right activists and substituted another animal for the offensive term 🙂

          • I think what you describe is one sensible strategy for judging sources of information, given that we rarely have the time and energy for something more extensive. Find some overlap between what that source tells you and what you know a good deal about, and judge the source by that.

    • Gile says:

      A website like will allow you to see a list of side effects and other information about marketed medicines (That website deals with medicines authorised in the UK obviously). For, example shows the side effects of Xolair and gives some information about their prevalence.

    • Alexander Stanislaw says:

      Medscape, mayoclinic are pretty good.

  32. Alraune says:

    The bitter irony here is that it wouldn’t be difficult to use that same database-scraping technique to tell the searchers when the symptom is probably spurious, but that would be on much more shaky ground legally.

    • Scott Alexander says:

      I still don’t like, and I still think they’re probably misleading to patients, but they do at least give people enough information to make the right decision. Their page for Xolair says:

      Percentage of XOLAIR patients where DEPRESSION is a reported side effect: 0.6317%
      Average percentage for all medicated patients where DEPRESSION is reported as a complication: 0.6152%

      Here it’s pretty obvious that this is just the background rate. But it’s stuck in a big report that has a lot of less useful things, and if you blinked you could miss it.

      And I still wouldn’t actually trust this – they say losartan more than dectuples the base rate of depression, but as far as I know it doesn’t really cause depression at all. Probably a sample size issue.

      • Anonymous says:

        I had a beautiful dream that existed.

      • DanielLC says:

        It would be nice if they said how many people took Xolair and used that to calculate the confidence interval for how many people would report depression as a complication.

      • Marc Whipple says:

        What this is actually going to do is make people say, “ALL PRESCRIPTION MEDICINES CAUSE DEPRESSION! Big Pharma is giving us depressants so we’ll be meek, unquestioning, and buy MORE drugs! CASE. CLOSED.”

        • Alsadius says:

          Sadly, that’s not even particularly impressive as dumb conspiracy theories go. I recently had a guy try to convince me that nuclear bombs are fake, but nuclear reactors work just fine. No, seriously –
 is a real page advancing this thesis. (It’s not really arguing for it, just repeatedly asserting it, but it does exist). Also, the same guy tried to convince me that the world can’t possibly be spinning, because how can an airplane flying 500 MPH land on a runway that’s moving at 1000 MPH?

          (And no, I don’t think he was faking. If he was, he’s a heck of an actor.)

          • Loquat says:

            I gotta say, that’s an impressive level of stupidity.

          • Said Achmiz says:

            I’ve wondered for a while how people like this manage to create these websites (their writings don’t give off an air of development savvy…), so I glanced at the page source for some of that site’s pages.

            “This file created 13:24 06/01/2016 by Claris Home Page version 3.0”

            Claris Home Page! My gosh! I made my very first web page with that program… in 1996!! No wonder his pages look like this; that thing doesn’t even support HTML 4, much less CSS…

      • Deiseach says:

        I’m going to ask the obvious stupid question: was your patient on a different asthma medication and if so, why did his doctor switch to the new one? If the old one wasn’t working anymore, or didn’t work so well all the time, could this be part of the contribution over time to depression (your asthma getting worse as you get older might not be the greatest thing for helping with a positive mental attitude)?

        EDIT: Regarding “On the other, patients are notorious for blaming drugs for any random thing that happens around the same time they started taking them”, so I Googled Xolair and the official page for the drug includes:

        low blood pressure, dizziness, fainting, rapid or weak heartbeat, anxiety, or feeling of “impending doom”

        Now, that’s only if the Xolair triggers anaphylaxis when you get your first injection(s) of it, but by the same token, feelings of anxiety and panic attacks could be mixed up with depression (I’ve had the three a.m. “feelings of impending doom” as part of a run of panic attacks that started out of nowhere and ended for no reason either, and they’re no bloody fun, let me assure you).

