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Tuesday, May 28th, 2013
Ibuprofen and acetaminophen, the two most commonly used pain relievers for infants and children, have had some parents worried after recent research had suggested that the medications may increase the risk of a child developing asthma. A new study, presented at a meeting of the American Thoracic Society, says the association is a misreading of the data. More from The New York Times:
The study, presented on Monday at a meeting of the American Thoracic Society in Philadelphia, found that children suffering from respiratory infections — which often lead to asthma — are simply more likely to be given over-the-counter pain relievers. These underlying respiratory infections and the fevers they cause, not the use of pain relievers, are responsible for the increased asthma risk, the authors argue.
“That’s essentially what we think is happening here,” said Dr. Augusto Litonjua, an assistant professor at Harvard Medical School and Brigham and Women’s Hospital. “We showed that children who took acetaminophen and ibuprofen in the first year of life had higher risks of developing asthma later on. But when we accounted for their concomitant respiratory infections, the effects were no longer significant.”
For the study, Dr. Litonjua and his colleagues examined data on nearly 1,200 women and their young children. The women were recruited early in pregnancy and were subsequently followed after giving birth. The researchers looked at how frequently the women used drugs like acetaminophen and ibuprofen, either for themselves or for their children. They investigated any diagnosis of asthma or wheezing symptoms, and they looked at respiratory infections, like pneumonia and bronchitis, that the children developed as infants and toddlers.
When they separated the children into groups, based on their exposure to analgesics in their first year of life, the researchers found that those with the highest exposure had a greater likelihood of developing asthma by age 7, a result consistent with earlier reports. But once they adjusted their findings to take into account the occurrence of very early respiratory infections, they found that the association between pain relievers and asthma diminished.
Much of the research linking pain relievers to asthma comes from observational studies, which are limited by a problem known as confounding by indication, in which the symptoms of an underlying disorder can be mistakenly considered a side effect of treatment.
Image: Infant receiving medicine, via Shutterstock
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Thursday, April 4th, 2013
Doctors are increasingly making the diagnosis of “GERD,” or gastroesophageal reflux disease, in infants, and the label may be prompting parents to medicate for infant issues that pediatricians would otherwise regard as normal, such as crying and spitting up.
A new report published in the journal Pediatrics argues that the use of the disease label is leading to the growing use of medication. “Labeling an otherwise healthy infant as having a “disease” increased parents’ interest in medicating their infant when they were told that medications are ineffective,” the article concludes. “These findings suggest that use of disease labels may promote overtreatment by causing people to believe that ineffective medications are both useful and necessary.”
Previous research has already established the growing number of medical interventions for GERD. One 2010 study by the Food and Drug Administration found that the prescription rate for a particular class of acid blockers increased 11-fold in the years between 2002 and 2009 for babies under age 1.
The new study, which was conducted as a survey of parents in a general pediatric clinic, attributes the rise to the use of the disease label GERD. From the survey’s abstract, “Parents who received a GERD diagnosis were interested in medicating their infant, even when they were told that the medications are likely ineffective. However, parents not given a disease label were interested in medication only when medication effectiveness was not discussed (and hence likely assumed).”
Image: Crying newborn baby, via Shutterstock
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Tuesday, August 7th, 2012
A drug given to pregnant women with a predisposition toward a rare birth defect in which babies are born with ambiguous genitalia is under fire in a paper published in the journal Bioethical Inquiry. NBC News has more on the paper, which charges that the drug is targeting sexual variations including lesbianism and “tomboyism”:
A new paper by Alice Dreger, a researcher and medical humanities and bioethics professor at Northwestern University’s Feinberg School of Medicine, targets that controversy and exposes what she regards as the questionable ethics that have allowed a generation of pregnant woman to serve as virtual guinea pigs for fetal engineering.
The paper, published in the journal Bioethical Inquiry, indicts Dr. Maria I. New, the most prodigious promoter of prenatal dexamethasone for CAH [congenital adrenal hyperplasia]. It also criticizes the institutions where New has worked and the federal government, for “de facto experimentation on fetuses and pregnant women, largely outside of prospective long-term trials and without adequate informed consent.”
Dreger charges that the government failed to collect and publish evidence about use of dexamethasone and that public funds were used for research to “prevent benign behavioral sex variations, including tomboyism and lesbianism.”
