Amber Teething Beads: A Follow-Up

By Darcy Cowan 02/04/2012 69


Over the week or so I expect the page views for my amber teething necklace post to top 20,000 over the two blogs. Interest in the article has just kept increasing over the last year or so of it being up, as opposed to the majority of my posts which slip into internet obscurity within days. In anticipation of the occasion I thought I’d cover some of the comments that this post has gathered over the last few months.

Many of the comments are along the lines of “It worked for me” and “Try it yourself”.

To the first, I don’t really have much to say. I can’t peer inside the inner workings of your child and determine what is going on. But at the same time a bunch of individuals making claims of efficacy without adequate control for bias, natural history and various other contingencies is not a compelling argument to me. Plenty of others swear by practices that have no hope of working*, why should this one get more credibility based on personal experience?

As to the second, three words for you: Anecdote and Confirmation bias. I know enough to realise that I am not immune to the wiles of confirmation bias, which would make my trial just another anecdote – something I don’t accept from others so what would make my own experience any more valid? I also realise that for most people this sort of reasoning is at best foreign and at worst incomprehensible. The general thinking appears to go something like “If I try something and it seems to work, then it works – QED”.

No.

Related to this point are appeals to the “Placebo Effect”, the idea being that simply trying something helps, somehow. This may be true. But I’ll expand on the faulty reasoning behind this assertion.

The placebo effect as this seems now to be the “go-to” explanation for all things unexplained so it might be a good idea to dwell on this concept on it’s own for a bit. First off with regard to talking about the placebo effect, it depends on what you mean. The placebo effect started off being simply the improvement seen in the control group for clinical studies. It was the group that was given everything except the active treatment. Therefore by definition the placebo response is what happens when people aren’t treated. It was the catch all for everything that could affect the outcome that wasn’t due to the treatment itself: poor method design, confirmation bias, reporting bias, observer effect on the patients, regression to the mean, natural history of the disease, etc, etc.

Recently there has been some work done to see if there is a real change in people that is due to thinking they are getting an active treatment, the so called “Placebo response/effect”, this has been mixed. It is true that people will report less pain and their brain will show less activation in pain related areas. But people are susceptible to what they are told, it turns out if you tell people a cheap wine is expensive they will enjoy it more. Is there a placebo wine effect? possibly, but the wine didn’t change and neither did any underlying physiology in relation to placebo medical treatments.

In fact recent studies in asthma showed that while people reported feeling better while taking placebo their ability to perform on objective measures remained the same, while those on active medications improved. If you feel better while still having a life threatening condition are you better? I don’t think so.

So in appealing to the placebo effect you have to concede that 1. the beads don’t have any active ingredient, and 2. don’t make any difference to the underlying condition.
i.e. They do nothing.
Now notice in my original piece this is not what I say, I merely point out there is no good reason to think they are doing anything, not that they definitely aren’t. A subtle distinction I admit.

In essence the argument becomes: “If you think it works then it does”, well I would counter with why don’t you use something that we know does work and then you can capitalise on both effects: You will think it works and it will actually work too. Double goodness.

One poster asserted that amber necklaces were registered with the Therapeutic Goods Administration in Australia as a Medical Device. Arguing that this must mean they have therapeutic properties.

This one was my favourite as it was almost laughably easy to dismantle. After only a few minutes I found that this was completely untrue (you can search the TGA resister here). Not only that but there were suppliers admitting** that they couldn’t claim therapeutic benefits because they were not on the register:

“Amber Teething Necklace Information – TGA Australia

Due to regulations of the Therapeutic Goods ACT, policed by the Therapeutic Goods Administration (TGA), whose register does not recognise the claimed healing and theraputic[sic] properties of Amber we are unable to offer any detailed information on Amber Teething necklaces or Amber in general in a theraputic[sic] advisory capacity.

Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In all amber related cases that we have seen, the TGA Panel note “that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which prohibits the publication of advertisements for therapeutic goods that are not included in the Register“” [Emphasis added]

A complaint was made against a supplier for making claims for the product and this was upheld in part because the necklaces are not on the register.

“The Panel noted, without making any formal finding, that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which  prohibits the publication of advertisements for therapeutic goods that are not included in the Register.

The website involved changed their wording to get around the regulations, spot the difference:

OLD: “natural pain relief provided by Amber works by placing the necklace on your body, this allows your skin to warm the amber beads, releasing healing oils which are then absorbed into the blood stream.

NEW: “Amber is believed to soothe naturally, when Amber is worn next to the skin it is warm and it is reputed to release natural oils that can care for the skin.”

What a difference a few words make.

At the time the comment was made alleging the necklaces were on the register I suspected that intended therapeutic benefits would be enough to fulfil the therapeutic benefits category.

This is supported both in the declaration of the supplier above and from the wording from the complaint, just prior to the excerpt above it states:

Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In representing the advertised products to have an “active ingredient”, to release “healing oils which are then absorbed into the blood stream”, and to relieve teething in infants, the advertisement clearly constituted an advertisement for therapeutic goods.” [Emphasis added]

Lets say though that the product had been registered with the TGA or will sometime in the near future, I would note that unless the administration was in possession of studies that are not published elsewhere there is no way that they could be sure that an actual benefit is occurring. Bringing us right back where we are now.

As an extra note on the activities of the Australian government on this topic I found it amusing to see that the Australian Competition and Consumer Commission issued a safety warning about Amber teething beads end of September last year (see here and here and here).

I say amusing because, while it’s not impossible, I do find it unlikely that one branch of the government is condoning their use while another warns against them. Luckily this is not actually the case.