        Xolair appears to be not for common or garden asthma, and frankly if the official site is merrily warning for the likes of the below, the unofficial sites must be scaring the living daylights out of people.

        What are the possible side effects of XOLAIR?
        XOLAIR may cause serious side effects, including:

        See, “What is the most important information I should know about XOLAIR” regarding the risk of anaphylaxis.
        Cancer. People who receive treatment with XOLAIR may have a higher chance for getting certain types of cancer.
        Fever, muscle aches, and rash. Some people who take XOLAIR get these symptoms 1 to 5 days after receiving a XOLAIR injection. If you have any of these symptoms, tell your healthcare provider.
        Parasitic infection. Some people who are at a high risk for parasite (worm) infections, get a parasite infection after receiving XOLAIR. Your healthcare provider can test your stool to check if you have a parasite infection.
        Some people who receive XOLAIR have had chest pain, heart attack, blood clots in the lungs or legs, or temporary symptoms of weakness on one side of the body, slurred speech, or altered vision. It is not known whether this is caused by Xolair.

        And check out what are the most common side effects:

        The most common side effects of XOLAIR:

        In people with asthma: pain especially in your arms and legs, dizziness, feeling tired, skin rash, bone fractures, and pain or discomfort of your ears.
        In people with chronic idiopathic urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

        Bone fractures? Does Xolair contribute to or encourage osteoporosis? Does it make you so faint and dizzy you keel over and fracture a limb?

        Quite frankly, after reading this list, I’m not surprised the poor bloke was feeling depressed!

        • SBK says:

          My understanding is that for really weird-sounding effects like bone fractures, if more than one or two people in a study happen to break their legs during the normal course of life events while taking a medication the FDA can require that it be listed as a side-effect regardless of whether the drug has anything to do with it. So I tend to take things like that with a grain of salt.

          • Deiseach says:

            Looking at the prescribing pamphlet, they mentioned something like 2% of people on Xolair had fractures against 1% on placebo, so I agree that while you’re likely to fracture, burn, scald, cut or otherwise injure yourself in the normal run of life and it’s not the drug’s problem, I do wonder if the dizziness, faintness, etc. side-effects might contribute to people going weak at the knees and managing to trap their wrists under themselves when they trip and fall so that they end up with a fracture.

          • HeelBearCub says:

            I think that the “whether the drug has anything to do with it” is a known unknown.

            You put some people in a trial on the drug, they have more fractures than those on placebo. At this point all you can say is that it happened. You can’t really say that the drug played no role in it.

            No one thought Cox-2 inhibitors had anything to do with heart attacks, until the data showed that they totally had something to do with heart attacks.

          • Albino Gorilla says:

            Alternative explanation: since people taking the inhaler can breath better, they attempt more vigorous physical activity than they were otherwise used to, and injure themselves in the process.

            Either way, it’s still just random speculation, and doesn’t really prove anything.

          • AlexL says:

            Now I want to find a medication that lists “dog bites” as a side effect…

        • Midge says:

          I’m going to ask the obvious stupid question: was your patient on a different asthma medication and if so, why did his doctor switch to the new one? If the old one wasn’t working anymore, or didn’t work so well all the time, could this be part of the contribution over time to depression…?

          I would think so. I’m an asthmatic, and, as I found out during pregnancy, subtly worsened asthma can manifest as depression. On days when my peak flow measurements were low, even if I wasn’t wheezing or consciously laboring to breathe, I’d want to hurl myself off a cliff. Like many asthmatics, I’m not as vigilant about keeping track of peak flow as I should be, so at first I didn’t notice the connection and just thought, “I want to hurl myself off a cliff, and I don’t even know why.”

          Asthmatics tend to be more depressed than average to begin with. As Scott says, “lots of things that mess with the immune system can cause depression,” and asthma itself is one of those things – not to mention the fact that it’s probably normal to find sensations of suffocation rather depressing. Bad moods can also trigger asthma attacks (not surprising that asthma was once considered a psychosomatic illness), so it’s a nice little vicious cycle.

