Tuesday, February 25, 2014

Paracetamol (tylenol) and ADHD: More junk science

LATimes article here.

let us count the ways the study could be wrong.

Selective reporting? Self reporting is notoriously wrong, because people just don't remember stuff...Moms whose kids have problems (be it ADHD or congenital abnormalities) try to think if they caused it. Give them a questionaire suggesting they took tylenol, and they think: OH HORRORS I DID.

2: No dose or trimester correlation.

researchers found that kids whose mothers took the painkiller at any point during pregnancy were 29% more likely to be diagnosed with ADHD

so did mom take one near term for a backache, or does she have migraine or chronic headaches and take six or eight a day every day, including many doses in the first trimester?

Without a dose/disease/trimester correlation, the study is useless.

3: How did they diagnose ADHD?

Yes, it is a real disease, but like most mental diseases, it's a continuum not a diagnosis, so where you draw the line can result in an "epidemic", be it autism or ADHD or paranoia (see this lecture at Gresham college on the problem)

did they take the paracetamol for a fever? Viruses can cause fetal malformations, and some viruses or other infections could cause ADHD (e.g. did she clean the cat litter, get toxoplasmosis, think it was the flu and treated it with tyleonol, but her kid got congenital toxoplasmosis)?

Did they take paracetamol for a hangover? Fetal alcohol syndrome is associated with ADHD.

Were the moms whose kids had ADHD older than the other moms? A 36 year old might be more prone to aches and pains, and also more prone to mild toxemia or age related arthritis etc. that make her more prone to take a pain pill.

There were 64,000 women in the study, and the diagnosis increase was 27%. But what are the absolute numbers?

I say this because all the hype about "statins" in lowering heart attack rates are impressive, until you note that statistics are impressive, but not the absolute numbers. (i.e. 20 vs 24 cases out of 100 thousand). So how many cases are we talking about here?

Was there publishing bias?
Members of the research team had long suspected that acetaminophen may behave as an endocrine-disrupting chemical capable of influencing fetal brain development, said Dr. Beate Ritz, chair of the department of epidemiology at UCLA's Fielding School of Public Health and one of the study's senior authors.

yup. Seek and ye shall find.

like this comment:
some studies have found higher rates of male babies with undescended testicles born to women who took it during pregnancy.

translation:" Some studies" means that some studies showed it and some didn't.

supposedly they checked for this by a long study where docs asked the moms all these questions and tracked the kids, diagnosing them by if they took medicine for ADHD.

The international research team, led by Dr. J¿¿rn Olsen, an epidemiologist at the University of Aarhus in Denmark, tracked the study's pediatric subjects from their first trimester of gestation for as long as 15 years. In addition to surveying parents about their children's behavior, they tapped into Denmark's comprehensive and reliable registries of physician diagnoses and dispensed pharmacy prescriptions to glean an accurate measure of ADHD in the population.
The study design averted a problem known as "recall bias" by gathering details on acetaminophen use long before signs of ADHD would become evident. Researchers did not ask pregnant subjects to detail how much or how often they took acetaminophen, but they interviewed them at the end of every trimester to gauge their use of the analgesic. That allowed the team to discern that the timing of a woman's acetaminophen use is likely to be important to fetal brain development.

Big Brother is watching you.

Overall, about 55% of the mothers took acetaminophen at some point during their pregnancy, the researchers found. Based on parents' assessments of their children's emotional, social and learning strengths and weaknesses over a six-month period, the baseline incidence of ADHD-like behaviors in children who weren't exposed to acetaminophen in utero was about 2.5%. Among those who used the medication at some point during pregnancy, the rate was 3.4%.

in other words, a one percent difference.

now tell us how many smoked, how many drank alcohol, how many took cocaine, and how many were so obsessive compulsive that they actually told you the truth.

Thursday, February 20, 2014

Healing an injured heart

I remember when one of my diabetic  patients tried to get in a human (adult) stem cell injection experiment in Minneapolis, but alas because of his diabetes, borderline diabetes, and a previous small stroke he was turned down.

