Quote Of The Day: ‘I’m Embarrassed For The AAP’
26 CommentsBy Ed Silverman // July 8th, 2008 // 9:05 am
The American Academy of Pediatric guidelines released this week recommend that some children as young as 8 years old be given cholesterol meds is, predictably, causing controversy. Why? A lack of evidence, for one thing. Nicolas Stettler, an assistant professor of pediatric epidemiology at the Children’s Hospital of Philadelphia and a member of the AAP panel defends the decision by saying extratrapolating data from adults using cholesterol meds makes sense. Not everyone agrees.
“To be frank, I’m embarrassed for the AAP today,” Lawrence Rosen of Hackensack University Medical Center in New Jersey, and vice chairman of an academy panel on traditional and alternative medicine (see photo), tells The New York Times. “Treatment with medications in the absence of any clear data? I hope they’re ready for the public backlash.”
Arthur Brunet
This is tantamount to slow murder of children. Profit over people at any coxt, disgusting. I took a statin drug for a short time and while on it I could not walk twenty yards without severe calf pain. Criminal and disgusting. These people are suppose to be doctors? First do no harm? Give me a break.
Nathan
No conflicts of interest here. (sarcasm) As noted, Lawrence Rosen founded and chairs the AAP’s section on Complementary and Integrative Medicine. As their website clearly points out, this group advocates the use of acupuncture, “biologically-based therapies” (whatever that means), environmental medicine, homeopathy, manipulative touch and energy, mind-body medicine, music & expressive therapies, nutrition, probiotics, and yoga.
Nothing is wrong with these techniques — but it should be hardly surprising that this guy opposes treatment of kids with statins. He probably opposes treating adults with statins too.
Atlex
Nathan,
I agree with your assessment, except that I would call this an obvious “bias” against drug treatment or towards complementary (ie, often unproven–my editorial comment) approaches rather than a COI, which seems now to focus around money only.
Atlex
Vince
Seems the advice to statin kids is based upon no evidence. From the original Times story
” “We are in an epidemic,” said Dr. Jatinder Bhatia, a member of the academy’s nutrition committee who is a professor and chief of neonatology at the Medical College of Georgia in Augusta. “The risk of giving statins at a lower age is less than the benefit you’re going to get out of it.”
Dr. Bhatia said that although there was not “a whole lot” of data on pediatric use of cholesterol-lowering drugs,”
The good Dr. is able to assess risk benefit on by his own admission not ‘a “whole lot” of evidence. Perhaps he divines these things. Time to follow the financial connections.
Vince
Just for accuracy as I read the article
“Lawrence Rosen of Hackensack University Medical Center in New Jersey, and vice chairman of an academy panel on traditional and alternative medicine ”
No reference to him as Chairman of the AAP’s section on Complementary and Integrative Medicine who is identified as Kathi Kemper, MD, . Just clink on the link in the story. It would surprise me if Dr. Rosen has a bias against ‘Traditional” treatment.
Nathan
Vince - you are correct. Sorry. He’s the vice-chair, not the chair. The link below states that he is a founding member of the American Academy of Pediatrics Provisional Section on Complementary, Holistic and Integrative Medicine. I don’t know if these two organizations are the same or different.
One way or the other, he certainly demonstrates a clear bias against drug treatment. His statement is not exactly shocking in context with his other work.
http://www.integrativepractitioner.com/article_ektid830.aspx
Justice in MI
Most university-based CAM programs emphasize evidence-based integration of mainstream and “alternative” approaches.
Where is the statement that suggests either this guy, or the group, is preternaturally “anti-drug”?
Vince
His bias is against recommending drugs in the absence of evidence . No study shows benefit or risk in this group. To effectively experiment on kids with no real idea of what long term negative effects will be seen is simply not good practice. It would however be extremely lucrative.
Vince
Nathan the link you provided was interesting her are some of the other members. From the link
Erminia “Mimi” Guarneri, M.D., FACC
Medical director and founder of the Scripps Center for Integrative Medicine
Board-certified in cardiology, internal medicine, nuclear medicine and holistic medicine, Dr. Guarneri is the founder and medical director of the Scripps Center for Integrative Medicine. ….. Her medical degree is from SUNY Medical Center in New York where she graduated number one in her class.
Dr. Guarneri served her internship and residency at Cornell Medical Center, where she later became chief medical resident. She served cardiology fellowships at both New York University Medical Center and Scripps Clinic. Dr. Guarneri served as an attending in interventional cardiology at Scripps Clinic where she placed thousands of coronary stents. Recognizing the need for a more comprehensive and more holistic approach to cardiovascular disease she pioneered the Scripps Center for Integrative Medicine where she uses state-of-the-art cardiac imaging technology and lifestyle change programs to aggressively diagnose, prevent and treat cardiovascular disease. She is a member of the American College of Cardiology, Alpha Omega Alpha, the American Medical Women’s Association, and a diplomat of the American Board of Holistic Medicine.’