Finally, this post is not intended to address every conceivable objection to my arguments, merely a survey of what has been proffered so far. I am not really convinced by anything I have yet seen but I remain open to changing my mind so long as the evidence is of good quality. It doesn’t have to be much, a good start would be something that suggests succinic acid has the analgesic properties attributed to it. Then we could address whether succinic acid is released from the beads at ambient/skin temperature. Finally we would need to tackle whether the succinic acid is absorbed topically in any significant dose (decent dose response curves could be obtained at stage one of this theoretical research programme).

All three of these items would need to be looked at in order to state that amber beads have good plausibility for what they are marketed for.

[Update 29/4/13: Apparently there is a chain email circulating blaming amber beads for a case of SIDS. This seemed implausible to me and a very brief check seems to back up my gut feeling. There is no reason to think that amber beads contribute to SIDS at all. For a more thorough break-down go here: http://www.hoax-slayer.com/amber-teething-necklace-sids.shtml . I am not one who feels we need to latch onto any reason to vilify our intellectual opponents and spreading misinformation (especially easily debunked misinformation) is a big no-no in my book.]

————————————————————————————————

*Not that I think this product has “no hope” of working, it could as far as I know. We just can’t make that determination on the basis of anecdote and there are no trials that I’m aware of.

** Argh, this site seems to have removed any trace of of this page. Should have archived it. It has essentially been replaced with this (archive):

In keeping with Australian Fair Trading guidelines no therapeutic claims are made and no medical advice is offered. The material provided on allaboutamber.com.au is for information and educational purposes only and is not a substitute for medical treatment or diagnosis. We assume no responsibility for treatment or cure of any illness or disease. If you have a health problem we recommend seeking medical advice from your qualified natural/health professional. This information is strictly a source of general information and is not intended for use as a tool for self-diagnosis. All About Amber provides this information for you to make your own decisions, if you want to use them on your own family, we believe they work for us and please read the reviews to gather many other peoples opinions.

Which seems to me to be saying “We can’t claim the beads have any healing powers directly, but they really do.”

They haven’t yet learned this lesson for Hazelwood jewellery (archive)though:

How does hazelwood jewellery work?

Hazelwood products are believed to help to create an alkaline environment in your body, which may help, precent[sic] and appease many of the symptoms caused by being to acidic. Hazelwood, being an alkaline wood, has the natural property of absorbing and neutralizing the body’s acidity through contact with the skin. By doing so, the necklaces can also help with digestion, constipation, eczema, migraines, acid reflux, heart burn, nausea, arthritis, skin problems, etc. If you suffer from one of these issues, it is highly probable that you are suffering from an acidity imbalance, and hazelwood may be able to help you alleviate these symptoms in a natural way.  Most people who suffer from an unbalanced pH are unbalanced towards the acidic. This condition forces the body to borrow minerals—including calcium, sodium, potassium and magnesium—from vital organs and bones to buffer (neutralize) the acid and safely remove it from the body.

Hhhhm, perhaps another post is in order. And a complaint.

As a brief aside, as it seems there are quite a few parents out there hungry for this information if you know of a good parenting or early childhood publication that would be willing to print the original article (probably in an altered form) then let me know.

And I’ll stop there before the footnotes become longer than the post.

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Filed under: Alternative medicine, Medicine, Questionable Techniques, Sciblogs, Science, skepticism Tagged: Amber, Health and Medicine, Placebo, Placebo Effect, Science and Society, Teething, Therapeutic Goods Administration


69 Responses to “Amber Teething Beads: A Follow-Up”

  • “By definition the placebo response is what happens when people aren’t treated.”

    Thank you. I’ve never seen it put so succinctly.

  • It’s a point I don’t think is emphasised enough,
    from the ever quotable Dara O’Briain
    “You’re healing yourself, give yourself the credit.”

  • Darcy, I note, apart from the three [same] links to the ACCC alert you haven’t referred to the alleged risks… this from the other thread…

    Skeptic’s Paradox:

    Having raised concern about a skeptic using folklore as evidence to caution someone against using amber bead necklaces, and using the Ministry of Consumer Affairs as their ‘evidence’ I put an Official Information Act request into the Ministr of Consumer Affairs asking for copies of their evidence…

    Have just received a near hundred page response of mostly repeated emails… their evidence can be summed up thus:

    Good Afternoon Everyone
    …
    We have thought long and hard on this issue and have had to balance off the potential risks with amber bead
    necklaces and the fact that it would appear that these items have been used for many years (perhaps hundreds)
    without any reported incidents. Contact with our counterparts in other jurisdictions has indicated that these things
    have not be involved in cases of injury or worse.

    So with that being !he case we feel that at this point in time, the best approach is to raise awareness of the potential
    ‘risks and to provide some simple’guidance on the safe use of these amber bead necklaces.

    It would be useful if you could raise awareness of the issue within your organisations and with any organisations you
    network with.

    It [c]an be a tricky judgement call with regard to product safety and what actions to take to mitigate risk.

    Any feedback would be useful – the website material can easily be changed if needs be.

    Hope all is well with you all.

    So there you have it… 200 years with no evidence of harm or accidents anywhere in the world and the skeptics still make claims putting people off… mean while anyone making a claim about any benefits they’ve experienced and they are labelled as woo-ist…

    That’s the Skeptic’s Paradox… They use woo when it suits their argument and reject it when it doesn’t… It’s also known as double standards.

    A question I have for you Darcy… when is something safe enough?

  • “By definition the placebo response is what happens when people aren’t treated.”

