E-DRUG: E-DRUG Demazin Syrup Response

[James McCormack <jmccorma@unixg.ubc.ca>]

E-DRUG: Demazin Syrup Response (cont)
-------------------------------------

In response to comments such as "when I took it, it worked for my child" in
regard to cold medications and children I hope that the following adds
useful information to the discussion.

When I mentioned there is reasonable evidence that these medications are
not effective in children, I should have added that there is reasonable
evidence that these products are no more effective than placebo. Placebo is
the "most effective medication known to science, subjected to more clinical
trials than any other medicament yet nearly always does better than
anticipated. The range of susceptible conditions appears to be limitless". 

Whenever one takes a medication for a symptom, clinicians should be acutely
aware of a concept called "regression to the mean" and the role it plays in
the placebo effect. Unfortunately this term alone is enough to bring up
visions of a third year stats course and drive one into a coma.

Regression towards the mean simply means that "if its bad, things can only
get better, and if its good things, can only get worse". In other words,
one will often only take or give out a medication (for symptoms) in
situations where the symptoms are likely to be at or near a peak. Otherwise
why else is the person going to the doctor or seeking out drug therapy.
Given that this is the case, a later evaluation by chance alone, will far
more often than not be better than the previous measurement. Unfortunately,
as suggestible individuals we infer that because things are improved it
must have been what I did. Have you ever experienced the early signs of a
cold and gone Oh Oh I'm gonna get a cold and then two days later you
realize that you didn't get a cold. If at the time you had taken some,
miracle cure or preventative intervention you would swear that it obviously
"nipped the cold in the bud" and we would tell others of our experience and
before to long we would try and market the product and sell it for a tidy
profit (just kidding).

Why does it appear that a cold medication helps children sleep? While it
may be that there is a slight sedative effect - but remember these
combination products have a stimulant and a sedative in them, it is also
very likely that by the time the drug is used the kid and everyone else is
so exhausted everyone falls asleep regardless of what we do. 

I heard a great line a couple of years ago that encapsulates some of the
above comments "clinical experience is OFTEN just blind prejudice". Now
before anyone thinks I am belittling clinical experience I capitalized the
word often so that you realize the word used was not always. Clinical
experience is very important but we too often recommend a product because
we have experience that it appeared to work in ourselves and two other
people. Just be aware of the concept of regression to the mean.  

"The history of medical treatment can be characterized largely as the
history of the placebo effect"

AK Shapiro. The Placebo Response. Modern Perspectives in World Psychiatry.
1971


James McCormack, Pharm.D.
Associate Professor
Clinical Division Chair
Faculty of Pharmaceutical Sciences
c/o Pharmacy Department
St. Paul's Hospital
1081 Burrard St.
Vancouver, B.C.
Canada
V6Z 1Y6
Tel 604-631-5150
Fax 604-631-5154
Email: jmccorma@unixg.ubc.ca

[Richard Laing has handed over the E-drug moderation to Wilbert Bannenberg
as per today; thanks Richard for a job well done! 
WB.  Moderator's email: WilbertBannenberg@compuserve.com]
 


  
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