Would it be easier to convince lots of people to buy and consume chanca piedra than to convince lots of people to drink an extra liter of water each day? Any thoughts comparing the relative impact and tractability of these two paths? I’m particularly thinking of patient compliance and of the fad/popularity of large water bottles in recent years.
We’ve also been wondering about that. I drink a lot of water myself but I tend to forget how much of a hassle it can be for a lot of people who are not used to drinking much water. Other conditions face similar trade-offs. For example, experts might insist that exercising 30 minutes per day is among the most helpful interventions against depression, yet many people would understandably much rather take a pill. The same goes for weight loss or other interventions that require lifestyle changes. Urologists have been recommending increasing water intake for decades, yet incidence keeps growing. Intuitively, it feels more tractable to test the effectiveness of chanca piedra through a large RCT and (if it works) have urologists adopt it as part of their standard recommendations than running global awareness campaigns to drink more water. But I admit I haven’t done a BOTEC.
Have you spoken with a doctor or medical researcher specializing in kidney stones about this?
Not yet! But, as part of our next steps, we plan to use this writeup to reach out to experts.
Considerations regarding the distribution of pain?
We haven’t looked into the distribution in detail (and there’s not much data, unfortunately), but we currently think that the median case is likely still very painful. For example, the American Urological Association states:
The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin or scrotum, often associated with nausea and vomiting. […] Renal and ureteral colic are often considered the most severe pain ever experienced by patients, and many female stone patients describe the pain as even more intense than that of childbirth.
In this survey, the mean (!) score of kidney stone pain (6.9/10, n=239) was only slightly lower than that of labor pain (7.2/10, n=308) with similar error bars. I think that this is more consistent with a story of the median stone being very painful (than with a story where, say, most stones are only mildly painful). In this (much smaller) survey, 9⁄93 people mentioned kidney stones to be among their top 3 most painful experiences ever, in line with the ~10% lifetime prevalence. “In other words, there is reason to believe that a large fraction of the people who have had [kidney stones] will rate them as one of their top 3 most painful experiences.” Neither of these two surveys selected for e.g. patients seeking medical treatment for stones (as is usually the case in the kidney stone literature).
It’s also worth keeping in mind that people who get kidney stones (including small, asymptomatic ones) are at a higher risk of getting stones later on.
Thanks for your questions, Joseph!
We’ve also been wondering about that. I drink a lot of water myself but I tend to forget how much of a hassle it can be for a lot of people who are not used to drinking much water. Other conditions face similar trade-offs. For example, experts might insist that exercising 30 minutes per day is among the most helpful interventions against depression, yet many people would understandably much rather take a pill. The same goes for weight loss or other interventions that require lifestyle changes. Urologists have been recommending increasing water intake for decades, yet incidence keeps growing. Intuitively, it feels more tractable to test the effectiveness of chanca piedra through a large RCT and (if it works) have urologists adopt it as part of their standard recommendations than running global awareness campaigns to drink more water. But I admit I haven’t done a BOTEC.
Not yet! But, as part of our next steps, we plan to use this writeup to reach out to experts.
We haven’t looked into the distribution in detail (and there’s not much data, unfortunately), but we currently think that the median case is likely still very painful. For example, the American Urological Association states:
In this survey, the mean (!) score of kidney stone pain (6.9/10, n=239) was only slightly lower than that of labor pain (7.2/10, n=308) with similar error bars. I think that this is more consistent with a story of the median stone being very painful (than with a story where, say, most stones are only mildly painful). In this (much smaller) survey, 9⁄93 people mentioned kidney stones to be among their top 3 most painful experiences ever, in line with the ~10% lifetime prevalence. “In other words, there is reason to believe that a large fraction of the people who have had [kidney stones] will rate them as one of their top 3 most painful experiences.” Neither of these two surveys selected for e.g. patients seeking medical treatment for stones (as is usually the case in the kidney stone literature).
It’s also worth keeping in mind that people who get kidney stones (including small, asymptomatic ones) are at a higher risk of getting stones later on.
I hope this helps! :)