    I thought the placebo effect was “By definition the placebo response is what happens when people think they are treated.”

    Even the MOH acknowledges the placebo effect can be used to good advantage… so why can’t parents?

  • Ron

    Your thoughts about what the placebo response is are incorrect.

    A placebo is an inactive or inert comparison to a treatment that is being tested. It is designed to make no physiological changes. It is the null hypothesis. There is nothing present in an inactive placebo for a person to respond to. It is not a treatment.

    If a person is told that an inactive substance is a treatment, then they are being lied to.

    Some people consider that the “placebo effect” is the result of the lie that an inactive substance is a treatment.

    That’s not the placebo response. Don’t confuse the two.

    Darcy is correct: “by definition the placebo response is what happens when people aren’t treated.”

  • Stuartg, obviously where one has two doctors one has three opinions… not that I’m a doctor.

    You are correct that a placebo is an inactive or inert comparison… but you are wrong to say that it is not a treatment in a clinical trial… Two groups are treated the same except one is given the active being studied and the other a placebo, (except in the case of vaccine studies in which case it is a pretend placebo.)

    Both are treated… Darcy is wrong in fact as both groups are treated, only one is treated with the active and the other treated with the placebo. Doctors know full well that for many patients if they don’t give a treatment of somekind the patient is likely to go away disappointed… so they prescribe something relatively inert so that the patient at least goes away satisfied that they’ve been listened to. I suspect many prescriptions for prozac/ssri’s fall into this category… otherwise the patient would be even more depressed. There is excellent evidence that the benefits of anti-anxiety/depression pills is a placebo effect.

    Some references to ponder… quotes from the scientific literature showing placebo treatment is alive and well.

    1. The “placebo response” occurs when a person who is ill perceives an improvement or actually experiences an improvement in symptoms or overall health from the psychological effect of receiving treatment rather than from the treatment itself.

    http://www.nationalmssociety.org/research/clinical-trials/placebo-response/index.aspx

    2. The placebo response can be defined as the benefit patients receive from a treatment that has no active components.

    http://nccam.nih.gov/research/results/spotlight/071511.htm

    3. At the conclusion of the study, data showed that only treatment with the albuterol inhaler improved lung function. Lung function did not improve with either of the placebo treatments or after the no intervention visit.

    http://nccam.nih.gov/research/results/spotlight/071511.htm

    4. The Placebo Response: Not in Your Head but in Your Brain; How sugar pills and sham treatments mimic the real thing

    http://www.psychologytoday.com/blog/the-fallible-mind/201201/the-placebo-response-not-in-your-head-in-your-brain

    5. Our secondary aims were to assess whether the effect of placebo treatments differed for patient-reported and observer-reported outcomes, and to explore other reasons for variations in effect.

    http://www.ncbi.nlm.nih.gov/pubmed/20091554

    6. Some support for this hypothesis is derived from brain-imaging studies of depressed subjects, showing that placebo and active treatments induce quite different changes in brain function, despite exerting similar benefits [6-8]. Similarly, neurophysiological research on analgesia has suggested that expectation pathways, rather than pain pathways, may be stimulated by placebo treatment [9].

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709636/?tool=pubmed

  • By the way, I’m intrigued that Darcy has talked about the placebo effect with regard to a device used on toddlers… do infants understand the placebo effect? Do they understand the concept of treatment? Do they understand that amber bead necklaces are not just another accessory?

    StuartG, can you advise whether such young children would be influenced by the placebo effect? Or are we talking about the placebo effect on the parents who put the necklace on their kid?

    What medical school would teach such an hypothesis?

  • What, Darcy? No comment on the claims regarding babies influenced by the placebo effect?

    Do you really believe that babies would be influenced by the placebo effect? Now that would resonate with the SBS (Skeptics Belief System.)

  • Hmmm, if the effect of the amber beads was due to the release of succinic acid then one would expect the beads to get lighter over time. Also, I would be surprised in simply sucking on amber would allow any release of substances in the amber at a reasonable therapeutic dose.
    It would be interesting to test this out using an accurate set of scales.
    As for the hazel wood absorbing and neuralising acidity just through skin contact, that seems quite fanciful. The claim that disease (generally) is related to acidity is not supported by evidence.

    With regards to placebo and children it is often proposed that a parent using a new therapy may pay more attention to the child but Im not sure I find this a convincing argument. Of course one needs to termite if a placebo effect is in fact present before bothering to suggest how it might be operating.

  • Damn spell check that should be “determine” instead of “termite” in my last post.
    Also the first line should say “proposed effect”

  • Don’t worry, Michael. Those little pests can be termitated (sic)… maybe they are responsible for the holes in the beads?

  • Ron

    In a conventional, ethical, trial, no one is lied to that they will receive the active drug. They are told that they MAY receive the active drug.

    Animals in the placebo arm of a trial may improve because of the increased care they receive from their owners, it’s all part of the placebo response. The same thing occurs in infants.

    (Sorry Darcy, I couldn’t avoid this; I know it won’t make a difference to Ron but it may to others.)

  • On the ‘acidity causes disease’ thing, Michael – the body’s homeostatic mechanisms ensure that pH remains within very narrow, constrained boundaries. Often those who argue that acid conditions cause disease also promote ‘alkaline’ diets (which for some mysterious reason often contain lemon juice!) to ‘restore the body’s natural pH’. They may have some effect on urine pH (via the kidney’s H+ pump activity) but not on blood pH (due largely to that same kidney activity).

