So, pretty please…with sugar on top. Stop prescribing codeine for children.
The safe and effective management of subjective symptoms in the pediatric population, in particular pain, has always been difficult. Young patients, even premature infants at the limit of viability, experience pain, a fact that sadly was not widely accepted until the late last century. But even with full recognition of pain as a potential concern in all pediatric patients, undertreatment of pain remains a system wide issue.
Pediatric pain management is especially challenging for a variety of reasons. Overall there are fewer pediatric friendly pharmaceutical options to choose from and limited data on available pain medications for children, leaving pediatric providers fitting square pegs in the round hole of adult medicine. Further complicating the situation is the fact that kids can have significantly different absorption and metabolism of drugs compared to adults. Finally, young children are more likely to be undertreated because of the reluctance to prescribe, or to consent to the use of, opioid medications by providers and caregivers respectively.
As if things weren’t difficult enough, the AAP Section on Anesthesiology and Pain Medicine has published a clinical report in the September Pediatrics that aims to remind providers that it is “time to say no” to one of the our most popular pain medications: codeine. Sadly, the authors are not raising new concerns. Instead, they are once again pointing out serious problems with this drug, problems we have known about for over a decade that have resulted in deaths and inadequately treated pain.
Unsubstantiated claims could be on their way out in Canada
When it comes to regulating and selling dietary supplements, should consumer interests be higher priority than those of manufacturers? While regulations are seemingly created to protect consumers, governments around the world have consistently given manufacturers the upper hand, prioritizing a company’s desire to sell a product over a consumer’s right to a marketplace with safe, effective products. Nowhere is this more the case than in Canada and the United States, where similar regulatory approaches have led to an industry boom and massive sales, but also a confusing marketplace for consumers and no persuasive evidence that all those supplements have any meaningful effects on our health. Drug store shelves in 2016 are packed with hundreds of products with unsubstantiated claims and untested products, and little credible information to guide selection. Since its beginnings, the contributors to this blog has been consistent in calling for more appropriate regulation: one that puts consumers first, not manufacturers, and evaluates all products (drugs, supplements or otherwise) with a consistent standard of science and evidence. Today, it looks like one regulator is preparing to move in that direction. Health Canada, Canada’s equivalent to the FDA, has proposed a new regulatory approach that is expected to block manufacturers from selling products with unsubstantiated and often misleading health claims. And they are asking for your input. Carly Weeks in the Globe and Mail writes, (more…)
Because I have a university e-mail address I frequently get spam from journals I never heard of soliciting submissions, and even offering editorial positions. I have generally ignored them, and it’s probably a good thing.
Over the last decade we have seen the rise of open-access science journals. The idea is a good one – journals charge a moderate fee to publish an article to cover costs, and then make all articles freely available online. It is a great way to leverage the power of the internet and make published science freely available. This contrasts to the subscription model where published research often sits behind a very expensive paywall.
The problem with the open-access model is that it created the means to easily generate income through predatory behavior. All you need is a website and minimal infrastructure and you can look like a real journal. Since authors are paying you to publish each article, just publish anything that gets submitted.
I didn’t intend to review Jon Palfreman’s book Brain Storms: The Race to Unlock the Mysteries of Parkinson’s Disease, but after reading it I decided it was too good not to share. Palfreman is an award-winning science journalist who has Parkinson’s himself. He has done a bang-up job of describing Parkinson’s disease, its impact on patients, and how science is working to understand and treat it.
Parkinson first described the disease in 1817. It is characterized by shaking, rigidity, slowness of movement, and difficulty with walking. There is a decrease in dopamine in the basal ganglia in the brain. One million Americans have Parkinson’s disease. The incidence increases with age; by age 80 one in fifty people are affected.
