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Don’t just stand there, do nothing! The difference between science-based medicine and quackery

Tree of Life - the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

Tree of Life – the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

The Merriam-Webster Dictionary defines science as:

Knowledge about or study of the natural world based on facts learned through experiments and observation.

And:

Knowledge as distinguished from ignorance or misunderstanding.

While this should distinguish science from pseudoscience, those who practice the latter often lay claim to the same definition. But one of the major differences between science and pseudoscience is that science advances through constant rejection and revision of prior models and hypotheses as new evidence is produced; it evolves. This is the antithesis of pseudoscience. At the heart of pseudoscience-based medicine (PBM) is dogma and belief. It clings to its preconceptions and never changes in order to improve. It thrives on the intransigence of its belief system, and rejects threats to its dogma. Despite the constant claims by peddlers of pseudoscience that SBM practitioners are closed-minded, we know that, in fact, PBM is the ultimate in closed-minded belief. Of course, those of us who claim to practice SBM aren’t always quick to adopt new evidence. We sometimes continue practices that may once have been the standard of care but are no longer supported by the best available evidence, or perhaps may even be contradicted by the latest evidence. Often this is a byproduct of habituated practice and a failure to keep current with the literature. While this is certainly a failure of modern medicine, it is not an inevitable outcome. It is not emblematic of the practice of medicine, as it is with PBM. When medicine is science-based, it strives for continual improvement based on modifications around emerging evidence. (more…)

Posted in: Critical Thinking, Medical Ethics, Public Health, Science and Medicine

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Hot-Zone Schools and Children at Risk: Shedding light on outbreak-prone schools

The subject of parental vaccine refusal and the impact that has on disease outbreaks has been covered many times on SBM and elsewhere. I apologize to our readers who are growing tired of the subject, but there is perhaps no subject more deserving of focus and repetition. There’s also an important angle to the discussion that I’ve written on previously and which deserves more attention, and that is the importance of the pro-vaccine parent voice, and the need for that voice to be heard.

It never ceases to amaze me how few of the parents I know think about the risk to their own children from vaccine-exempt children in their schools and communities. Even parents who do think about this rarely seem concerned enough to speak up or even discuss it with others, let alone become active in doing something about it. With the rise in vaccine-preventable disease outbreaks, including the current high-profile Disneyland measles outbreak, and the ongoing pertussis epidemic in California, the tide seems at least to be turning slightly. The dramatic impact that vaccine refusal and the resultant decline in herd-immunity can have on a community is now penetrating the public consciousness. My hope is that parental awareness and outrage grow regarding the flagrant disregard of science, common sense, and citizenship exhibited by those parents who refuse to properly vaccinate their children. My hope is that the culture of tolerance of this intolerable anti-science threat begins to turn, and that it is no longer seen as acceptable for some parents to put the safety of others at risk.

Which brings me to the focus of this post. (more…)

Posted in: Epidemiology, Legal, Public Health, Science and Medicine, Vaccines

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If you don’t buy this supplement for your child, you’re a terrible parent

kids-dha-cerebrum-small

The supplement industry wants you to buy their products, and they’re not above using a little parental guilt to make you into a customer. In the photo above, the promoter is my local pharmacy, where the large window display caught my eye:

Give your Child The Tools to SUCCEED in School!

Who doesn’t want their child to succeed? And if you knew a supplement could give you or your child a learning edge, would you consider it? I’d imagine many do. Supplements have a remarkable health halo. As a pharmacist myself, I’ve noticed this when speaking with patients – few consumers identify any potential risk or downsides to supplement use. Some don’t even think of them as medicine at all. The marketing has resonated: Supplements are perceived as “safe”, “natural” and “effective”. But whether you’re giving your child a prescription medicine to treat attention deficit hyperactivity disorder, or you’re giving a supplement to “improve focus and brain function”, you’re still administering a chemical substance to a child with the intent of changing brain function. We’d probably think twice before pouring an unknown substance in our car’s gas tank, especially one claimed to boost performance. We’d probably ask for some evidence that it works, and some assurance it wouldn’t harm our vehicle. A decision to use a drug or supplement in a child deserves just as much consideration of benefits and risks. (more…)

Posted in: Science and Medicine

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Legislating Ignorance

Child-GUN

Science is under attack, and not just from anti-vaccine celebrities and parents with degrees from Google University. Scientific illiteracy is being woven into the very fabric of our society through legislative assault. If you dismiss this as alarmist hyperbole, you haven’t been paying close enough attention.