  • I tried to do a google search on succinic acid last night to see if it linked to any medical research but all the popped up were websites talking about amber beads and teething, with a lot of sites mentioning that amber beads contain succinic acid.

    Then it occurred to me that this is the old “natural is good” fallacy. Surely if succinic acid would help with teething then it could be administered as such, rather than assuming that the succinic acid can leach out of amber, magically in the correct dose to sooth a child without poisoning them.
    Like many alternative therapies, it seems to be they are grasping at a little bit of science (contains succinic acid) in order to explain how the beads “work”.

  • Michael, in originally researching the subject I could find no evidence at all the succinic acid acts as an analgesic. No-one has shown me anything in the intervening time.

    You raise an interesting point about giving succinic acid directly, I wonder if those who would use the beads would accept using the same putative active ingredient orally? I wonder what the equivalent dose might be. You could probably work it out by looking at the weight of the beads, percentage of succinic acid (which is often well touted by the seller) and how long the beads effective lifetime is expected to be. Given these things are sometimes handed parent to child heirloom style you might almost get to homeopathic doses.

    I should point out that there does seem to be some evidence that even large doses are tolerated well so I’m not worried about poisoning.

  • FWIT, I personally find the succinic acid theory implausible… there is no science to support that as far as I’m aware (correct me if I’m wrong.) Pubmed has 15 records with succinic and teeth but none with succinic and teething.

  • “In a conventional, ethical, trial, …” StuartG, could you point me to one of these please? 🙂

  • Alison,
    Yes, the “acid is bad” excuse comes up a lot in pseudoscience. I encountered it with the “explanations” for the detox foot baths.
    And when they claim that things such as lemon juice counteract acidity, it certainly emphasises the fact that reality has left the building (and is probably on a plane to the Bahamas!)

  • By the way, it’s encouraging to see skeptic paradoxers actually start to look at/for some evidence to support the cause… A good place to begin is Pubmed… and the Cochrane reviews are reasonable at looking at StuartG’s so-called, “a conventional, ethical, trials” and sorting the wheat from the chaff. Often they conclude that most of StuartG’s a conventional, ethical, trials are actually quite dodgy… Flu vaccinations is a classic…

    In the case of placebo effect, the view is that any clinical benefits are small with treatments for pain perhaps being a notable exception… you can read for yourself here…

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003974.pub3/pdf

  • I stumbled on this while browsing the Cochrane Reviews (as I often do)… I suggest skeptic paradoxers (scibloggers who use anecdote to ridicule the use of anecdote) should really be concentrating on these killing fields… not bullying ordinary mums and dads who actually care about their kids.

    Margaret McCartney’s writings are appealing. This is not only because she is an excellent writer, but also because they mix insufficiently uttered common sense with iconoclasm and challenges to mainstream thinking. Her recently published book – The Patient Paradox: why sexed up medicine is bad for your health (Pinter and Martin, 2012) – is packed with these things.

    The ‘patient paradox’ in the title of the book refers to the way that political, professional and commercial promotion of screening and testing have become so pervasive that normal people are being converted into patients, and that, partly as a consequence of unwarranted diversion of limited resources to fuel this trend, many real patients in need of effective professional help are losing out. The inexorable conversion of people into patients has been achieved by exaggerating the chances of important health problems developing in symptomless people (for example, by citing relative rather than absolute risks), while ignoring or downplaying the adverse psychological and sometimes physical effects of the process of ‘patient creation’.

    http://www.cochrane.org/news/blog/reality-check-systematic-reviewers

  • By the way StuartG, what conventional, ethical, trials are there supporting paracetamol for infants upset while teething? Is that still the standard medical treatment?

  • Ron

    You appear to be the Google expert, not me, so you can find the trials online yourself, or maybe try the old fashioned way, the medical library.

    “Is that still the standard medical treatment?” Has it ever been?

  • Sorry, StuartG, I thought you were a medic… I was obviously wrong, otherwise you would have known… or maybe not.

    Immersing myself in medical literature is a large part of my life… Unlike skeptic paradoxers, googling is a means to an end for me… helps me find links to enable information mining of scientific literature. Our kids were brought up on amoxyl and paracetamol for just about anything… most ‘teething’ problems were diagnosed as otitis media when our children were young… The most common medical treatment options even today for glue ear include the use of decongestants, mucolytics, steroids, antihistamines and antibiotics. The effectiveness of these therapies has not been established.

    http://www.ncbi.nlm.nih.gov/pubmed/15674886

    Two Cochrane Reviews challenge antibiotic treatment by demonstrating that the benefits from antibiotics are modest and may not outweigh their risks (Kozyrskyj 2010; Sanders 2009). Approximately 17 children needed to be treated to prevent one child experiencing pain after two to seven days (Sanders 2009). Another systematic review showed that 60% of children will improve spontaneously in 24 hours without any antibiotic treatment and 80% of cases will resolve within three days (Rosenfeld 2003). Antibiotics also threaten adverse effects in the individual, such as diarrhoea, stomach pain, rash and vomiting. Antibiotic use also inevitably promotes resistance by natural selection, thus limiting their usefulness for future generations (Nasrin 2002). In recent years there has been a trend away from clinicians prescribing antibiotics for all AOM.

    [extract from Cochrane Review]

  • Ron

    Teething is not a medical problem, just an everyday part of life.

    If you took your kids to the doctor, with or without a medical reason, your doctor would naturally assume there was a medical problem and investigate for one.

    If your car is short of gas/fuel, but you take it to a mechanic, the mechanic likewise assumes a mechanical problem and investigates for one.