          I’ve heard corticosteroid treatment for asthma is known to cause depression, though inhaled, rather than systemic, steroids are supposed to minimize the risks. Personally, I love the way I feel on systemic steroids – it’s like all the badness in life has magically melted away. Systemic steroids are terrible drugs to take long-term, though, unless you really need them – and magically feeling great when you take them is not a real “need”.

          I haven’t tried Xolair yet, though I may be eligible. Depression would be the least of my concerns if I were to try it. (Although… taking Xolair is a pretty big investment. On top of the money cost, it’s an injected medication, and rather time-consuming to get. If I were to invest in it and not see my asthma improve noticeably, the dashed expectations themselves might be rather depressing.)

    • Cadie says:

      Could someone create a better database, including simplified summary data such as % of patients on the drug who had that side effect, % of people in the control group who had that side effect, and number of studies and study participants? “Combining 3 studies, 7% of the 1500 people taking Thisdrug at 200mg/day experienced headaches, compared to 4% of the 1250 people taking placebo experiencing headaches. ~3% of patients on Thisdrug 200mg will have headaches as a side effect, and ~4% will have headaches due to other causes.” It’s not actually saying that someone’s side effect is or is not caused by the drug; it only gives the numbers so the patient and doctor can consider the data and the patient’s specific situation to decide what to do about switching, changing dosage, ordering more tests, etc.

      Then if it got a lot of links from medical sites and interested bloggers and such, it could rise in the rankings and eventually be on the first page of search results.

    • What if the debunking site happens to debunk one of the cases in which the side effect is real and gets sued “for more money than exists in the entire world”?

  33. Anonymous says:

    It is very unfortunate how cheap talk is.

    In the penicillin scenario, who would they be suing? The website for false claims? Has that ever happened?

    • Scott Alexander says:

      Not that I know of. I don’t know if you would really have a case or not.

      • Marc Whipple says:

        I am an attorney, this is not legal advice.

        It’s very unlikely they would have a case so long as nothing on the page was a) objectively false and b) consisted of actual medical advice or the practice of medicine.

        Darn First Amendment.

        • Jeremy says:

          I’m curious about lawyers posting information online. I wasn’t able to find a good reference on it.

          As I understand it, lawyers are afraid of things posted online coming across as “legal advice”, because then they may be sued for giving bad advice. Is it because lawyers have a special responsibility, or would a lawyer recommend anyone post the same disclaimer. What if you don’t say you’re a lawyer? What if you say you’re a law student (I notice a lot of people posting legal information online are law students). If you say it’s not legal advice, does that absolve you of all responsibility specific to being a lawyer?

          Any answers to these questions will, obviously, not be interpreted as legal advice….

          • brad says:

            Two different things:

            1) Law students don’t want to be accused of practicing law without a license, which is a crime in many places and could result in failing the character and fitness requirement for ultimate bar admission. Law schools in recent times have started warning students about this sort of thing.

            2) Lawyers don’t want to give legal advice both because it is unethical to give legal advice without sufficient background information (thus subjecting them to bar sanctions) and because they could be sued for malpractice. Saying this is not legal advice, should make it clear that there’s no attorney-client relationship. But they aren’t magic words and in the right circumstances could probably be disregarded by a bar committee.

            As for non-lawyers giving advice on the internet, a lot of that depends on the field’s regulatory rules and ethical strictures. For example, brokers have specific rules about recommending securities, so you’ll often see a disclaimer.

          • alaska3636 says:

            I am finishing up my CPA exams and I just finished the regulation portion. It made me think that there is nothing you can tell anyone without liability exposure. I asked my boss about it and he said that there are certain things that he will do to disclaim all “assurances”, but that there is just no way to get around exposing yourself. When he is doing audit work, his main driver is what his peer review will think about the work he did. My days of giving liberal tax advice end upon my license date, I guess.