Some very strange phenomena have been observed. Parkinson’s disease is less common among smokers and coffee drinkers. When a patient becomes frozen and unable to take the next step, if you draw a line on the floor they will step over the line and walk on. Patients who can’t walk can run, ride a bike, or ice-skate. Some patients appear to have strong responses to placebos, with reversal of symptoms for long periods. Exposure to vibration seems to decrease symptoms; in the late 1800s patients were treated with vibrating chairs until controlled studies showed they didn’t work. (more…)
One of the most effective spin techniques used by advocates of “integrative medicine” (also sometimes called “complementary and alternative medicine,” or CAM for short) to legitimize quackery has been to claim basically all non-pharmacologic, non-surgical interventions as “integrative,” “complementary,” or “alternative.” Thus, science-based interventions such as diet changes to treat and/or prevent disease, exercise, and other lifestyle alterations are portrayed as somehow so special that they need their own specialty, “integrative medicine,” even though they are simply part of medicine. I pointed this out a mere two weeks ago when I discussed the National Center for Complementary and Integrative Health (NCCIH) review of non-pharmacological treatments for pain. It was a systematic review that was essentially negative but spun as positive for some interventions and lacked some key analyses that a good systematic review includes, such as assessment of the quality of the studies included and evaluating them for bias.
Such were my thoughts over the weekend as I got into a Twitter exchange with an advocate of integrative medicine who was touting the benefits of diet as a cancer preventative and how a course in nutrition “opened her eyes.” That in and of itself wasn’t particularly annoying, although I strongly suspect that the nutrition course she took was not given by actual registered dietitians or other experts in science-based nutrition (she wouldn’t say when questioned). What was annoying is that she trotted out some tropes beloved by integrative medicine proponents, such as the claim that most doctors don’t do prevention because they get paid to treat. She was called out for it:
Oddly enough, on the same day a post from the American Society of Clinical Oncology (ASCO) came up in e-mail lists that discussed the actual evidence for the utility of diet and exercise for cancer prevention. It’s almost as though Twitter were telling me it was time for me to discuss this issue from a science-based perspective. So I will attempt to do so.
Fluorine atom showing its 1S and 2S/2P electron orbitals (hybridized) with atomic nucleus at centre
[Editor’s note: With no further ado, and with no introduction necessary, here is a second post from Craig Pearcey; Witness his science and despair, quacks of the world!]
First for the basic chemistry
There is one particular word that tends to get many CAM supporters very vocal and the conspiracists thinking about running for their home-made bunkers in a basement somewhere. It is the word “fluorine” or any of its analogues. However, before getting into their anti-fluorine claims, we need to briefly review it properties as both an element and in various molecular forms. Without this background it may be possible to make certain assumptions about fluorine that are baseless for a given molecular structure and application. It is this very type of error that the antivaxxers and many in the CAM field make in regards thimerosal – i.e. Ethyl(2-mercaptobenzoato-(2-)-O,S) mercurate(1-) sodium, methyl-mercury, and elemental mercury. All three have significantly differing chemical properties based on their molecular structure, but some individuals/groups continue to attribute the toxicity and chemical properties for elemental mercury to thimerosal (Ethyl(2-mercaptobenzoato-(2-)-O,S) mercurate(1-) sodium). Similarly, drawing conclusions on thimerosal toxicity from methyl mercury is equally flawed. In addition, in their instance in equating the three they refuse to provide any viable mechanism how thimerosal is converted into either elemental mercury of methyl mercury, or how they can be attributed the same chemical properties. (more…)
I knew humans could resemble worms, but this?
My wife and I are entering an age where our aches and pains are becoming a major ongoing topic of conversations. The pain of raising kids has transitioned into the pains of growing older. These aches and pains are, in the scheme of things, minor and intermittent.
At work I get to see real suffering and it keeps my own in perspective. And there are a lot of people who feel awful, some for obvious reasons such as cancer or AIDS and some from ailments that are more enigmatic, such as systemic exertion intolerance disease (SEID), the illness formerly known as chronic fatigue syndrome.
In the context of SBM, SEID is a gateway disease into the world of pseudo-medicine.
A syndrome with no known cause and few effective therapies at best, those who suffer from the process are easy pickings for SCAM practitioners. When you feel like crap month and month with no improvement or even an explanation for your suffering, you keep looking until you find an answer. (more…)
Where’s the sauna detox?
