TigerDoc

Yes, I agree with your position on immunity if not your interpretation of the strength of the evidence of glyphosate harms. RFK Jr. stood up for glyphosate's safety, seems to just want to go after Monsanto, says it's the adjuvants not the active ingredients that's harmful. I take it that's not good enough for you? You'd prefer a total ban?

Pointing to specific pathways is good - much more informative than just saying “it’s poison”. The profit angle is also real in agriculture, but it cuts both ways - yield, food prices, farmer economics, and environmental tradeoffs all get mixed in. That’s why people end up arguing about evidence rather than motives. What were you hoping MAHA was going to do with glyphosate?

Worth separating hazard from risk. glyphosate can cause harm under certain conditions, but that’s true of almost any biologically active chemical. The debate is about risk at real-world exposure levels (this same principle is relevant to the mercury in vaccines vs. emissions issue as well). Some groups classified it as “probably carcinogenic” while some regulators like EPA have generally concluded typical dietary exposure is low risk. That gap is why the issue stays contentious. If we’re going to worry about it, the conversation should probably focus on exposure levels and evidence, not just the fact that it kills plants because things you put in your body all the time without a thought (e.g. salt & caffeine) can also do that.

CCTA has real advantages and incentives absolutely play a role, but I'd complexify this a bit - the situation is probably more layered/messy than a single explanation. Medicine tends to look confusing because it’s trying to optimize several things at once - catching disease early, avoiding cascades of extra testing, managing risk, dealing with insurance constraints, and working within whatever resources a local system actually has. Incentives matter, but large systems usually evolve under a mix of pressures, not one steering wheel.

IOW, beware stories about big systems with only one moving part.

Feels like y'all are actually pointing at the same uncomfortable truth from different angles - that medicine is both incredibly helpful and very fallible. The “docs get it wrong sometimes” stories and the “these drugs are powerful and complicated” concern aren’t really contradictions - they’re two reasons this is a hard policy question.

Part of me says the real question isn’t “trust vs don’t trust”, but where the guardrails should sit given that humans (patients and clinicians) are imperfect and there’s of course a version of this debate that isn’t about who’s naive, but about how much friction we want between people and powerful tools.

The other part of me wants to lean into the trust issue & engage the questions of what would make health professionals and institutions more trustworthy, but maybe that can be blended too, because I think there are some limitations to human improvement and that well-calibrated guardrails in themselves might help the distrust problem, but it's more complex than just that, because our odd information environment sometimes distorts our judgements of trustworthiness.

He was extending charity to the argument (hence him saying "I doubt it"). I don't blame people for looking for ideas to get health care more cheaply but I agree with you that this one has some significant failure modes (as almost everything does, really). :lol:

I've been there. We talk in professional shorthand and forget that words like “superbug” land as sci-fi to a general audience. The interesting part of threads like this is realizing how much translation work there is between “clinical risk” and “how people picture it.” I have to stay humble or get trapped in dominance-display doom loops. :lol:

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I'm not sure the policy makers care about the specifics all that much. You can make the argument that even medications like NSAIDs should be more closely monitored given their sundry effects on the body.

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Agree, and the dog that hasn't barked in the thread is we're a full five pages in and no one has called this out as a pharma cash grab yet.

Don't make me do your job, baws. :lol:

Seems like two different instincts here. One is the precautionary “more casual access could push resistance” & the other is “if that’s true we should see it where access is looser”.

The tricky part is that resistance doesn’t show up as “people I know got into trouble”, it shows up in surveillance data over years. Some countries that had easy access actually tightened rules after seeing rising resistance, but it’s also not the only factor - prescribing culture and stewardship matter a lot.

Probably the useful question is what do the actual trends look like in places with OTC access?

I think this is part of the point. Why legislate to contain costs of insurance, expand access to providers trained in exercising medical judgement and how to safely administer medications when we can just let people assume the risks and the costs themselves. We have a saying in our field that the doctor who treats himself has a fool for a patient - and that's meant to caution people who have medical training about the risks of self-treatment.

People aren't wrong to intuit that distortions in medical markets exist and they make this intuitive cognitive jump:

If the system has profit distortions --> maybe breakthroughs get hidden.

But how distortions actually show up in the world is really quite complex & variable depending on the kind of distortion. E.g., high prices yields access barriers, patent games result in delays in generics, administrative complexity turns into waste, and there is a robust literature for all of it. But where is that for suppressed cures? You can't find it and have to appeal to CT-logic (conspirators naturally conceal evidence) to preserve the possibility, and that's plausible enough to keep people hanging in for it if they're motivated to believe it (and lots of people get shafted by the medical system in many ways and many other industries as well, so there are lots of such people out there). Unfound suppressed cures could of course just still be hidden just waiting to be found, but meanwhile year after year modern medicine is doing this to cancer survival whether those suppressed cures are there or not: