I'm happy your son is doing better.

But the FDA isn't your parent, getting diagnoses are hard, and it's up to you and your doctor to decide what treatment is best, not the FDAs.

The FDA is just a big organization that regulates advertising, and what can be prescribed. Every drug has risks, and the only way to ensure the FDA doesn't approve drugs that will hurt people is to make sure they never approve any drugs.

I'm not clear on what this has to do with the FDA? Would you want the tubes and boxes to have stronger warnings? Other than that it comes down to doctors giving appropriate diagnosis and protocol. There isn't really a scandal in terms of someone cashing out on the overprescription of lowish cost topicals .

I'd like for the FDA to either...

Not allow Hydrocortisone based ointments over the counter, and to include two week addiction warning labels.

Or...

I'd like them to get out of drug regulation at all so people aren't engendered with a false sense of safety and are allowed to make up their own minds without a rent seeking gatekeeper (doctors).

That said, I think, as you suggest, my problems may be more with the medical system and authority in general.

That is absurd. 1% hydrocortisone sold over the counter is a useful medication for millions of people. The risk and abuse potential is extremely low. It isn't really addictive in the way opioids are. I'm sorry you had a bad experience but that's not a valid reason to change the system.

So, your preferred solution is that they either require a prescription for the specific drug you used (at a doctor's suggestion) that does not currently require a prescription -or- that they allow all drugs without a prescription because doctors cost money and are the worthless except that they can prescribe a drug?

Those seem to be contradictory things. I think you just want the doctor who (apparently) misled you to be punished. Which is reasonable and what malpractice suits are for. The FDA's job isn't to review every prescription written by every doctor.

If the packaging doesn't inform you of side effects from the medication then the doctor prescribing it should. The doctor can also limit refills to prevent overuse.

FYI - There are other side effects from long-term use of steroidal ointments.

I believe you meant to respond to someone else

In Australia Topical Steroids are not over the counter. I'm always surprised by how many things I can get over the counter in the US. Here we need a Drs. prescription for pretty much anything stronger than a vitamin or mild painkiller.

Australia is becoming a nanny state so no big surprise you have to get permission to buy simple skin ointments.

I think it's safe to change "becoming" to "has become", it's no longer in transition.

They absolutely are. I have some in my cupboard right now, including some quite strong ones (one of which is brand new to being OTC).

Could you name it?

Depending on the strength, Yes they are

Which ones?

Derm aid is a widely known trade name available in 0.5% or 1% hydrocort formulations on the shelf of any pharmacy you walk into

TSW seems like it's not very well supported by data? I mean if you are treating a rash with a steroid, one shouldn't be surprised it comes back if stop using it?

That said, topical steroids beyond 1% hydrocortisone are powerful drugs that can have long-term side effects (thinning of skin). But on the flip-side, there are often no alternatives.

>TSW seems like it's not very well supported by data?

How would you design an ethical experiment to get said data?

Particularly considering the timespans involved.

Please review the following case study(s).

https://www.medicaljournals.se/acta/download/10.2340/0001555...

In some of the children it took over two years, but every child was left with normal skin or mildly itchy skin in their inner elbows or behind their knees.

Nothing like the dehibilitating steroid withdrawal these children and my son went through.

Your reference are case reports and even has this disclaimer "While TSW was considered the most likely diagnosis in these children, confirmation was not possible partly due to the fact diagnostic criteria for TSW did not exist when they were first assessed, and partly due to the inability to completely exclude all differential diagnoses".

And of course you can ethically confirm this data through a clinical trial. Enroll kids with specific diagnoses, treat half of them with steroids, half without and compare outcomes.

I'm not saying TSW doesn't exist, but the evidence for it doesn't look very conclusive.

Your quarrel is not with the FDA. They approved topical steroids as safe and effective, which was correct. But the FDA generally can't control how physicians use those drugs. If a doctor misdiagnosed your son or prescribed improper treatment then you should file a complaint with your state medical licensing board.

Also, not to victim blame at all, but - any medicine, regardless of whether it's over the counter or not, needs to be discussed with a doctor.

That's why they literally have that label on everything you buy, and warning about using it on your own, either in the short- or long-term, depending on the specific medicine.

Just because people assume it's safe, doesn't mean it's safe, and is nobody's fault but their own for not reading the actual instructions and safety labels.

