Rethink Health - November 2008

News through the Good HealthKeeping lens

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Which Painkiller?

A mother recently rang me for reassurance, and instead found herself heading for A&E as fast as she could get. Her child had swallowed four adult paracetamol tablets – enough to harm a child weighing 10kg (22lb) or less, or up to age two. I expect when she got there the news was good, but she certainly needed the child seen.

This incident stirred up a bee in my bonnet. In the mid-eighties we learned that aspirin, then the usual remedy for childhood aches and pains, could cause a serious condition known as Reye’s Syndrome if given during a viral infection, most notably chicken pox. Six cases occurred per million of the population up to 1986. As a result parent were warned off aspirin for children under 12, and paracetamol became fashionable instead. The incidence of Reye’s Syndrome dropped to 1 per million by 1991.

This was, however, a massive leap out of the frying pan into the fire. I have never seen Reye’s Syndrome during 40 years of medical practice, but have several times witnessed the tragedy of paracetamol poisoning. Paracetamol is the most commonly used agent in attempted suicide – 70,000 cases per year. Twenty adult tablets, or less than two packets, may be enough to kill. And this is a death that may occur several days later, as a result of gradual but catastrophic liver failure.

This is serious, but not what bothers me. An ongoing dose of 4 grams daily – 2 tablets four times – is enough to produce chronic poisoning with liver damage. 6 grams daily may be enough to kill an adult slowly. One Cabinet Minister died in office this way, not so long ago, despite access to the best doctors in the land.

And only this month we had news of a study involving 200,000 children in 31 countries, which suggests that widespread routine use of Paracetamol may account for the rising tide of childhood asthma. A dose before age one raises your risk of asthma (by age 7) by 42% - a monthly dose even higher. The cause may be the illness it was given for rather than the drug, but it pays to be cautious.

So when parents tell me they have given their child a dose of paracetamol (Calpol™) just to take the edge off an injection, I see red. I do not blame them, but the Health Visitors who advise this kind of nonsense. In the first place, the “pain” of a live virus vaccine injection is almost nil – there is no chemistry in it to sting, and the injection is very shallow. Secondly, a numbing spray just before the injection would be more use, though still very hard to justify. Thirdly, we have to get real about pain and encourage children to cope with these small challenges, rather than arouse them to fearful anticipation. Most importantly, however, is the glib use of a dangerous medicine – for which the useful dose is not much smaller than a potentially dangerous one.

• Please be positive about anything you expect your children to go through, otherwise why would you do it? Your attitude informs your child’s.
• Bin your Paracetamol.
• In my view, Ibuprofen (Nurofen™) is safer – but use all these things very sparingly.
• If you don’t yet know how to manage feverishness without medicine, look up “fever” in our website library, or ask us to send you a copy.

Fuddled Mothers are Brainier

Many career women are distressed by the way they feel their mental faculties “go off” in early motherhood. Take heart – according to Professor Craig Kinsey of the University of Richmond, Virginia, you’re simply gearing up for different mental priorities. In those terms you are getting brainier, more attentive and better guarded against degenerative disease.

Put your accountancy practice on hold: parenthood is all too brief, and worth everything you’ve got. Your brain is just gearing up for the challenge.

Food Scores

Look out for the NuVal scoring system, devised by another American scientist to sum up the nutritional value of any food. Broccoli, blueberries, okra, oranges and green beans score a perfect 100, pineapples and radishes 99, apples 96. Brown rice scores 82 but white only 57. Salami comes in at 7 and apple pie at 2.

His formula, based on the values already published on food labels, may be open to criticism; but it’s a lot easier to make sense of than what we get now. Perhaps it may catch on here.

New Thyroid Batch

We have just changed to a new batch of whole thyroid, and because of the dwindling rate of exchange the price has gone up nearly 20%. 100 tablets now cost £13.85 including postage, entirely for this reason. The tablets may also be a little more potent, being freshly manufactured. We will warn you individually with your first prescription of the new material, that the dose may need adjustment downwards.