Conventional advice, but wrong: A request

I’m preparing a presentation on the evidence-based use of over-the-counter (OTC) medications. The audience will be pharmacists. Given the breadth of the topic, I’m going to focus on OTC treatment myths – and I’d like your input.

What are some myths about OTC medications that refuse to die, despite evidence to the contrary? What conditions, or classes of drugs, would most benefit from some scientific scrutiny? And when it comes to managing self-limiting conditions, what common treatment advice is in greatest need of an evidence check?

Please leave your suggestions in the comments, or pass them on to sciencebasedpharmacy at gmail dot com.

How do you respond to “It worked for me”?

A regular reader of SBP describes a common reaction to the provision of science-based information, which I’ll paraphrase:

What do we do if someone is insisting on anecdotal evidence? In particular, someone who is positive that arnica, or Traumeel helped their joint issue? If someone says, “I couldn’t move my hand, or my finger, and as soon as I put it on, it was fine the next day” What do I say? I know what the science says, but what’s the most effective way to respond?

What response and strategies have you tried that have been effective in helping develop an understanding about anecdotal evidence? And what would you suggest under these circumstances? Please share your thoughts in the comments.

Echinacea for Colds and the Flu

From flickr user tranchis

There's no persuasive evidence Flu Shield, or other echinacea products, can prevents colds or the flu, or lessen their symptoms or severity.

Colds and the flu (influenza) are among the most frequent and universal illnesses we all experience. Yet we don’t have any truly effective treatments for them. Sure, there are plenty of products available to treat the symptoms. And there are vaccines and some prescription treatments for influenza, which have modest effects.  But it would be nice if there was something that reliably protected us from getting sick at all, or could speed up recovery if we catch something.

We all have our own approaches for dealing with colds. Given that most infections are mild, differ in their symptoms, and will generally resolve on their own, it’s difficult to distinguish if any treatment is actually doing anything. Sure we felt better, but did the Tylenol take the headache away, or did it go away on its own? Would you have coughed as much if you didn’t take that cough suppressant? And did that chicken soup really make the cold go away sooner? Continue reading

Vaccines are a pain: What to do about it

Photo from flickr use Wayan Vota

As much as I support vaccines, I see the short term consequences. Vaccines can be painful. Kids don’t like them, and parents don’t like seeing their children suffer. That this transient pain is the most common consequence of gaining protection from fatal illnesses seems like a fair trade-off to me. But that’s not the case for every parent.

Today’s post isn’t going to focus on the extremes of the anti-vaccination movement. Rather, it’s going to look at ways to make vaccines less painful and more acceptable to children. The pain of vaccines can lead to anxiety, fear, and even nonadherence with vaccination schedules. Fear of needles and injections is not uncommon, it’s estimated that 10% of the population avoids vaccinations for this reason.

The vaccine schedules are intense. Where I live, the public vaccination schedule specifies seventeen injections of six different products over six visits in the first 18 months of life, plus influenza vaccinations and one-offs like H1N1. That’s a lot of visits, and a lot of tears if a child doesn’t handle them well.

In light of what’s known about the prevalence of needle fears, their potential effect on vaccination adherence (that could persist through adult life), and the possible impact on public health because of unvaccinated individuals, it makes sense to do whatever we can to minimize the pain and discomfort of vaccines, increasing their acceptance to children and their parents. But what works? I’ve personally found Smarties (the real ones) and Dora the Explorer stickers are effective distractions and bribes. But I’m not about to call my n=2 trial good science. Nicely, there’s much more evidence to guide our recommendations. Continue reading

Good Idea, Bad Execution: Dosing Errors, A Preventable Harm

Crossposted at Science-Based Medicine, today’s post expands on a prior SBP post.

Our desire to practice in a science-based way can face many hurdles, and can even be thwarted at the last possible moment – in the form of dosing errors. The workup may have been comprehensive, the diagnosis could be correct, the most clinically and cost-effective intervention chosen, and whammo. An overdose or underdose, possible toxicity, and a failure to achieve the desired outcome. It’s a completely avoidable, but often overlooked aspect of the practice of medicine. Continue reading

Seasonal Science Advocacy With Gifts That Save Lives

The holidays are upon us, and it’s traditionally the time of year when celebrate our good fortune, and pause to give thanks. Exchanging gifts is a big part of of the holidays, and it can sometimes be challenging to find something meaningful, that the recipient will appreciate.  Chocolates, toys, and gifts sometime become our “go-to” gift options. These things are nice in their own way, but I’d like to suggest something that not only reflects your good taste, but also your science advocacy.  It’s a gift that will also make a demonstrable impact on the lives of others. This holiday season, consider giving the gift of vaccines. Continue reading