    Please use some common sense.

  • StuartG, you may be right, but if I took my car to the mechanic without realising it was short of petrol, I’d be annoyed to find that he’d ‘solved’ the problem by changing the oil and the break-pads!

    If teething made the infant/toddler irritable, especially if it was a first child, and wasn’t sleeping or feeding much, I would not be surprised if ‘worried mum’ took the kid to the quack’s just for reassurance if nothing else… in which case one would hope that reassurance was given… not a prescription… it still happens… I know because I’ve seen it happen…

  • Ron

    So, you’d take your car to the mechanic when it was out of fuel, just for reassurance.

    Perhaps you’d get your plugs and fuel filter replaced as part of the reassurance?

  • “Is that still the standard medical treatment.” Has it ever been?

    I notice that you haven’t answered my question.

    Yours was a standard Catch 22 question along the lines of “are you still beating your wife?” To get any answer you need to first demonstrate whether paracetamol/acetaminophen has ever been standard treatment for “infants upset while teething.”

    A medical librarian would be able to help you.

  • StuartG, you comment about teething is revealing… as is your apparent need to utilise a medical librarian. The last time I needed to go to a medical library was when I wanted to trawl through some archives looking for evidence relating to MOH claims that BZP was developed and used to treat worms in cattle… I knew what the answer was from my extensive internet searches… I’d obtained copies of the original patent application, but needed to be sure… I spent a couple of hours going through medical and veterinary journal and, as expecetd, found no evidence of such use…

    You say, “To get any answer you need to first demonstrate whether paracetamol/acetaminophen has ever been standard treatment for “infants upset while teething.””

    Certainly when our kids were infants in the mid/late 1970’s that was the case.

    I know from observation of our grandkids and their friends that the practice is much less today, but still common. One thing I’ve observed is most parents of young children I know are internet savy, and source info from a variety of sources and are, by and large, risk averse. Interestingly, nearly all infants I’ve observed wear amber necklaces; if they do no harm, them what’s the problem with that?

    This paper might enlighten you somewhat. It’s 10 years old, but skimming through related literature I suspect it’s still relevant.

    Look forward to your response.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128949/pdf/814.pdf

  • Actually, StuartG, I have taken a car to a mechanic when it was out of fuel… only I didn’t realise it was out of fuel… Even worse, we towed the car to the garage… the problem was that the fuel gauge was faulty and it was indicating there was plenty of fuel in the car… so there you are!

    As I said, if I took my car to the mechanic without realising it was short of petrol, I’d be annoyed to find that he’d ’solved’ the problem by changing the oil and the break-pads!

    Plenty of worried mums take their grizzly kids to the doctor… plenty of doctors top-up the medicine cabinet rather than providing reassurance.

  • By the way, StuartG, I’ve been advised that you are a medical doctor… is that not the case? Do you have kids?

  • How timely, this in todays Journal of the American Medical Association (JAMA)… this article appears to be free for all; it’s titled, “Choosing Wisely: Helping Physicians and Patients Make Smart Decisions About Their Care”

    It’s about an initiative to try and wean doctors off over testing/prescribing/treating patients and in the process saving billion$ and preventing unnecessary harm.

    It notes that that as much as 30% of all health care spending is wasted… Yet physicians do not always have the most current effectiveness data, and despite acting in good faith, they can recommend diagnostic or therapeutic interventions that are no longer considered essential… Clinicians often report feeling compelled to accommodate patients’ requests for interventions they know are unnecessary… and that patients need trustworthy information to help them better understand that more care is not always better care, and in some cases can actually cause more harm than good…

    All good stuff… as has been shown, more doctors/doctoring actually increase the risk of harm…

    It notes, “A 2010 reader survey of nearly 1200 healthy 40- to 60-year-old men and women, with no known heart disease, risk factors, or symptoms, showed that 44% had received screening tests for heart disease rated by Consumer Reports as very unlikely or unlikely to have benefits that outweigh the risks.10 Moreover, those who had received the testing did so without first getting crucial information from their physician. For example, only a few “healthy” adult respondents reported discussing with their physician how accurate the tests were (9%), whether they saved lives (1%), potential complications that might occur (4%), or what the patient would need to do if the test indicated a problem (11%).10​ Choosing Wisely will help provide the other side of this important story. ”

    As they say when it comes to modern commercial medicine, “less is more!”

    Makes the $20 Amber Bead necklace look like a safe option to me.

    One thing for sure, skeptic paradoxers won’t be interested in this JAMA article… they’ll just keep on bullying people with different belief systems with the zeal of fundamentalists using anecdote to discredit the use of anecdote.

    http://jama.ama-assn.org/content/early/2012/03/30/jama.2012.476.full

  • I note over on another blog from which I’ve been banned because Grant doesn’t like being challenged to front up with evidence, there is this exchange…

    Darcy Cowan 1 hour ago
    I notice they seem to have taken the opportunity to remove all “pro-vaccine” sites from their resources page.

    Grant Jacobs 55 minutes ago
    Darcy,

    Really? I haven’t checked for myself (time…) but that wouldn’t be a good look – it would gives the impression that they’re dropping all ‘balance’ from their content (esp. as regards their slogan ‘for an informed choice’).

    Darcy Cowan 7 minutes ago
    I wish I’d archived the previous version so I could be absolutely sure (I did for some articles and the disclaimer) but I note in my complaint that there were prochoice and pro-vaccine sections and I seem to recall MoH and the IMAC webpage being on there.
    Can’t find them now. There is a MoH page listed but it’s only for breastfeeding.

    https://sciblogs.co.nz/code-for-life/2012/02/24/ias-talks-about-vaccination/

    This is prima facie evidence that skeptic paradoxers don’t know how to look for evidence… it took 4 seconds exactly to find what they are claiming is now lost…

    Just ask, boys, and I’ll send you what you want… it’s all there on the net if you knew where to look.