Every day thousands of pediatric health care providers throughout the country provide safety advice to patients and their parents during routine health maintenance visits. As part of this important routine we ask a series of standard questions to assess the safety of our patients’ environment. Some of these questions are easy and straightforward, and some are more personal and potentially awkward for patients and their parents, including questions pertaining to sexual practices and preferences and psychosocial history. An important series of questions focuses on potential hazards in the home, such as how toxins and medicines are stored, how pools are secured against curious toddlers, and whether there are guns in the home and how they are stored and secured. Parents are usually appreciative of the advice we provide, and thankful for our concern and attention to these issues. Occasionally patients or parents are taken aback by some of these questions, and very rarely they prefer not to answer them (in my 20 years in practice, I can recall only one time this has occurred). We ask these questions because accidental injuries and deaths are common occurrences in the pediatric population, and there is good evidence that patients tend to follow the advice we provide our patients. (more…)

Posted in: Legal, Medical Ethics, Politics and Regulation, Public Health, Science and Medicine

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Lemons and Lyme: Bogus tests and dangerous treatments of the Lyme-literati

Tick

It’s that time of year when every day I can expect to see at least one patient with a concern about Lyme disease. In Lyme-endemic regions such as Western Massachusetts, where I practice pediatrics, summer brings a steady stream of children to my office with either the classic Lyme rash (erythema chronicum migrans, or ECM), an embedded tick, a history of a tick bite, or non-specific signs or symptoms that may or may not be due to Lyme disease. Sometimes the diagnosis is relatively straightforward. A child is brought in after a parent has pulled off an engorged deer tick, and there is a classic, enlarging ECM rash at the site of the bite. More often the presentation is less clear, requiring detective work and science-based reasoning to make an informed decision and a diagnostic and therapeutic plan based on the best available evidence. Depending on the story, the plan may include immediate treatment without any testing (as in the straightforward case described above), immediate testing without treatment pending test results, or waiting as we watch and see how a rash progresses before doing anything. An example of this latter course of action would be when a patient comes in with a pink swelling at the site of a new tick bite. In this case, it may not be clear if the swelling is a Lyme rash or simply a local reaction to the bite, a much more common occurrence. The classic ECM rash (an enlarging, red, circular, bull’s-eye rash at or near a tick bite) typically develops 1-2 weeks after a tick bite, but can occur anywhere from 3-30 days later. It then expands and darkens over another 1-3 weeks before fading. This classic rash is not the most common rash of Lyme disease, however, as it occurs in only about 30% of cases. Instead, the rash may be uniformly pink or red (or even darker in the center) without the target-like appearance, or may be a linear rash, expanding outward from the tick bite site. In the case of a patient who comes in with a vague, pink swelling within a day few days of a tick bite, we will typically wait and see what happens to the rash. If it is a local reaction, it will likely resolve within another few days. With Lyme disease, the rash will continue to enlarge and declare itself as an ECM rash. Another unclear and not uncommon situation is when a patient comes in with non-specific symptoms such as fatigue, musculoskeletal pains, and headache. If warranted by the history and the physical exam, we may in this case order Lyme testing. This may not give us an answer even if the patient has Lyme disease, because results are often negative in the first few weeks of the disease. In this case, if symptoms persist or evolve, we will repeat the testing in another few weeks at which point true Lyme disease will test positive and can then be treated. The good news is that the treatment of Lyme disease, particularly in the early, localized phase of the disease, is extremely safe and effective with a 14-day course of antibiotics. The testing is also relatively straightforward, with very good sensitivity and specificity when performed correctly. And this is where the bad news comes… (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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VacciShield: Pixie dust for an imaginary threat

