Advice on Paracetamol is Unscientific and Unsafe

Same as Tylenol in the US

http://www.scoop.co.nz/mason/stories/GE0409/S00084.htm

Advice on Paracetamol is Unscientific and Unsafe
Monday, 20 September 2004, 4:22 pm
Press Release: Ron Law

Press Release:
Ministry's Advice on Paracetamol is Unscientific and Unsafe
Ron Law
Beyond Alternative Solutions

"The Ministry of Health's advice regarding the use of paracetamol in
children is unscientific and unsafe," says Ron Law, a risk and policy
analyst.

There is no scientific evidence supporting the routine use of paracetamol
to reduce fevers in children, and certainly not in fevers up to 39°C as
recommended by the Ministry of Health.

It has been known for over a decade that routine administration of
antipyretics such as paracetamol may interfere with the clinical evaluation
of patients with infections, such as meningitis, that their use may prolong
infection and reduce the antibody response in mild disease [and presumably
following vaccination], and increase morbidity and mortality in severe
infection.

There is also no scientific evidence that antipyretics prevent febrile
convulsions... it's all part of medical folklore that the Ministry advice
is based on.

So why is the Ministry of Health advising parents to give children
paracetamol for "slight fevers" up to 39°C following vaccination with
meningococcal B vaccination... [even fevers as low as 37.5°C] when there is
no evidence to support such use -- and it can do harm?

Surely social responsibility requires the Ministry of Health to apply the
cornerstone of the Hippocratic Oath; First Do No Harm?

"If similar advice was given by a dietary supplement company they would be
prosecuted under the Fair Trading Act for fraud,"says Ron Law [09-832 4773]

Even the World Health Organisation advises against such use. They say that
routine use of antipyretics such as paracetamol does no significant good,
and may be harmful. The WHO says that fever represents a universal and
usually beneficial response to infection, and its suppression under most
circumstances has few, if any, demonstrable benefits.

On the other hand, some harmful effects have been shown to occur as a
result of suppressing fever... they may result in an increase in morbidity
and perhaps the occurrence of occasional mortality.

The World Health Organisation states categorically that antipyretics, such
as paracetamol, should not be encouraged either in developing countries or
in industrial societies. So why is the Ministry of Health encouraging
paracetamol use when there is no scientific evidence of benefits, but
scientific evidence of harm?

The Ministry of Health states that fevers greater than 39°C are "very
rare." Using internationally agreed definitions, as used by the Ministry of
Health itself, that means that less than 1 per 10,000 vaccinations would
warrant the use of paracetamol; In other words, less than 10 children since
the commencement of the Meningococcal B vaccination programme.

Besides the medical reasons for recommending against routine Paracetamol
use for treating fevers, Paracetamol medications are by far the leading
cause of poisoning in New Zealand children.

Interestingly, a leading brand of paediatric paracetamol provides no
product safety information sheet in their product packaging, but offers a
website. The website is parked and provides no information.

Even Medsafe's website has no datasheet for that brand -- What's the point
of companies having to compile product information sheets if they are not
available to consumers?

"Based on the scientific evidence available to the Ministry of Health, why
is it putting young New Zealanders at greater risk from harm due to
recommended paracetamol use than are harmed by meningococcal B itself?"
asks Ron Law.

The Ministry of Heath's advice makes a mockery of its belief that it
policies are evidence-based. The Ministry's advice is so unsound that the
precautionary principle as applied to risk management practice requires
that the Ministry advice to parents and healthcare professionals be
retracted forthwith.

Note to editors: Ron Law is risk and policy analyst who has lectured widely
in medical science and business management. He was an invited member of the
Ministry of Health expert working group that advised the Ministry on the
management of medical injury within the New Zealand health system.
]

"john" wrote in message
...
Same as Tylenol in the US

http://www.scoop.co.nz/mason/stories/GE0409/S00084.htm

Illegally copied material deleted.

I basically agree with the article. Unless the fever is going to harm your
child (like if you child gets febrile seizures or have a real high fever),
then there is no need to give medicine to lower his fever.

Jeff

"Jeff" wrote in message ...
"john" wrote in message
...
Same as Tylenol in the US

http://www.scoop.co.nz/mason/stories/GE0409/S00084.htm

Illegally copied material deleted.