  • Ron

    I’m paraphrasing, but you offer an old paper that shows nothing is medically indicated for teething, and nothing apart from your own experience that paracetamol is standard medical treatment for teething.

    I think you’ve answered your own question.

    Note that medical doctors come in different varieties. None are needed to treat teething (your own papers), and I would hesitate to take a child with a cold to, for example, a pathologist or cardiothoracic surgeon.

  • Stuartg, your paraphrasing confuses ‘medically indicated’ and ‘medical practice.’

    As you’ll know many medical treatments are not medically indicated, but they are given because it is medical practice.

    I note you’d not take a child with a cold to, for example, a pathologist or cardiothoracic surgeon… I agree… But I note you haven’t included GP… what treatments are medically indicated for the common cold?

  • Sorry, Ron, I apologise, didn’t read things correctly because I was in a hurry.

    You haven’t provided any evidence that paracetamol has ever been standard medical treatment for teething, so your question is still a Catch 22 type.

    I was wrong thinking you may have answered it yourself.

  • I will try to answer from a personal perspective.

    You asked “Is (paracetamol) still the standard medical treatment (for teething)?”

    I asked you “Has it ever been?”

    I, personally, have no knowledge, apart from your statement, that paracetamol has ever been “standard medical treatment” for teething.

    Again: has it ever been?

  • StuartG, obviously they don’t teach much medical history in med school these days, otherwise you’d know the answer.

    I must admit it somewhat concerns me that woo-deniers are often the most vocal supporters of woo… another skeptic paradox I suspect.

    Take a read of the full article posted in Nature (x British Dental Journal)
    Note how many kids were killed by ‘science-based medicine.’

    and to think, this blog is about bagging Amber Beads which have no history of having caused harm to anyone… let alone killing thousands of babies in the name of scientific medicine.

    Read the whole article and try and work out where woo starts and woo ends…

    A report of the myths and modern approaches to teething : Article : British Dental Journal

    snip…
    There remained a widespread fear of the role of teething in infant illness and mortality. In 1894 Dr M. Thrasher, writing in Dental Cosmos, stated his belief that, ‘So deadly has teething become, that one third of the Human family die before the twenty deciduous teeth have fully appeared’.

    Soon after this, in 1896, Dr S. W. Foster, also in Dental Cosmos, explained, ‘The teething child becomes wakeful, restless and fretful, refuses nourishment; the alimentary canal becomes more active, diarrhoea follows and if relief is not given, relaxation of the vital forces follows and we have nausea, vomiting, convulsions, paralysis and not infrequently, death’.

    He stated that more deaths occur in the teething period than in any similar period during the human lifespan and inferred that teething may be the leading cause of death in the population.

    Over the centuries, an extensive folklore had built up around teething. The condition even acquired a Latin name, Dentitio Difficilis. However, not everyone agreed with the belief of the majority. In 1771, George Armstrong, a paediatrician, wrote, ‘Teething in the manner as was observed in convulsions is said to carry off a much greater number of children than it actually does, for almost all children that die whilst they are about teeth are said to die of teething’.

    At the time that Drs Thrasher and Foster were writing in Dental Cosmos, Dr W. C. Barrett addressed the First District Dental Society of New York. His paper was called The Slaughter of the Innocents and attacked the hypocrisy of his colleagues.

    ‘”The child is teething”, is the vague explanation given to many an anxious mother by practitioners who are either incompetent to form a complete diagnosis, or too indolent and careless to seek for the hidden springs of disease… “Only teething”. To how many promising young existences in which were centered the hopes, the ambitions, the heart affections of a family circle, have these words sounded the knell. “Only teething”, and the fond parents looked with but little alarm upon the symptoms of the gravest character.’

    It is easy to imagine that he was not only a dentist with views ahead of his time, but a theatrical orator also.

    With increasing understanding of medicine and diseases came a gradual but recognisable change in the belief and practice of the dental profession. In 1910, 1600 deaths in England and Wales were attributed to teething, compared with 5016 in 1839.

    http://www.nature.com/bdj/journal/v191/n1/full/4801078a.html

  • g tips and tooth care – Pregnancy and baby guide – NHS Choices
    http://www.nhs.uk/conditions/pregnancy-and-baby/pages/teething-and-tooth-care.aspx

    Paracetamol or ibuprofen for pain

    CKS identified no studies examining the use of these analgesics for relieving the discomfort associated with teething. However, their use is widely recommended by experts [Grundy and Shaw, 1983; Ashley, 2001; Jones, 2002; Wilson and Mason, 2002; Anderson, 2004; Nield et al, 2008].
    Both paracetamol (120 mg/5 mL) and ibuprofen (100 mg/5 mL) suspensions are licensed for the relief of teething symptoms in infants 3 months of age or older.
    http://www.cks.nhs.uk/teething/management/scenario_teething/management/basis_for_recommendation

    Over-the-counter medication in children: friend or foe? – Australian Prescriber
    http://www.australianprescriber.com/magazine/24/6/149/51

    http://www.pharmacylive.co.nz/common-conditions-detail?cid=56c01b80-7d5e-4c72-bc2a-b5c8f743f562

  • Marshall Hall, (1790–1857) a physician, stated that he ‘would rather lance a child’s gums 199 times unnecessarily than omit it once if necessary’ and instructed his students to do it, before, during and after the teeth appeared, sometimes twice a day.

