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PaperclipPerfector  1d ago (text post)   1595 thread views

Small-Scale Question Sunday for August 17, 2025

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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That has long been the case. There are a number of medications which are approved in Europe but not in the US, for example.

While true this gets considerably confusing. Sometimes the more expensive drug is approved in the U.S. sometimes Europe. Sometimes the "more dangerous" drug gets approved here, sometimes there. Political considerations of all kinds pop up (like childhood vaccines). It gets weird.

Compounding matters is the fact that sometimes things are not approved for an FDA indication, unlikely to get approved by insurance, unlikely to get approved by your hospital/pharmacy, scheduled, totally legit but 100% sure to get you sued if anyone complains and so on...

My favorite example is Gabapentin, which has thirty seven million off label uses but only two official uses - and 9/10 competent physicians will get it wrong if you ask them.

Of course, the real situation is quite chaotic and a lot is based on a pile of ad-hoc decisions. FDA got lucky with Thalidomide - if you are very slow in approving everything, sooner or later some bad stuff will slip by faster regulators and it's time to uncork the champagne! - so they took it as the confirmation that not approving stuff is much better than approving stuff for many years after. But it's not based on some well-founded general scientific truth. And definitely doctors and what they think - at least if we're talking about rank and file doctors who actually talk to patients, not the ones that spend their days sitting in committees - have pretty little input into it and very little power in the process, as far as I know. It's not like "doctors were ruling it with their awesome knowledge and Trump came and started banning life-saving stuff because he's evil". It's "doctors did what FDA said to do before, and keep doing it under Trump, and will continue to do so long after Trump is forgotten".

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