Quite frankly I really do not see the bias in this group .
Nathan
Vince - you raise a very good point. On this site, we spend hours debating the risks vrs benifit of drugs. Many people advocate non-drug treatment for disease. That’s fine — but there is no risk-benifit studies of these alternative treatments. We can’t a priori assume that nondrug treatments are safer than drugs. And we certainly can’t assume that non-drug treatments are more effective than drugs. The problem is that we’ll never know the true safety or efficacy of these types of treatments because no one does controlled clinical trials for non-drug treatments.
Nathan
Vince — woops, re-reading your post, I realized I misread what you said. Sorry. Non-the-less, I think the point I just raised is a valid one. I think that if you go to the website for Academy of Pediatrics Provisional Section on Complementary, Holistic and Integrative Medicine you’ll find that they are pretty clearly in favor of minimizing drug treatment. How many of the above treatments (accupuncture, massage, homeopathy, etc) have a EVIDENCE-BASED proof of efficacy? I would bet that none of them do.
Justice in MI
Hi Nathan - I have to be brief, but you are incorrect that there are no evidence-based studies of many CAM tx’s. Indeed, there are reams of them. It is, quite frankly, amazing to me that you jump to the conclusion, ” I would bet that none of them do.” This is precisely as prejudicial as many cynics about pharma.
You’ll ask me for specifics which I don’t have time to provide right now. But the areas of clinical nutrition, impact of meditation, obviously diet and exercise, and acupuncture have been studied multiple times (with, as with drugs, not always consistent results). Either way, evidence is evidence.
(You will recall how many of are most important drugs - including statins - were originally botanicals.)
You may also say “diet and exercise” are not CAM. Well, they once weren’t, but they have become so, especially as clinical nutrition has advanced.
Sam
The problem is that the American public has been brain-washed to
believe everything can be solved by taking a pill. Shame on the parents
who allow their children to over eat foods that are no good for them.
Shame on any physician who will not enforce changes of life-style and
prescribe statin drugs.
At 8 years old don’t you think there is enough time to teach children
lessons that will last a life time instead of taking pills for a life time.
Justice in MI
It’s probably also worth remembering that the AAP guidelines that started all of this were also _not_ mainly about drugs, as Atlex rightfully reminded us.
Indeed, if one reads the guidelines closely, drugs play a relatively small role.
Did they suggest massage or acupuncture? Well, not as I recall. But neither does Doc Rosen, as far as I know.
Ruth
This reminds me of pediatric “ADHD”. I don’t see very many pediatricians working with a child and his/her family on alternatives to pills that carry major risk, alternatives such as exercise, diet, limiting television, quiet time, etc. I have a friend who refused medication due to its dangers (all ADHD drugs carry dangers), worked on the above with her son, and viola’, her son is doing fine. The AAP would do well to look to alternatives for numerous drugs such as antipsychotics, doubt dubious diagnoses such as “bipolar disorder”, and roll up their sleeves and join the team with parents to help their children through natural means.
Nathan
Justice - good point, as always. I certainly over-reached with my generalization. My point is that many (most?) non-drug treatments have not been put through nearly the same rigors of testing that most pharmaceuticals go through. It’s dangerous to assume that a drug will be safe. It’s equally dangergous to assume that some of these other treatments will be safe. (in particular I’m thinking of herbal remedies, probiotics, etc) Equally important, many of these remedies have not faced the rigors of a placebo control efficacy test.
Justice in MI
Nathan - I agree that, overall, there has not been the same degree of study (for the obvious reasons of funding, regulatory requirements, the fact of being “alternative”, etc.)
But I was surprised at the number of RCTs with placebo there actually are of many CAM modalities. (I spent a year at our med school in a program about them.) Clearly, that is easier to do for some than others, although I’m sure you heard about the “fake acupuncture” studies and others.
What personally concerns me the most are the herbs and other supplements, and how little we know about adverses, interactions, etc., not to mention the amount of adulteration and misbranding. Happened to run across an “all natural”, guaranteed cholesterol product the other day that was full of red yeast rice, etc. And yet it advertised itself as “entirely safe,” “statin-free,” so “side-effects,” etc..
Tip of iceberg.
David Colquhoun
I don’t now which universe Justice in MI is living in when he says most university CAM courses use evidence.
Well perhaps Yale’s “more fluid concept of evidence” as documented in Integrative baloney @ Yale, http://dcscience.net/?p=231
The spoof video on YouTunbe of Yale’s contribution to endarkenment thinking has had a lot mote views that the originals, so perhaps there is hope yet for reason.
The fact is that most CAM activities in US medical schools don’t give a damn about evidence, as long as the bucks flow in from NCCAM and Bravewell.