    By 1839, 5016 deaths in England and Wales were attributed to teething. The English Registrar-General report on teething of 1842 discussed infant mortality: 4.8% of all infants who died in London under the age of 1, 7.3% of those between the ages of 1 and 3 and 12% of all deaths under four years were directly attributed to teething.

    The belief in lancing the gums was widely and firmly held by both the medical profession and the public. In 1850, Condie, in his book Diseases of Children, reported:

    ‘A curious case is related by M. Robert, in his treatise on the Principal Objects of Medicine, of one of the effects of difficult dentition, as of the division of the gum. A child, having suffered greatly from difficult dentition, apparently died and was laid out for internment. M. Lemonnier was desirous of ascertaining the condition of the alveola. He accordingly made a free incision through the gums but on preparing to persue further his examination, he perceived the child to open his eyes and give other indications of life. He immediately called for assistance; the shroud was removed from the body and by careful and persevering attention, the child’s life was saved. In due time the teeth made their appearance and the child’s health was fully restored.’

    In 1884, the Medical Society of London held a meeting on the subject of teething. Edmund Owen, Surgeon to the Hospital for Sick Children, stated that the lancet and the leech now ‘lie together in the same dark tomb’. Most colleagues at the meeting disagreed. Many believed that childhood ailments were caused by teething and had anecdotal evidence to support this. It was considered by most that failing to lance contributed to the high rate of infant mortality. The American physician Samuel Gross complained that young doctors were not using their lancets.

    http://www.nature.com/bdj/journal/v191/n1/full/4801078a.html

  • Interesting, lots of stuff unrelated to teething. How anyone in 1894 could attribute deaths from childhood disease, poor hygeine, poorly separated water and sewage systems to teething is difficult to understand and a somewhat amusing historical anecdote.

    I have no idea why this anecdote was relevant even in 1894.

    Ron, you use the internet. This is the product of more than a century of research that has occurred since 1894. If you believe anecdotes from 1894 are relevant today, please feel free to use the postal system to communicate as that is more appropriate than the ‘net.

    Again: has it ever been?

  • StuartG asks, has it ever been…?

    Obviously it has…! Maybe you need to get your medical librarian to help you learn a bit about why parents may well be looking for non-drug interventions in such issues as teething… especially as kids continue to due from paracetamol use.

  • StuartG, you obvioulsy didn’t read the article…

    In a 1975 study of 64 primary care paediatricians in Philadelphia, Honig found that only five believed that teething was not responsible for symptoms such as irritability, eating problems, wakefulness and rashes.4 Eighteen felt that teething could be responsible for temperatures up to 39.4°C.

    Dentists are equally reluctant to discard the teething diagnosis. Most dentists do not routinely treat children of this age and their opinions often reflect dental folklore. Most parents (and grandmothers!) believe in the distress of teething.

    Teething complaints are confined almost exclusively to the eruption of the deciduous dentition. Other than impacted third molars, the eruption of permanent teeth is free from the symptoms frequently ascribed to the eruption of the deciduous teeth. In 1990, Wray commented that the current understanding was that teething coincides with the stage of development when active immunity is struggling to take over from the waning passive immunity of the mother.5 This often results in ENT or gastrointestinal infection in a child with an obvious oral fixation who will naturally suck or chew their fingers.

    More recently, the possibility of the signs and symptoms related to teething being due to viral infection has been proposed and investigated. King studied 20 infants presenting with a parental diagnosis of teething difficulty, compared with 20 infants with no distress acting as a control.6 Almost half of the studied group had oral swabs positive for herpes simplex virus (HSV). None of the control group had positive oral swabs. King concluded that oral HSV infection should be included in the differential diagnosis of infants presenting with teething difficulties.

    The few remaining signs and symptoms left to teething, eg fever, irritability and eating difficulties, are quite consistent with primary herpetic gingivostomatitis.

    http://www.nature.com/bdj/journal/v191/n1/full/4801078a.html

  • Ron,

    You keep avoiding the question. “Obvious” is not an answer.

    Unless you can demonstrate that paracetamol has ever been “standard medical treatment” for teething, your question is entirely irrelevant.

    Again (sixth time): has it ever been?

  • It sure has been…

    CKS identified no studies examining the use of these analgesics for relieving the discomfort associated with teething. However, their use is widely recommended by experts [Grundy and Shaw, 1983; Ashley, 2001; Jones, 2002; Wilson and Mason, 2002; Anderson, 2004; Nield et al, 2008].
    Both paracetamol (120 mg/5 mL) and ibuprofen (100 mg/5 mL) suspensions are licensed for the relief of teething symptoms in infants 3 months of age or older.
    http://www.cks.nhs.uk/teething/management/scenario_teething/management/basis_for_recommendation

  • Ron,

    You do realise that paracetamol has only been marketed since 1956?

    Any information that paracetamol has been “standard medical treatment” for teething will be from after that date. Just over a half century. No need to search for anecdotes from the 1800s.