Well, I have no idea how that one went (I believe it was mildly successful in some patients) But now the BBC reports a large study in London


The study, which will involve 3,000 patients in 11 European countries, should show whether the treatment can cut death rates and repair damaged tissue after a heart attack.
All the patients will have standard treatment to widen their narrowed arteries, which involves inserting a small tube called a stent. In addition, half the patients will have stem cells taken from their bone marrow and injected into their heart.
This will happen within days of them suffering a heart attack.

so they will be trying to fix people early after a heart attack, not later trying to repair hardened scar tissue.

It is unclear exactly how a patient's own bone marrow stem cells might help repair their heart.
Donor adult stem cells have been used successfully for decades in bone marrow transplants, but in that situation it is a like-for-like replacement.
Expecting these cells to survive in the heart and transform into specialised heart cells is a huge challenge.

are marijuana related accidents underreported?

if I am sceptical about the rush to marijuana legalization (which has followed a lot of exaggerated one sided hype by the PC) it is because I saw how drugs and alcohol have decimated the inner cities and the Indian reservations where I have worked.

The difference between Alcohol and marijuana is the half life.

One drink/one beer/on ounce alcohol will normally be detoxified by the liver in one hour. It will raise your blood alcohol to 0.05 (slightly higher in small women).

In other words, even after a bender, it's usually out of your system quickly (which is why pilots have to refrain from alcohol for only 12 hours).

On the other hand, a single joint, even todays very concentrated marijuana, is low level when it comes to intoxication. You may get a rush, but then it settles down into the fat. But if you smoke several tokes a day, you end up with a steady state that doesn't go away, sometimes for months.

This is also the problem with Valium, where I have accidentally induced low respirations after using  for five days in a very complicated alcoholic withdrawal in a bad drunk. (Luckily, there is an anecdote)

So if you smoked a lot over the weekend, you are still intoxicated for days. So one horrible accident where two women died, the teenager had a negative blood alcohol (but the family of the dead women shouted at her that it was her fault because they knew her as a heavy marijuana smoker).

But since the tests are lousy, to check the level you have to do a pee test, which is hard t€o do when you are busy saving someone's life after a car accident.

Ditto for the "walk the line" test: We had one guy who was regularly stoned while working as a nursing assistant, but when I was called in to check if he was intoxicated, the test was negative.

from the NYTimes:
Score well on all three of these Olympic events, and there’s a very good chance that you are not drunk...
But it is nowhere near as good at spotting a stoned driver.
In a 2012 study published in the journal Psychopharmacology, only 30 percent of people under the influence of THC, the active ingredient in marijuana, failed the field test. And its ability to identify a stoned driver seems to depend heavily on whether the driver is accustomed to being stoned.
A 21-year-old on his first bender and a hardened alcoholic will both wobble on one foot. But the same is not necessarily true of a driver who just smoked his first joint and the stoner who is high five days a week. In another study, 50 percent of the less frequent smokers failed the field test.

of course, being the NYTimes, they find experts to claim being high on weed is not as dangerous as being drunk.

Yeah. I heard that about violent crime too...tell that to our beaten women and the child we buried after his weed happy father shook him to death.

And the NYTimes argument that it slows people down, so they don't speed, misses the real problem: Essentially you are tranquillizing them. Child neglect, not able to hold jobs, and shoddy workmanship are the result.

my opinion is that the legalization is more about keeping the underclass from rebelling, and maybe about keeping the children of the late middle class from getting angry.

But then, I have Irish genes, and the Brits kept the Irish under control with cheap whiskey, the slums of London quiet with cheap gin, and of course the Americans gave "fire water" to the Native Americans to steal their land.

Tuesday, February 18, 2014

Brain vs consciousness

For later reading: Article at PJMedia.

discusses the lack of progress in using newer technologies for CPR and the Near Death experiences found in some (not all) of those who survive.

