June 29, 2013

IT'S ABOUT CONTROL, NOT ABOUT MEDICINE (via The Other Brother):

A diagnosis is a diagnosis -- except when it's not? (Bill Gardner, 6/27/13, The Incidental Economist)

[T]he GERD diagnosis has increasingly been applied to infants who do not have the specific physiological symptoms of GERD, but who spit up and cry frequently and are hard to soothe. These latter infants are now frequently treated with PPIs. As Eric Hassall explains in the Journal of Pediatrics,

in the 6 years from 1999 to 2004, there was a >7-fold increase in PPI prescription. One of the PPIs... saw a 16-fold increase in use during that 6-year period...

Writing with a sarcasm unusual in a scientific journal, Hassall notes that

These data would imply that somehow the diagnosis of GERD has been missed over the past several decades or has recently become a major scourge of infants in the developed world, with acid suppressing drugs becoming a new essential food group in their own right. This change in practice has come about for several reasons, none based in medical science.

It has been true forever that lots of babies spit up a lot, cry a lot, and are difficult to soothe. And the great majority of these babies have been successfully 'treated' with long walks, car rides, rocking chairs, but mostly just waiting while the babies grow out of it. This is exhausting and stressful for parents. Hassall believes that the growth in the use of PPIs occurred because extensive direct-to-consumer advertising for PPIs and similar medications for adults popularized the term "acid reflux." So it made sense to parents that these drugs would provide a solution for a seemingly intractable problem. And for doctors, calling the problem GERD and prescribing a PPI to the infant was a way to at least soothe the parents.

Posted by at June 29, 2013 8:11 AM
  

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