They are making a laughing stock of US medicine, which is being set back to the days of make-believe that prevailed before the Flexner report (1810), or before the age of enlightenment itself.
pharma pr hack
This is from WebMD. You will note that statins may be great for people with heart and vascular disease. But in the US pharma is pushing them like f***ing candy. These are serious drugs with serious side effects.
They work well in individuals with these diseases but why would you take something preventatively that may or may not help something you may or may not get down the road but definitely will give you significant side effects. TO CHILDREN.
I don’t know if you have ever looked around but there is already a really long waiting list for organs in this country and a pitiful amount given each year- less than a thousand; but most statins can either a) raise liver enzymes or b) cause kidney damage. Where are all these organs going to come from to replace the ones that are going to be shot from overmedicating kids from cardiac possibilities not even probabilities?
These drugs weren’t tested or made to be long term lifetime drugs. None have even been around for all of my lifetime- are you really willing to risk your child to guard against the possibility of something that may or may not happen? With those kinds of side effects?
June 6, 2007 — The benefits of taking cholesterol-lowering statin drugs far outweigh the potential risks for the vast majority of patients with heart and vascular disease, a new review of the research suggests.
Longtime statin researcher Jane Armitage, MD, of the University of Oxford, found the incidence of serious side effects to be very rare in patients taking standard doses of the drugs, although the risks rose with higher doses.
Doc
PR Hack,
Virtually no drug given chronically, except maybe warfarin and digoxin have a ‘lifetime’ of data behind them. Most studies are done for specific time frames with enough calculated endpoints to see if stat sig is reached. You are greatly mistaken going that route. Should childern be given these drugs? That is a different question, however in adults giving chronic therapy for hypertension, high cholesterol, hyperglycemia, etc based on 2-5 year studies is valid. Try stopping those therapies at 3-5 years like the studies and see what happens.
Justice in MI
For David C - Well, we folks who live here call it the “milky way,” but that’s probably not what they call it in, say, Andromeda.
I don’t have the time (or, frankly, the inclination) to list some of the most interesting double-blinded RCTs of CAM therapies. But if you tell me they don’t exist…well, give my best to all the folks in Andromeda.
Kirk out.
Atlex
JiM,
Yes, there are many RCTs of CAM; however, they are confined to a vrery limited number of conditions, diseases, and maladies. However, many, if not most, of the “claims” associated with these treatments have no RCTs to back them up. That doesn’t mean they don’t work, but it doesn’t mean they do work either.
Atlex
David Colquhoun
Wrll Atlex is a bit closer. Just look at the Cochrane reviews for heavens sake. Almost all CAM is wishful thinking or fraud.
If this discussion (never mind the original nutty suggestion of statins for kids) is representative of the intellectual level of American Pediatrics, it makes me glad to live in Europe.
Justice in MI
David wrote: “I don’t now which universe Justice in MI is living in when he says most university CAM courses use evidence.”
I actually wrote no such thing. I was referring to a year I spent as a faculty associate at our own med school. What “most univeristy CAM courses use” is of concern to DC, but not a topic I commented upon (or could).
The fact that he needed to change the meaning of a simple sentence for the sake of his crusade probably already tells us something about his personal championing of “evidence” and “objectivity.” No evidence of either in his respose to me.
Maybe the best CAM to be recommended at this point is a long, slow look in the mirror.
For Atlex, I appreciate your note. I am no CAM-champion in general, as my original post makes clear enough. As I said, many of the problems “tip of the iceberg.” I was responding to Nathan’s (and now DC’s) monolithic denials, both of which seemed to me (for different reasons) not dealing with some of what _is_ there (to whatever degree).
David Colquhoun
Well I would not say my views were ‘monolithic’, but rather that I’d taken the trouble to read the evidence (admittedly that’s meant wasting a lot of time reading appalling papers, but at least it qualifies me to offer an opinion.)
If you want the evidence, it isn’t really hard to find. Look at the Cochrane reviews on the web. You will find only the slimmest of evidence for any sort of CAM and essentially none for the lunatic fringe like homeopathy.
Alternatively, read either of two excellent and honest books from people who have spent a long time assessing the evidence.
Trick or Treatment by Simon Singh and Edzard Ernst, Bantam Press, 2008
Snake Oil Science, The Truth about Complementary and Alternative Medicine. R. Barker Bausell, Oxford University Press, 2007
Justice in MI
Thanks for the references, David. This is not a “big issue” for me one way or other. But it’s of general interest, and happened to come up in the thread.
How about this: You wrote, “(never mind the original nutty suggestion of statins for kids)”
I won’t ask you to compare the evidence-base for pediatric statin use with, say, TM or other regular medititation for hypertension, but do I understand rightly that this is a context in mainstream medicine in which you also feel the science isn’t there to back up the guidlines? That’s where this thread began.
Your thoughts apppreciated. Thanks