Comment by moldbug | Hacker News Reader

Comment by moldbug | Hacker News Reader

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Omeprazole has been about for nearly quarter of a century; and is fairly well understood - hell I can walk down to my local drug store and pick up a load from the shelves.

You say this like it follows.

I can too. I can read the label as well, which says to take it for no more than 28 days "without the advice of a doctor." Presumably this is the period for which it's been studied.

The idea of doing a double-blind study of the various systemic effects of a decade of induced achlorhydria is... absurd. How can you say it's understood? It's not understood, at all, either by my standards or yours.

So, without perfect information - I decide. I don't like the fact that all my ancestors for 100 million years had HCl in their guts, and I don't. I do like the fact that I'm not in the process of getting Barrett's esophagus and my abdomen doesn't hurt all the time.

Weighing risks and deciding without perfect information: fact of life. Trying to outlaw this process: like legislating that pi equals 3. Classic failure mode of the utopian 20th century.

Presumably this is the period for which it's been studied.

So, without perfect information - I decide.

The thing about the modern world is that you can make informed choices - information is only a Google away.

For example; my specific knowledge of that particular drug is not high. But this morning I found out:

- The drug is well researched as being tolerated in the short to medium term

- There is concern that long term use may increase the risk of intestinal or stomach cancers (based on mouse studies)

- So far the longest term test has been 6 years (somewhat longer than your 28 days theory).

In fact, 28 days is a standard recommended limit for drugs available over the counter. It is fairly hard to do damage to yourself, with those sorts of drugs, in that time - but after that you really need the advice of a doctor who understands all of the risks involved. Again, this detail is available online with a little searching.

There is a long list of other side effects, risks and theories that are studied - mostly based on 5 year studies from what I can tell - and the current view is that those risks are pretty low.

What you've proven, here, is that you've not made an informed choice, because you appear unaware of the actual long term concerns. You've not weighed risks; you've weighed one obvious risk that you understand (and I presume the doctor told you about). That is only the very tip of the iceberg.

- There is concern that long term use may increase the risk of intestinal or stomach cancers (based on mouse studies) - So far the longest term test has been 6 years (somewhat longer than your 28 days theory).

In fact, 28 days is a standard recommended limit for drugs available over the counter. It is fairly hard to do damage to yourself, with those sorts of drugs, in that time - but after that you really need the advice of a doctor who understands all of the risks involved.

I can't believe you just said "understands all the risks involved." On the basis of mouse studies and some completely uncontrolled, non-blind 6-year longitudinal study. Or meta-analysis. Or whatever.

Is this the best information we have or can get? Sure. Are the words understands all appropriate? No, they are not.

Aiming for this kind of certainty, and constantly, unconsciously boasting of it, is how postmodern medicine works itself into a box where it's completely unable to think. The information available in this case is shite. But the decision still needs to be made.

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