It's medicine, for Christ's sake, even if relatively benign looking. It has the intent on changing something about your body. Why do people think you can just go to the corner store and take whatever you want without actually thinking about it?

I think it's established that in the opioid crisis, all medication was prescribed by docters, for 2 important reasons:

1) pressure from patients (and sometimes the doctor themselves, too). What is wrong with drugs? I mean, we can all agree that there's a minority in society that doesn't see the problem here. There are plenty of medical people in that minority.

2) pain medication "cures" everything (cheaply!). Can't diagnose what's wrong? Opioids cure it! Not really sure if anything is wrong at all? Opioids make patient happy! Patient scared of treatment? Opioids cure the problem without the treatment! Patient can't pay for real treatment? Opioids cure it!

In my 20s, I used to run through the woods fairly often, and a couple of times a year would get careless and get a rash from poison ivy. A topical steroid usually helped.

I'm sorry to hear about your son, though.

On Twitter or Facebook this is where someone would link the New Yorker cartoon with the guy turning to his wife from the computer and saying, "look honey, I found something all the world's top scientists and doctors missed!"

When my daughter was very young her doctors tried to give her an oral antibiotic for a little infected sore she had on her finger. At the time I was much more of a "just do what the doctors say!" type, but luckily my wife insisted we handle it on our own with topical antibiotics instead. Now, knowing more about all the harms caused by antibiotics I'm extremely grateful we didn't just slavishly follow the doctors' advice. In seriousness, good job looking out for your son.

That's what I find so frustrating about these comics and the general narrative about medical care and procedures.

Anyone who has had to deal with doctors regularly knows how little they should be trusted. There are those who will diagnose any chronic health issue as anxiety, those that prescribe life-destroying drugs for a scratch, those that dismiss patients with serious medical conditions as drug-seeking or "being whiny". That's only worsened by the widespread arrogance in the profession that makes them speak with unwavering confidence about things there is little certainty about. Good patient care can only be achieved when the family is well informed and ready to get involved and push back.

If you go on any disability forum, you'll find hundreds of testimonies to that effect.

In my country we often joke about how hard it is to find that one "perfect" doctor - knows what he's doing and knows about his strengths and weaknesses, isnt too arrogant or unwilling to accept his own doubts on the diagnosis, experienced enough yet doesn't charge too much and whatever is prescribed seems to work magically for you.

Once you find someone like that, you're set. Not that one has to blindly follow that person, but it lifts a lot of stress off your head.

Edit: I am not from USA

There are loads of psychiatrists who will ask you what you want prescribed. I’m not too sure how they are different from drug dealers.

Reading a few articles on the internet doesn't make you well informed though. Certainly not well informed enough to accurately diagnose medical conditions. It's a doomed if you do, doomed if you don't situation.

I think the commenters point was not about people reading articles on the internet and feeling that they've got a better understanding than doctors. It's about medical professionals thinking that they are infallible.

Sure. And I think that that leads to people distrusting doctors, and trusting things they read on the internet.

So despite 12 years of elite education, doctors still prescribe Tylenol, even though current science says it basically does nothing except screw with your liver.

Chiropractic is bunk. Audiology is a tool of price gouging hearing aid cartels. Every doctor that played along with the Sackler playbook directly perpetuated the opioid crisis. Optometrists are a front for cartels of glasses and lens manufacturers.

Much of what is qualified as medicine is exploitative corporate fuckery.

Toxic incentives abound, but god forbid we question the integrity of the system.

There's a lot wrong with the institutional role of "doctor" in the US. Part of it is that there aren't enough of them. Part is that the institution is granted a veneer of authority over things it has no claim to (see: psychology.) Part is corporate pharmaceutical corruption and bad incentives.

There are many situations where self directed research is going to be much better than what you'll get from a brief visit with an overworked, irritated, often arrogant and egotistical doctor without intimate knowledge of your unique medical situation. It's infuriating to get those half-assed "best guess" diagnoses or prescriptions.

I would trust an earnest high schooler with Google over a doctor from, say, 1920, with almost any medical situation except actual surgery, and maybe not then. I trust my own understanding of scientific evidence and research over doctors from 1970 or maybe even later.

How much time is needed by modern, educated doctors to exceed the quality of advice gained by self directed, appropriately conducted research, using the best of what the internet has to offer?

