Honestly, Slate is second only to HuffPo in its rate of eye-roll-inducing, "why do I bother" stories? (And yet, I still go back, largely for Dahlia Lithwick.) Its obvious pride in its ersatz edginess and counter-intuitive take on [insert topic] annoy me on a regular basis.
Today's arglebargle is about acid-reducing medications for infants. Writes Darshak Sanghavi:
And now the war on stomach acid has a new front: babies with colic. Normal infants reflux all the time (the average preemie, for example, has 71 minor spit-ups daily), but fewer than one in 300 has any evidence of damage to the esophagus. Randomized studies regularly show that acid blockers do nothing to help baby reflux. Worse, drugs like Nexium or Zantac (which blocks acid in a slightly different manner) may increase brain bleeds and gut damage in preterm infants as well as the risk of food allergies in older infants.
The overuse of drugs like Nexium isn't a new problem. For years, doctors prescribed COX-2 inhibitors like Vioxx and Celebrex, though they worked no better than Tylenol and ibuprofen. Pediatricians use antibiotics to treat almost half of all kids with colds, though the powerful drugs do no good and drive up the number of resistant microbes. Can we really blame the drug companies for these messes? Malcolm Gladwell, writing on the prescription drug crisis, notes, "For sellers to behave responsibly, buyers must first behave intelligently." For many adults with heartburn and for many babies with colic, doctors regularly write useless prescriptions and insurers happily pay to fill them.
In the meantime, the next time your pediatrician suggests Nexium, Prilosec, or Zantac for your baby's mild spit-ups, ask her to explain their necessity better. Tell her you don't need any fancy pills. You would prefer a far more powerful therapy—words of explanation.
Dear God, the douchebaggeryon display here is breathtaking.
I'll start by conceding a point. Nexium is ridiculously over-prescribed. It is no more effective than the (now-generic) Prilosec, and its persistent use by lazy prescribers irks the living daylights out of me. Sanghavi's point about that is a fair one.
But egads, one would really expect a pediatric cardiologist to write a better, more intelligent article about medical science. I'll start with the last paragraph first. I do not prescribe anything for "mild spit-ups, "fancy pills" or otherwise. (Typically newborns have trouble with pills, no matter the degree of fanciness.) For "mild spit-ups" I typically use "words of explanation" about the mechanics of newborn stomachs, and how common it is for babies to spit up. I do sometimes prescribe Zantac (or rather, its generic equivalent) for babies that seem very fussy after feeds. This is because reflux can be very painful, and babies can't tell us what they're feeling. If the medication makes no difference, I stop it.
Are Zantac et al overprescribed? Probably. But let's dial down the rhetoric about pediatricians as pill-happy under-explainers.
The first paragraph quoted above is so intellectually dishonest and so rife with fear-mongering, it disgusts me. Not one of the embedded links supports the contention Sanghavi associates with it. "Brain bleeds" links to an abstract for a study about whether acid-blocking medication protects the lung, and which mentions the brain not at all. "Gut damage" links to one study about acid-blockers possibly being related to a very common complication for very low-birth-weight preterm infants, and it is flagrantly inappropriate to either make a broad conclusion from one study or to extrapolate about healthy infants from a much different, far sicker population. "Food allergies" links to (again) one study in mice and humans, which was entirely lab-based with nothing to do with actual patients experiencing actual allergies. Sanghavi grossly misrepresents what the science is saying.
Finally, the thing that sent me over the edge -- "[p]ediatricians use antibiotics to treat almost half of all kids with colds." Really? That link yields yet another abstract. The setting for the study was merely "physician offices," not specifically pediatricians. Thus, there is no way of knowing how many providers were family practitioners vs. pediatricians. Beyond that, the article is 12 years old!! So, what we have here is one snapshot of medical providers from a dozen years ago used to denigrate what pediatricians "do."
This makes my blood boil. This kind of sloppy laziness would be bad enough from a lay writer, but there is no excuse for it coming from a pediatrician. Slate should be ashamed of publishing such a poor excuse for writing.