          • Marc Whipple says:

            What he said. “This is not legal advice nudge-nudge-wink-wink here is exactly what you should do and how you should do it” will not impress the ARDC as a disclaimer of professional advice, especially if you claim expertise. But by and large if a reasonable person understands that the lawyer is speaking generally and not providing specific advice, you’re probably okay. “This is not legal advice” is a pretty good approach to making that clear.

            It’s pretty hard for a non-lawyer to mess up bad enough to be successfully charged with the unlicensed practice of law, but it happens. If you’re really getting into “here’s what you should do and how,” and you’re not a lawyer, A) Don’t do that, and B) If you must, you should speak generally, not give specific advice, and use appropriate disclaimers (“I am not a lawyer, and this is not legal advice,” is very common.)

            It also helps avoid the formation of an attorney-client relationship. For a public discussion that’s a semi-redundant worry, but if the communications were private (like the guy who emailed me the other day asking about whether or not he had accidentally created a copyright license) a reasonable person might think that one had been created which could cause problems with conflicts and/or privilege. Since my reply was generalized and non-specific (and labeled accordingly) I didn’t have to worry about whether the potential licensee was somehow a former client of mine or a related party, or whether I had to treat the email exchange as privileged information.

          • Nolo (formerly Nolo Press) has been around for a while, so it’s clearly possible to give legal advice on the grand scale to the general public.

          • keranih says:

            As I understand it, lawyers are afraid of things posted online coming across as “legal advice”, because then they may be sued for giving bad advice. Is it because lawyers have a special responsibility, or would a lawyer recommend anyone post the same disclaimer.

            The speech of certified professionals is not free in the way that the speech of ordinary individuals is. In granting special limited license to conduct business as a lawyer, MD, etc (*) the state sets up a framework in which that business can be practiced, including under what circumstances advice can be given. A professional in violation of these restrictions can lose their state-granted permission to conduct business.

            (*) Frankly, those are the big two, although I know that engineers/house repair tradesmen/CPAs also undergo some restrictions.

          • Marc Whipple says:

            Nolo Press (of which I am a big fan) puts prominent disclaimers in all their books, and even more importantly, their books are meticulously researched and edited so that to the extent they may provide legal advice, it is being ethically provided. If you have a good system, then yes, this is eminently possible.

            As for the unauthorized practice part, see the link above. Similar general principles would probably protect them in other states.

          • Patrick says:

            Brad gets it right. Because “this is not legal advice” is not a magical phrase, I usually add “and if you take this as legal advice just because a pseudonymous person on the internet said he was a lawyer, you are an idiot. For all you know I’m not a lawyer at all.”

          • Douglas Knight says:

            Marc, the link says exactly the opposite of what you claim. Nolo is not protected by general principles, but by a last minute act of legislature. And since that was a state legislature, it doesn’t protect them in other states.

          • Marc Whipple says:

            @Douglas Knight:

            Actually it doesn’t say one way or another – the case never went to the jury and it was certainly never heard by an appeals court. Nolo claimed First Amendment protection among other things. I think they had a good argument and that they very likely would have prevailed. The Legislature intervened before we found out the “rule,” and again for reasons that would probably apply in most other states.


            This is the disclaimer on Dr. Ibee Grumpy, MD’s blog.

            Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I’m really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.

            Dr. Grumpy will usually say something along the lines of, “Can’t talk, I have to go feed my yaks” if he thinks somebody is getting too close to asking medical questions in the comments.

          • Jeremy says:

            So, if a lawyer posted “I am not a lawyer and this is not legal advice” would they be held to a higher standard than some anyone else who did the same?

            Are there some things that are pretty much impossible to give information about because it’s basically impossible to do so without implying an attorney-client relationship?

          • Marc Whipple says:


            1) If a lawyer posted that they were not a lawyer in an anonymous forum, disclaimed legal advice but gave it anyway, theoretically they could get in trouble for conduct unbecoming if it became known that they had done it, but in the real world I see it as vanishingly unlikely unless they screw up big.

