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January 24, 2008
Pediatric OTC cough and cold
The battle is proceeding apace. The Baltimore Health Commissioner is pushing the issue of safety and efficacy of the OTC cough and cold preparations in children before the FDA. Doctors are elated on the one hand that they have found a voice in the drug process. OTOH they are assailed by parents who "know better about their own kids." I had a mother the other day assail me because she "didn't want her child to ever be sick" so she had hoarded quantities of these medicines. I heard a poll mentioned on the radio last week in which the majority of parents "thought" the medicines worked and were safe. So evidence to the contrary, we are to make decisions based on the anecdotal whims of individuals. (Not that I am against anecdotal whims entirely, when there is no good evidence.)
But most interesting is the response of the drug companies. They emphasized the safety of these drugs when used as directed. They failed to mention the lack of efficacy when used as directed. Which may be why parents don't use them as directed.
Posted by Robert Maddox at 01:35 PM | Comments (0)
CT scan cancer
The NEJM published a study last month (or Nov. 29, 2007) which estimated that CT scans are responsible for 1.5% - 2% of all cancers. There are 62 million scans done in America each year. This was merely a calculation based on cancer effects on the 25,000 Japanese who survived the atomic explosions. They do reasonably estimate that the lifetime attributable cancer risk of necessary CTs is very small and must be weighed against the benefit.
But it should give those pause who advocate CT for cancer and CAD screening.
Posted by Robert Maddox at 01:18 PM | Comments (0)
Knowledge Matters
This is the subtitle of a commentary in the latest JAMA. Written by an affiliate of the ABIM, it is a credible argument for improving the quality of care by assuring that doctors have the necessary knowledge base to make appropriate clinical judgments.
There are several articles he relies on (footnotes) that I would love to chase down if I can find the time and access. And I am in sympathy with his basic argument. I frequently wonder what I am missing, and whether the habits of thinking (including history taking, examination and diagnosis) I have developed over the decades are misleading me.
One very important caveat in all this (which should be a separate post) is that no matter what errors medicine commits or corrects, it all pales in significance to the number of abortions which it continues to commit each year. By any measure of efficacy, medicine will long remain in the negative. Roe v Wade lessened the legal guilt but not the moral, and it allowed increased numbers of men and women to have their children slaughtered. The recent decrease announced probably only reflects the decrease in conceptions last year, not a repentance.
Posted by Robert Maddox at 12:54 PM | Comments (0)
Return
My apologies to anyone who missed me. But then you both probably have seen me enough in person. I have had a number of changes in work and home with little access to a computer on which to make and discuss the great discoveries about which I blog. I have not quit reading or studying, and hope to return soon to a more reasonable schedule.
There is a new theological discussion blog which has so many interesting posts already that I cannot keep up. But some of the wisdom there has very direct application to the constantly changing (maturing , I hope) understanding of our situation in medicine.
So welcome back, I hope.
Posted by Robert Maddox at 12:40 PM | Comments (0)