At issue is the treatment for CAH, an adrenal disorder that causes an overproduction of male hormones. CAH can occur in several forms, but “classic” CAH affects roughly 1 in 16,000 births in the United States. It occurs when two parents each carries a certain genetic mutation. Typically, they’re unaware they’re carriers until a child is born with the disorder.
The condition affects both boys and girls. In boys, it can result in larger penises, short stature and, later in life, cardiovascular and blood pressure problems.
In girls, like [26-year-old Jenny] Westpahl’s daughter, the male hormones can cause ambiguous genitals. That may sound like mainly a cosmetic issue, but girls with CAH can have frequent urinary tract infections. They may be unable to have sexual intercourse, or they may find it extremely painful. Even if they are fertile, they may not be able to bear children.
Image: Pregnant woman with medication, via Shutterstock.
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Monday, April 2nd, 2012
Researchers at Ohio State University are conducting an ongoing study to see whether a new class of medications, behavior-focused parental training, or a combination of the two is most helpful for children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).
The medication is a non-stimulant drug known as atomoxetine. It is an alternative to a class of drugs known as psycho-stimulants, which are often prescribed for behavioral issues but can carry alarming and ultimately counterproductive side effects. Atomoxetine works on a different neuro-chemical in children’s brains, and researchers are hopeful it may show results when psycho-stimulants fail.
Some parents in the study are receiving the drug, while others are receiving professional training in ways to manage ADHD and ASD symptoms and behaviors. Still others are receiving both therapies.
“What we’re trying to do is have the greatest possible impact,” said Michael Aman, who is leading the study, in a news release. “Obviously, it gives us an opportunity to look at each technique in isolation, but more importantly, it enables us to look at the combination of the two treatments and to see if there is a bonus.”
As for the pill, Aman says “this is the first truly different medicine that has come along in several decades.”
Image: Father working with son, via Shutterstock.
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Tuesday, January 10th, 2012
Medications commonly used to treat attention deficit hyperactivity disorder are in short supply because tight regulations by the US Drug Enforcement Agency are limiting the manufacture of the drugs, The Boston Globe reports. Parents whose children are on medications including Ritalin, Adderall, and their generic equivalents are more and more often having to jump through logistical hoops to get their kids’ prescriptions filled.
From the Globe:
Often, parents must come back to his office after an appointment to request a new prescription for a different dose pill, replacing a 30 milligram pill, for example, with three 10 milligram pills to be taken in the morning, since pharmacies aren’t allowed to make these replacements on their own to handle shortages.
The drug that seems to be in the shortest supply? Adderall XR (extended release), said [Children's Hospital Boston's psychopharmacology director Dr. Joseph] Gonzalez-Heydrich, which is made by Shire and lost its patent two years ago. (The drug appears on this FDA list of drug shortages.)
Shire has instead been promoting and steadily producing its newer and more expensive drug Vyvanse — which is in plentiful supply and works similarly to Adderall XR; the DEA allows manufacturers to decide how they will divvy up their restricted production among expensive brand names and lower-priced generics.
“I’ve switched a lot of my patients to Vyvanse since it’s more in stock and has a similar action,” said Gonzalez-Heydrich. But many are forced to pay more for the prescription as a result.
Gonzalez-Heydrich offered advice to parents who are struggling with this issue:
Those expecting to get a new prescription for their recently diagnosed child should be aware of the shortage and ask the doctor to call their local pharmacy to see what’s in stock before walking out with a script.
Those bringing their child in for a prescription refill should call their pharmacy before their child’s appointment — even in the doctor’s waiting room — to find out whether the store has their child’s prescription in stock and, if so, in what dosage.
“If they have the drug in stock, ask if the pharmacy can set aside some pills for a prescription that’s about to be filled,” if their stock is running low, advised Gonzalez-Heydrich. Doctors can’t call in prescriptions, so pharmacies can sometimes run out during the time it takes to bring the script in to be filled.
Parents may also want to call around to other pharmacies to see what they have in stock, also before the doctor’s appointment. That way, said Gonzalez-Heydrich, doctors can tailor the dose and number of pills based on what’s in stock.
Image: Prescription medication, via Shutterstock.
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