So I want to blog about scientific stuff.
I'm a pharmacist, I recommend paracetamol for babies all the time. It works, we consider it safe as a professional group and there are very rarely any issues over safety if given responsibly. People do make mistakes and overdose their babies and that can cause trouble, but generally, it is a safe, effective and useful medication for babies and young kids.
Recently, there's been some news about asthma and paracetamol. That children given paracetamol once a month at an early age, regularly, seem to develop asthma at a higher rate than children. The news article cited states:
And seven-year-olds are more than three times more likely to have asthma if they were given paracetamol at least once a month in the previous year, compared with children who did not get paracetamol.
Three times ey? That's shocking. Well. I'm sure it isn't quite as blinding as that; but I'd have to check the paper to make a better summary. As it might be a relative risk of 0.1 becomes 0.3.
I also work for the evil evil pharmaceutical industry. We have lots of drugs that do nasty stuff to people. One of our drugs has a listed side effect where a known relationship exists between the drug and the side effect (in an almost MC Escher way) of unexplained death. That's right, one of our drugs kills people, we know it does, but we have no idea why.
I also recommend that people watch an episode of The Hollowmen from a fortnight ago. We've discussed this episode at work. It is quite truly, the sharpest review of the industry I've ever seen. Especially when the company says it can't lower the cost of the drug anymore because of the cost of developing it, upon which the company chef walks in and says "Would your guests require wine?"
Anyways, the problem with a large study of 200000 children is the sheer power of numbers can show up very very rare situations; ultimately best described as weak signals that may not have any clinical or real life significance at all. If 600 children developed asthma on paracetamol and 200 on placebo/nothing, that would mean that the average child had a 0.4 % total risk over seven years of developing asthma. That's one in 250 children.
This issue has raised its head before - both pros and cons for the industry of drug peddlers. Powerful studies can show more signals - efficacy and safety. Powerful studies are expensive. Only pharma has the money to do big powerful studies that are conducted under strict regimes. Powerful studies have been abused for lots of reasons - mainly for marketing reasons by pharma.
This drug X is 22 % more effective at lowering blood pressure than drug Y, (when drug Y was a fairly poor performer compared to drug Z and really the comparison should be between Drug X and Drug Z).
Anyway, I think I'm saying caution. With any big study, the cause and effect is often hidden. My Occam's Razor suggests that children with asthma were more likely to be unwell in their initial years then children who were not - mainly because asthma is a chronic disease involving mast cell destabilization and histamine release, which leads to the swelling of the lung tissue and anaphylaxis. It has to start somewhere somehow; I just doubt (even with my pharmacy and pharmaceutical hat on) that paracetamol is that trigger.
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