500,000 lives destroyed in cold blood by greed

[Sibelio]

I think 3% is easily justifiable. There is a paper which argues risk is cumulative and is 33 per 1000 patient years or something like that. My experience confirms the cumulative nature of risk as I didn’t get PFS for 8 years on finasteride but got it eventually upon resumption after a hiatus. If you take finasteride long enough you are more likely to create the circumstances eventually that would lead to PFS.

If you think about it, there are many people on this site who got PFS after more than 5 year on finasteride. None of these people would be captured in the longer clinical trial of finasteride lasting 5 years. So by definition, lifetime risk of side effects is under-estimated in the literature.

Further, Traish is talking about persistent side effects, not PFS per se, I think. Any sort of lasting effect due to finasteride is a persistent effect. I have argued and I think this would be easy to justify that 100% of people who take finasteride would have penile tissue changes. In a lot more than 5% this would be outright and visible shrinkage. So as you can see it is in fact very easy to defend this number depending on how you define persistent side effects.

Also, Traish is arguing that side effects are significantly under-reported in the clinical studies due to bias, which is true as we know. Belknap wrote a paper about this.

[Sibelio]

I think in Belknap’s statistical paper, the comparison is between long term exposure and short term exposure because otherwise there is no proper control group. So we don’t know what the true risk of side effecs of finateride is. But I may not be remembering well.

Also, in that paper side effects are only inferred if the person has sought medical attention about them (in the same medial system). Belknap himself has acknowledged that that puts a very conservative bound on the estimated number of people with side effects.

[whathaveidone4669]

@Sibelio

s the cumulative nature of risk as I didn’t get PFS for 8 years on finasteride but got it eventually upon resumption after a hiatus. If you take finasteride long enough you are more likely to create the circumstances eventually that would lead to PFS.

That’s interesting to think about for sure, also clinical trials are not reflective of the context in which allot of people will take the drug in the real world (ie coming on and off, taking other drugs at the same time), which may further contribute to risk. I also agree that there was a huge amount of bias in the original propecia clinical trials you would be an idiot to argue against that given recent revelations. Also more generally virtually all the safety trials regarding finasteride (not conducted by Merck) were poorly designed to detect the real incidence of sexual side effects (let alone other side effects) and even more so whether the side effects resolved. Was this due to bias or just poor design, it’s hard to say. Also interestingly there’s a study in BPH patients where 4% of people got sexual side effects and in 2% the side effects were persistent.

Despite all this I’m sceptical of a 3-5% incidence of PFS just based on how I rationalize the medical system working. In any case I think studies will uncover the real risk of side effects in the next year or two.

[BibFortuna]

@Sibelio

in that paper side effects are only inferred if the person has sought medical attention about them (in the same medial system). Belknap himself has acknowledged that that puts a very conservative bound on the estimated number of people with side effects.

This is a very fair point. However, I still feel uncomfortable treating Traish’s larger estimate as a fact unless/until there are other professionals who agree.

[Sibelio]

@BibFortuna

Please do. I’m not trying to be a dick, I’m genuinely curious to know what deadly drugs are still on the market.

@whathaveidone4669

Despite all this I’m sceptical of a 3-5% incidence of PFS just based on how I rationalize the medical system working

I would love to crush your faith in the medical system (and humanity) but this would be a very long post/conversation. Maybe another time.

Here is a post of mine that kinda touches on that theme, in a now closed thread (cough cough, shall I tag anyone…).

Final year medical student here - interested in PFS

Again, this kind of thinking - that somehow it would have become known if PFS were a bigger problem - is a big but common mistake. I can bring examples from many different fields where a phenomenon was thought to involve a small number of people - for years, decades, centuries and millennia - until the right conditions were created for information about the true prevalence to become known. (I will intentionally bring more “provocative” examples, even though I can choose from among hundreds of a…

This shorter one too, as it mentions sexual side effects from SSRIs…

Final year medical student here - interested in PFS

How do you know it is a very small minority? Was there ever a clinical trial conducted to measure cumulative risk of developing PFS after stopping finasteride as a function of time on finasteride, for example? Clearly the answer is no. Was there ever a study conducted to measure penile shrinkage, independent of PFS? Rats seem to get that in scores… There was a time when sexual side effects from antidepressants were also believed to be in the low single digits, following results from clinical tr…

[whathaveidone4669]

@Sibelio

I would love to crush your faith in the medical system (and humanity) but this would be a very long post/conversation. Maybe another time.

A not depressing at all conversation for someone who is planning on a career in medicine lol

[BibFortuna]

Thank you for the link you provided, but I hope you can share some of that “faith-crushing” evidence in the future. I can’t say I’m completely convinced of your claims, but I’m certainly more open-minded towards them now.

[Sibelio]

Ok guys, start with this one. A very conservative, evidence-based claim that doesn’t even scratch the surface of what medicine has become (always has been).

Why Most Published Research Findings Are False

[Mark2012]

Any “clinical trial” funded by Merck has to be taking with a large grain of salt.

It would be like taking the word of a serial killer at face value.