Thursday, February 13, 2014

why watchful waiting can result in a live baby

the Irish kerfuffle about a woman who died after a "spontaneous" rupture of membranes at 18 weeks ignores that usually the membranes reseal, or the woman goes into spontaneous labor (which is safer than inducing labor or doing a D&E)

the UK MAIL has an article on one of these babies

Wednesday, February 12, 2014

March 1 is the day of rememberance for those who were killed because they were handicapped.

No, not the victims of the T4 project, but those killed today for being useless eaters....

and the press covers it as justified homicide: the autistic self advocacy network points out in the case of autistic children killed by parents, the press spins it as justifiable homicide:
The media portrays these murders as justifiable and inevitable due to the "burden" of having a disabled person in the family....The victims is disregarded, blamed for their own murder at the hands of the person they should have been able to trust the most, and ultimately forgotten. And then the cycle repeats.

yes: Dr. Brophy, an advocate in Michigan, once wrote a paper about it in the AAFP journal where the case supporting "assisted suicide" was a conversation he had with the husband of a woman with Alzheimers: and the doc and husband agreed they would like to kill her.

The answer, of course, is helping caretakers, but never mind. The real reason behind the push for euthanasia is money...and only a few more crass people in the UK press admit that.

Tuesday, February 11, 2014

Friday, February 7, 2014

Eat your veggies

No link, but there was a report that noted poor people no longer are starving, but fat from high calorie food that is now cheap.

Heh. I remember when poor kids ate a coke and candy bar for breakfast: Now they eat a McMuffin. Change is good.

But the article noted that people simply won't buy the more expensive and hard to cook veggies.

Maybe instead of salad bars, (which is coated with sulfites to keep it from turning brown, so I get hives if I eat it). they should add stir fry veggies a la Chinese chop suey.

Or maybe the experts might want to read the UKMail, whose headline has what every mom already knows:

Smothering children's vegetables in ketchup and cheese sauce really DOES help them eat greens for life

  • This trick makes children look more favourably upon the vegetables

Read more: http://www.dailymail.co.uk/health/article-2553896/Smothering-childrens-vegetables-ketchup-cheese-sauce-really-DOES-help-eat-greens-life.html#ixzz2sfLvtUwC
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Tuesday, February 4, 2014


Drudge reports an increase in heroin use.

Blame the Taliban. StrategyPage has the background.

Heh. Maybe Obama should join with Russia and Iran over this.

in the meanwhile, we docs are being scapegoated for the druggies and their pushers (including a few rogue docs) who are diverting pain medicines.

One side effect is the danger to real pain specialists.

Ironically, Gosnell's dismembered babies didn't attract attention, even after reports of dismembered late term fetuses in the trash, but he got caught for selling drugs.

Of course, that won't stop the pro aborts from making him a hero and a victim of the right/victim of racism.

Sunday, February 2, 2014

Bedbugs one, people zero

From Wired

In September 2011, the CDC released a Morbidity and Mortality Weekly Report of interest to anyone with bed bugs, or that fears bed bugs:
Portions of this post originally appeared at the Old Bug Blog, October 2011; updated with new material Jan 2014.
Since not everyone thinks reading a 10-page technical CDC report is a fun dinnertime activity, here is a summary.  The CDC analyzed data from what’s called the SENSOR system -– state public health folks and poison control offices report certain categories of injuries and occupational hazards to a national database.
There is a clear increasing trend of reports of “acute illnesses” related to bed bug control over time. Over 50% of the injuries happened in the 2008-2010 time period, which nicely parallels the way both cases of bed bugs and media coverage of bed bugs have increased.
The good news: only 111 case reports involved pesticide injuries or poisoning while trying to control bed bugs; and there was only one fatality in the 8-year period studied. That is also the bad news. Those numbers are a major underestimate.
The numbers in the CDC report don’t include people who tried “Kill it With Fire!” as pest control, with dismal results. Dousing your couch with rubbing alcohol to kill bed bugs while smoking: Bad Idea. That one left 30 people in an apartment complex homeless.

sorry I haven't been on line for awhile: internet off and on (with local brownouts) and then my laptop died.

Now my laptop is fixed (for now) and my tablet battery died. Sigh.