vaccishield

I know by now I shouldn’t be, but I am still amazed by how readily so many people buy into the seemingly endless array of bogus sCAM nostrums. Many are marketed and hawked for the treatment or prevention of diseases that are poorly managed by science-based medicine. There are countless examples of dietary supplements that are purported to effectively treat back and joint pains, depression, anxiety, autism, chronic pain, and chronic fatigue; the list goes on and on. The lure for these treatments is at least understandable and, although frustrated that scientific literacy and rational thought loses out, I empathize with the desire to believe in them. On the other end of the spectrum is the even more ethically corrupt substitution of safe and effective treatments with products that are not. I encountered what I find to be possibly the most frightening and dangerous example of this recently at my practice. A family new to the area called to schedule a routine health-maintenance visit for their 5-year-old daughter. When our nurse reviewed the medical records the mother had faxed over, she noted that the child was unimmunized and explained to her that she would need to begin catch-up vaccinations. The mother matter-of-factly stated that her daughter was actually fully vaccinated with a vaccine alternative. She had received a series of homeopathic vaccines from a naturopath. I am not going to discuss this egregious example of sCAM here, though it was addressed in previous SBM posts.1,2 Instead I’d like to focus on another part of the sCAM spectrum. Here lies a form of sCAM that, in some ways, is even more difficult for me to comprehend. These are products invented, marketed, and sold solely for the treatment or prevention of fictitious diseases or problems that exist only in the realm of fantasy. (more…)

Posted in: Herbs & Supplements, Medical Ethics, Naturopathy, Nutrition, Science and Medicine, Vaccines

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Amber Waves of Woo

As a pediatrician I have an opportunity to observe a wide variety of unusual and sometimes alarming parental efforts meant to help children through illness or keep them well. I have recently noticed one particular intervention that seems to be becoming more prevalent, at least in my practice. I’ve begun to see more and more infants sporting Baltic amber teething necklaces. These consist of multiple small beads of amber on a string that is worn around a baby’s neck, and are supposed to relieve the discomfort of teething. Before I had any idea what these necklaces were for or how they were supposed to work, my first reaction was to inform these parents of the dangers of necklaces or anything placed around an infant’s or young child’s neck. Strangulation is a known cause of accidental injury and death in children, and pediatricians are trained to discuss this as part of the routine anticipatory guidance we give to parents. In addition, we strongly advise against giving infants or young children any small items that could be accidentally aspirated, such as the beads found in a necklace of this sort. But I was equally surprised to learn that these necklaces are not intended for babies to chew or gum. Instead, they are supposed to ease a baby’s teething discomfort simply by lying against the skin.

I will not discuss teething here, or the many myths that surround it; that was well covered in a previous post. I will reiterate that there is little-to-no evidence that the majority of concerns parents have about teething are actually due to teething, including fever and diarrhea. The irritability associated with teething also tends to wax and wane for only several days before and after the emergence of a tooth. But let’s assume for the moment that these necklaces actually work to ease the discomfort of teething, and whatever other problems parents tend to associate with the long period of time during which infants and young children develop their teeth. Assuming these necklaces work as recounted in the glowing testimonials on countless websites and parent blogs, how do they produce their dramatic results?
(more…)

Posted in: Critical Thinking, Energy Medicine, Health Fraud, Herbs & Supplements, Pharmaceuticals

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You can’t beat the common cold, and that’s a fact

>> Disclaimer: nothing in this post is meant to be taken as medical advice. Always consult your own provider.

For those of us dedicated to supporting science-based medicine and fighting the ever-widening reach of sCAM, pseudoscience, and health fraud, finding a new woo-filled claim or a dangerous, evidence-lacking trend to write about is relatively easy. Many of us may not realize, however, that some of the most commonly used and recommended treatments, one of which at least is probably sitting in your medicine cabinet as you read this, is equally devoid of evidence to support its use.