It is no secret that we at SBM are not particularly fond of the National Center for Complementary and Integrative Medicine (NCCIH; formerly, the National Center for Complementary and Alternative Medicine). We’ve lamented NCCIH’s use of limited public funds for researching implausible treatments, the unwarranted luster NIH/NCCIH funding bestows on quack institutions, the lack of useful research it has produced, and its failure to shoot straight with the public when discussing alternative/ complementary/ integrative medicine. Nor does NCCIH’s research appear to affect CAM practice. Lack of evidence of safety or effectiveness is no impediment to use among CAM practitioners or “integrative” physicians.
So I shouldn’t have been surprised (NCCIH’s promise to “do some real science for a change” notwithstanding) when, a few days ago, I ran across a study of which I was previously unaware (for good reason, as you’ll see) on clinicaltrials.gov:
Sauna Detoxification Study: Pilot Feasibility
The goal of this study is to assess the feasibility of the approach, conduct a dose-finding investigation, and obtain pilot data on hyperthermia via sauna to apply in follow-up trials in the assessment of human chemical body burden reduction, for general wellness, detoxification, and pain reduction.
The investigators wish to determine if a hyperthermia-based detoxification protocol is feasible to conduct: including assessment of recruitment, enrollment, retention, protocol adherence, adverse events, and changes in serum polychlorinated biphenyls (PCBs).
Complementary and Alternative Medicine Sauna Detoxification Study: Phase I
The purpose of this study is to determine the impact of sauna use on polychlorinated biphenyls (PCB) in the blood of healthy human adults, as well as to assess safety, feasibility, and tolerability, and effects on quality of life and wellness. We hope to determine if there is a link between lower PCB levels in blood and sauna use.
A recent New York Times article about how the sugar industry manipulated research starting in 1965 is getting some attention. The article is largely based on a recent JAMA Internal Medicine article that reviews historical documents revealing how the Sugar Research Foundation (SRF) (based largely on revealed internal documents) put their thumb on the scale of diet research starting in 1965 in an attempt to shift the blame for heart disease from sugar onto fat.
The Diet Wars
I think this latest round of information can only be understood in the context of the longstanding diet wars. Heart disease has become the number one cause of death, as life expectancy has increased and we have reduced many other causes of mortality.
Overweight and obesity are also diseases of modern civilization which is characterized by abundance and an increasingly sedentary lifestyle. Further, the food industry is driven by market forces which favor tasty foods, which often means being high in fat and/or sugar.
This doctor (Ben Carson) believes “glyconutrients” cured his prostate cancer. Researchers in the field of glycobiology think he is wrong. They don’t even accept the term “glyconutrients.”
It has been a long time since I first became aware of Mannatech, the multilevel marketing company that sells “glyconutrient” dietary supplements. After its claims were debunked and it lost a court case, it had dropped off my radar; but last month it came roaring back in the form of an email from a reader in South Africa. He said his in-laws had recently become Mannatech Sales Associates. Although the company can’t legally claim that their products cure any ailments, they continue to imply that their products give your body the tools it needs to cure itself. Company representatives and other advocates continue to claim in seminars and on the Internet that Ambrotose helps with a variety of conditions including MS, AIDS, cancer, lupus, colitis, diabetes, fibromyalgia, cystic fibrosis, ADHD, neuralgia, wound healing, and much more. There are even claims that it “cures” Down syndrome and even changes its characteristic facial features. My correspondent had done his own research and had concluded that Mannatech was marketing modern day snake oil with outrageous claims. But he was shocked that there was so little impartial information available about “glyconutrients.”
He is right: much of the available information about “glyconutrients” is from people who are trying to sell products; there isn’t much unbiased information available. Science-Based Medicine has not previously addressed “glyconutrients” or Mannatech except when Dr. Gorski recently wrote about presidential candidate Ben Carson, MD, shilling for Mannatech and claiming that Mannatech products had cured his prostate cancer. Let’s take a closer look at the science behind the claims for “glyconutrients.” (more…)