I basically agree with the article. Unless the fever is going to harm your
child (like if you child gets febrile seizures or have a real high fever),
then there is no need to give medicine to lower his fever.

Jeff

Actually, true simple febrile seizures aren't dangerous unless the
child is mechanically harmed by the thrashing that occurs during the
seizure. Simple febrile seizures do not mean the child will develop
epilepsy, they do not cause brain damage, etc.

As to "a real high fever", fever by itself is not a disease state, it
is a symptom. The only time a fever actually causes thermal damage to
body tissues is when it climbs over 106-107 degrees F. I've only ever
heard of this happening due to heat stroke or malignant hyperthermia.

I tell the parents of my patients that if you have a febrile toddler,
the only reason to treat the fever is to make the child comfortable.
If he has a temp of 103 but is running around, playful and happy,
leave it alone.

In any case, if someone has a sick child, febrile or not, consulting a
bunch of strangers on Usenet is foolish. Go to your child's doctor
for advice.

Mark, MD

"Jeff" wrote in message ...
"john" wrote in message
...
Same as Tylenol in the US

http://www.scoop.co.nz/mason/stories/GE0409/S00084.htm

Illegally copied material deleted.

I basically agree with the article. Unless the fever is going to harm your
child (like if you child gets febrile seizures or have a real high fever),
then there is no need to give medicine to lower his fever.

Jeff


COMMENT:

Jeff: Yes, but you missed the subtext of the article, which is a
deliberate blurring of the dangers of treating the fever in a live
infection, and treating the fever from a non-live vaccine (like
meningococcus B).


The article says:

It has been known for over a decade that routine administration of
antipyretics such as paracetamol may interfere with the clinical
evaluation
of patients with infections, such as meningitis, that their use may
prolong
infection and reduce the antibody response in mild disease [and
presumably
following vaccination], and increase morbidity and mortality in severe
infection.

COMMENT:

That phrase "presumably following vaccination" is the bull**** part.
Not proven. Makes sense as a good hypothesis for live vaccines such as
MMR, but a pretty long inference and may very well not be true when it
comes to an antigen vaccine like meningococcal B vaccines.

The article continues:

So why is the Ministry of Health advising parents to give children
paracetamol for "slight fevers" up to 39°C following vaccination with
meningococcal B vaccination... [even fevers as low as 37.5°C] when
there is
no evidence to support such use -- and it can do harm?

Comment: What harm would it do? The unwary reader might assume that
the meningococcal B vaccine might cause meningitis (so lack of fever
might interfere with clinical evaluation). But the vaccine cannot
cause meningitis, so the point is irrelevent. As is also the point
about "morbidity and mortality in severe infection." The
meningococcal vaccine can't cause any kind of infection, severe or
otherwise. In sort, there's no particular reason to think the advice
to use Tylenol/paraceamol when they get vaccinated with meningococcal
vaccine, is bad advice. Probably it will make children with high
fevers from meningococcal vaccine, more comfortable.

The question of whether or not to use antifebrile drugs in
vaccinations with live viruses which DO causes (mild) infections, is
another matter worthy of debate and further clinical study. But this
article contributes nothing to that debate because it's too ignorant
to even draw any distinctions between types of vaccines. And it's
chosen the wrong type here, as a fulcrum issue.

The acticle continues:

There is also no scientific evidence that antipyretics prevent
febrile
convulsions... it's all part of medical folklore that the Ministry
advice
is based on.

Comment: Indeed, the preponderance of evidence probably supports a
lack of effectiveness of antipyretics in preventing febrile seizures.
Recent reviews of available good randomized studies (of which there
are only about 4) suggest no effect. This is counterintuitive, and
deserves to be more widely known. But presenting it in the context of
how to treat kids with fevers after a vaccination in which they have
no infection, is not the way to do it. Such treatment may be confort
based, and while it might not prevent convusions, there's no reason to
think it does any harm, either.

On the other hand, when an active infection with a live organism is
going on, whether from a vaccination or natural disease, the role of
antipyretics should be re-evaluated. It's indeed very possible they do
more harm than good, overall. It's just a shame this question wasn't
raised by the article in a relevent context, such as vaccination by
MMR, or in children suffering natural viral or bacterial illnesses.
Meningococcal B vaccination is the wrong place to even bring the
subject up.

SBH