Every drug store has row upon row of medicines designed to treat or prevent an acute upper respiratory tract infection, otherwise known as the common cold. Despite this, very few are able to live up to their promise. In most cases, particularly where children are concerned, the side effects of these medicines can be worse than the symptoms they are intended to treat. Because I am a pediatrician, and because the evidence for cough and cold medicines (I will refer to them here as CCMs) for children is particularly absent and because adverse events due to CCMs are most frequently seen in children, I will focus mainly on this population. (more…)

Posted in: Pharmaceuticals, Science and Medicine

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Danger Zones of Parental Vaccine Refusal

Back in 2009 I wrote a story entitled, “The New Plague”, about my experiences as a pediatrician with the frightening trend of parental vaccine refusal in New York City. In that post I discussed some of the complex social factors contributing to this phenomenon, and some of the common vaccine myths to which many parents fall prey. I recommend that you read that post, as it is (unfortunately) as timely today as it was then. Now I’m a pediatrician in Amherst, Massachusetts, and I find it necessary to revisit this dangerous trend in parenting.

As I described in my previous post on the subject, my old practice was at an interesting crossroads of several communities that seemed to perfectly embody the socioeconomic and cultural characteristics commonly found in communities with high rates of parental vaccine refusal. Ironically, these tend to include people who are educated and socially privileged; those empowered to question authority. In 2010, I left New York City and moved to Western Massachusetts to take a job at Baystate Children’s Hospital in Springfield. There I was in charge of the teaching clinic where pediatric residents are trained in the outpatient care of children. The children we took care of in Springfield comprised a very high-risk, underprivileged population. Our patients were significantly below the poverty level, with high rates of developmental and educational disability, a high teen pregnancy rate, and high rates of domestic violence, drug use, and gang involvement. Children who were not up to date with their vaccinations were behind because of poor continuity of care, with many missed appointments and gaps in follow-up. I now work at a private practice further north in the Pioneer Valley of Central Massachusetts. Here, my experiences with vaccine lapses are starkly different. Now, when I encounter a child who is not fully vaccinated or is completely unvaccinated, it is the result of a parental decision. A very flawed, dangerous, and misinformed parental decision.
(more…)

Posted in: Public Health, Vaccines

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Melatonin for sleep disorders – Safe and effective?

It’s summertime, and the living is easy. Forget the solstice. For most of North America, this week is the real start of summer – July 1 in Canada, and July 4 in the USA. Vacation time means breaking out of that those usual routines of work and school. I’m amazed after a few weeks of vacation how much sleep my body will accept if given the opportunity, where it will climb from six to nine hours a night within a week. I try not to change my kids’ habits too much, and one area I’m fairly disciplined with is maintaining a predictable sleep/wake cycle, even when they’re on vacation. I’ve learned, mainly through trial and error, that I suffer the consequences when my own kids don’t get enough sleep, or when their sleep cycle is thrown off. It wasn’t always like this. I remember a period of what felt like years when I had to crawl out of my child’s bedroom on my hands and knees so as to not disturb a child who simply would not fall asleep. And when it finally, mercifully, occurred, it would be a brief respite before the cycle began again. The sleepless nights left us all cranky and exhausted. Admittedly I was fortunate, either due to my successful parenting (but more likely mean reversion) and my kids are pretty good sleepers now. I’m reminded of my good fortune when I speak with exhausted and frustrated parents who have children that cannot sleep and are worried about the causes and consequences of persistent insomnia. As a pharmacist I’m regularly asked about insomnia for both kids and adults as there are a number of over-the-counter products available, and many consumers are understandably apprehensive about seeking out prescription products. Tell someone there’s “natural supplement” for sleep and there’s usually a lot of interest. That’s what I’ve seen with melatonin, a hormone that is sold without a prescription in Canada, the United States, and other countries. It is widely perceived as safe and alternative health purveyors like naturopaths, and even some health professionals, may recommend it for treating sleeping problems in both adults and children. Beyond sleeping, some believe melatonin is a wonder drug with efficacy for diseases ranging from chronic fatigue to cancer to irritable bowel. (more…)

Posted in: Herbs & Supplements, Naturopathy, Science and Medicine

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