Obviously the doctor's advice will exceed what the patient can accomplish on their own, given sufficient time. Absent sufficient time, a person spending 4 weeks researching online could, and probably frequently does, exceed the domain specific knowledge and assessment by a doctor making a 5 minute "best effort. "

It shouldn't be combative, and doctors should be willing to investigate information brought by patients from legitimate resources. The gap between "civilian" and doctors available information and education is not nearly as great as it once was.

Dismissing the situation as "don't believe what you read on the internet" is a shallow and ignorant stance. We have the sum total of human knowledge available to us via Wikipedia, specialist sites, forums, scihub,arxiv, and so on. Everything, including the good stuff, is online.

People can and do use rational, scientific thinking to engage with that information, and in that situation, the doctor's 12 years of education only means something if they can spend an appropriate amount of time acquiring evidence and information from the patient. There's not enough of them, so unless a situation is serious and demands immediate attention, doctors often won't be able to provide sufficient time to make their expertise relevant.

I don't dispute the problems with medicine you listed, although there are also good doctors out there, if you can find them. And sure, if you spend enough time researching something and can filter the facts from the misinformation on the internet then you might be able to do a better job than a doctor that spends less than an hour. But how much of the general population will put in that effort versus trusting the first thing that comes up in a Google search?

Now if you do your own research, and use that to improve your interaction with your doctor that is good. But replacing medical professionals with google searches can potentially be dangerous, at least for some conditions.

Absolutely, the biggest pitfall with self research is not knowing what set of unknowns you have to fill in the blanks for. The value of education is the deep context in which any particular fact will fit, so it takes a lot of effort to fill in a rational approximation of what a doctor can diagnose. 1 hour of a doctor's time could be worth months of effort on your own.

Someone with MS might have their doctor recommend against being vaccinated. Someone else with MS might be fine, but their two stories could lead people to radically different conclusions, when it's the unique particulars that validate the judgment of the doctors in question.

We need a better culture of scientific discourse in public, allowing for nuanced and depth without the pitfalls of fallacious thinking.

Hyperpartisan and sensational media amplify the feedback loop in ragebait meme propagation. Maybe there's a mathematical tool or theory in graphs or networking that could help identify and shut down the spread of argument and combative discourse - not particular ideas, but particular forms. Seemingly opposite facts and opinions can be true in parallel and it's dangerous to attempt to either validate or censor one side or the other.

The latest crusade on misinformation and "anti vax" views is an example of how spectacularly flawed tools of censorship and rightthink can be.

Thank you. I really appreciate this.

It's been rough losing faith in what is basically not just the medical establishment, but kinda also society writ large.

I guess at least I can take comfort in the self confidence gained through experience, but now all I see is in question.

Hopefully I can aim my new found confidence at solving some of the issues that now seem obvious to me.

I'm curious -- OTC antibiotic ointments are easy to get access to and downright obvious to use when there's a skin injury. Did you not try that before going to the doctor?

If I'm the doctor, the risk/reward for me is to overdo antibiotics and make sure to kill infections with them, if the parent has come so far as to come see me. It's risky to say "use an ointment" if there's even a slim chance it doesn't work.

Yes, we had tried those and also prescription mupirocin and none had worked by themselves. We wound up having to lance the infection on her finger daily and treat it with the mupirocin for a couple of weeks. Her whole hand was in a bandage for that time, and some of the doctors were telling us she might lose part of her finger if it wasn't treated.

I'm not sure I follow -- you tried topical antibiotics, it didn't work, you went to the doctor who recommended an oral antibiotic, you ignored that and tried a different topical antibiotic and it worked? What's your point exactly?

That’s not what that comic means.

The harms of antibiotics include an immense reduction in child mortality and morbidity from strep, persistent ear infections, meningitis, tuberculosis, pneumonia, gangrene, and the list goes on.

Yeah and our child had none of those things. When needed, oral antibiotics can be a lifesaver. When overprescribed they are wrecking people's gut biomes and causing all kinds of issues, some of which can persist for a lifetime.

I would agree you made a prudent choice but it does seem like a drop in the bucket as any kind of exposure to modern lifestyle in childhood correlates with similar issues of perturbed microbiome, autoimmune disease, reduced fertility, and metabolic syndrome. Exhaust particulate, herbicides, plasticizers, PCBs, heavy metals, and the like are universal.

Even the background level of 410ppm CO2 which a child can never escape is extremely unnatural.