            2) Yes and no. I can talk about pretty much any general legal principle to anybody, even if I know they have a particular interest in it due to some actual case or controversy, as long as I make clear that I’m talking about general principles and what I say may or may not apply to their actual situation. But if they want specific analysis of a factual situation, answering them is fraught with peril.

        • Decius says:

          But could they get a settlement for less than winning the case would cost?

    • Deiseach says:

      Can penicillin cause cancer? My father was allergic to penicillin, and I’ve met a few people since with the same allergy, and it’s always been very important to MAKE A BIG EFFIN’ DEAL IN HOSPITALS ABOUT THIS because they will forget to mention it at shift changeover and dose you up with penicillin or a penicillin derivative or alike and if you swell up, turn blue and stop breathing, well too bad for you.

      • Gile says:

        Funnily enough whenever I’ve worked in a hospital, one of the most common things I hear is that the worry about penicillin allergies is exaggerated. In other words, it’s said that most of the patients who report being allergic to penicillin just happened to develop a rash years ago and now think they’re allergic when they really would be absolutely fine if given it. Of course they usually won’t be given penicillin because the hospital wouldn’t take that risk but then they end up being given reserve antimicrobials which is problematic in itself as it allows resistance to those drugs to build up in the population.

        • Evan Þ says:

          Guess what? I was one of those people when I was a kid. Fortunately, about five years later, we got a new doctor who was more skeptical about my alleged allergy and “challenged” me with a high dose of penicillin over a week. And, I was perfectly fine.

          (Yes, anecdotal evidence. But that at least proves it does happen.)

        • Deiseach says:

          Well, finding out about “Oh hey, turns out I’m allergic to penicillin” when you’re given it and immediately come out in urticaria and inability to breathe and medical personnel running around going “Oh shit” is perhaps not “Pshaw, you’re worrying unnecessarily” 🙂

          Looking back, I wonder if it was something to do with his immune system having been triggered. I’ve mentioned my father was in the Irish Army and went on two U.N. peacekeeping missions; one of them was to the Congo and he got the usual inoculations for Foreign Lurgies beforehand and had a bad reaction to one of them.

          He also developed an odd reaction to oranges and tomato ketchup around the same time (I may be telescoping events; I was very young and the 60s/early 70s all blend together into one period in my memory) where he’d come out in rashes (huge blisters and red like bad sunburn) if he ate those, where before he had been fine and in after years, it faded.

          So I do wonder if something messed with his immune system and created this penicillin allergy in his 30s which was lying in wait to pop up in later life, when he was in hospital for an infection and given penicillin. But I have no idea one way or the other.

          • Lambert says:

            I often wonder whether this is a thing, as a friend of mine developed several allergies/intolerances at the same time. Doubt it helped that they took a goof few months to realise what was causing it.

        • I blame doctors more than patients. I took -cillins many times in childhood with no problem, had a very minor anaphylaxis after taking amoxicillin in college, and no one would ever give it to me again. When tests proved I genuinely wasn’t allergic the allergist advised me to lie and say I’d never had a reaction, because if I told the truth no one would take the liability. I still tell my PCP, but as far as the pharmacy is concerned I’ve never had a problem.

          • MK says:

            I am not a doctor, I might be an alpaca herder, this is not professional medical advice.

            Everyone should be careful with antibiotics. Resistance is one thing that people worry about, especially with daily exposure to antibiotic hand soaps, but gut health is universally a sensitive subject. Antibiotics kill bacteria in the digestive system. Bacteria in the digestive system are VERY important to health. I have never had a doctor tell me to eat yogurt or take any probiotics while on antibiotics even though that is exactly what one should do.
            Be careful with antibiotic use. know the difference between frivolous and serious use. Doctors are not omniscient. Learn how to research things correctly, and either discuss or adjust based on findings. I think that is good advice no matter what one is talking about. This blog definitely helps teach us how to do that. Thank Ubwewe, grand deity of the alpaca, for Scott Alexander.