  • CKS identified no studies examining the use of these analgesics for relieving the discomfort associated with teething. However, their use is widely recommended by experts [Grundy and Shaw, 1983; Ashley, 2001; Jones, 2002; Wilson and Mason, 2002; Anderson, 2004; Nield et al, 2008].
    Both paracetamol (120 mg/5 mL) and ibuprofen (100 mg/5 mL) suspensions are licensed for the relief of teething symptoms in infants 3 months of age or older.
    http://www.cks.nhs.uk/teething/management/scenario_teething/management/basis_for_recommendation

  • Now you’ve confused me… I’m lost… 🙂

    And yes, I’m aware paracetamol became mainstream in the 1950’s. I suspect you didn’t read the full Nature/BDJ article… I was just drawing attention to the science-based killing fields that have been around for quite some time. When Our children were infants/toddlers in the mid/late 70’s early 80’s it was very rare to take a child to the Drs and not come away with amoxyl and paracetamol, especially when teething and ear ache were concerned. My interest in this evolved at the time from the fact that I’d be testing kids and adults for paracetamol poisoning which on night duty of on-call were urgent tests as NAC needed to be started ASAP…

    Are you trying to suggest paracetamol was never a mainstay of treating teething issues? Is that what you’re suggesting?

  • Ron,

    Actually, I did read on:

    “Given that teething is a normal physiological and self-limiting process, simple self-care measures are recommended as the risk of harms to the infant is minimal.”

    Where does that say that Paracetamol is “standard medical treatment” for teething?

  • The other two are advice for the public, not relevant since you are talking “standard medical treatment.”

  • StuartG, Where did I ever say that paracetamol is standard medical treatment for teething? Please cut and paste the post where I said that. I’ll disappear for the rest of the weekend if I did… 🙂

    I ask the question, “Is it still…”

    You said, “I, personally, have no knowledge, apart from your statement, that paracetamol has ever been “standard medical treatment” for teething.

    Again: has it ever been?”

    The answer to that is clearly in the affirmative.

  • Ron,

    “Please cut and paste…” By all means.

    “By the way StuartG, what conventional, ethical, trials are there supporting paracetamol for infants upset while teething? Is that still the standard medical treatment?”

    The question you asked is “is (paracetamol) still the standard medical treatment (for teething)?” I have been careful to quote you.

    You have supplied four links.

    Three are definitely advice to parents and hence irrelevant to the question (no doctors involveed). One could actually be construed as advice to doctors and says:

    “Given that teething is a normal physiological and self-limiting process, simple self-care measures are recommended as the risk of harms to the infant is minimal.”

    From your own internet search results, the answer to your earlier question is a resounding NO, i.e. there are no trials supporting paracetamol for infants upset while teething.

    Game over?

  • Sorry, to be more accurate:

    You have supplied no evidence that suggests that paracetamol was ever “standard medical treatment” for teething.

    (I had an excellent wine with my tea, but probably a little too much!)

  • StuartG, Good try…!

    As you note, I never said it is still standard treatment, I asked, is it?

    Secondly, you’ve correctly acknowledge that there is no scientific evidence advocating its use…

    Thirdly, you correctly note that paracetamol is still widely recommended for parents to use.

    Fourthly, you conveniently ignore the CKS link showing that paracetamol has been (and according to CKS still is) widely recommended by medical experts……;

    “CKS identified no studies examining the use of these analgesics for relieving the discomfort associated with teething. However, their use is widely recommended by experts [Grundy and Shaw, 1983; Ashley, 2001; Jones, 2002; Wilson and Mason, 2002; Anderson, 2004; Nield et al, 2008].
    Both paracetamol (120 mg/5 mL) and ibuprofen (100 mg/5 mL) suspensions are licensed for the relief of teething symptoms in infants 3 months of age or older.”

    http://www.cks.nhs.uk/teething/management/scenario_teething/management/basis_for_recommendation

    Given the above, yes, I accept it’s game over… It has been until recently, at least, standard fare for medical practitioners to advocate paracetamol use for alleviating teething problems despite the lack of evidence.

    And yet skeptic paradoxers ignore the medical industry’s practice of woo medicine while rubbishing those who choose to use amber beads which may or may not work, but which, unlike paracetamol, there is no evidence of amber beads ever killing anyone.

    Nice chatting.
    Ron

  • Ron (I’m still having fun, Darcy)

    1. You asked “is it still..?” implying it has been at some stage. If you did not mean that paracetamol has been “standard medical treatment” for teething at some time in the past, then why ask the question?

    2. I never said there was any evidence advocating the use of paracetamol in teething. I never said there wasn’t, either. I carefully said that I had no knowledge. Please do not attribute things to me that I did not say.

    3. Paracetamol (in New Zealand) can be bought at the supermarket, the Warehouse, or even the corner dairy. That is marketing, not a medical recommendation.

    Please do not confuse the use of OTC paracetamol by parents with “standard medical treatment.” We all know that some parents will give children in pain paracetamol, without reference to any medical source. That isn’t “standard medical treatment” for teething.

    4. The CKS link starts off with a warning that it is not reliable, then says “Given that teething is a normal physiological and self-limiting process, simple self-care measures are recommended as the risk of harms(sic) to the infant is minimal.”

    Even if you choose to rely on a self advertised unreliable site, there is no paracetamol involved in its recommendations.

    You still have not provided any evidence that paracetamol has ever been “standard medical treatment” for teething, and I asked six times.

    Seriously Ron, the following comes entirely from what you have said in “Amber Teething Beads: A Follow-Up.”

    You are not a doctor.

    You said you’d “be testing kids and adults for paracetamol poisoning which on night duty of on-call were urgent tests as NAC needed to be started ASAP…” NAC is not ASAP, paracetamol levels have to be taken at least four hours after ingestion to determine whether NAC is needed or not. Many years ago some research in Christchurch ED reduced the amount of paediatric paracetamol tests by about 99%. There aren’t many paediatric paracetamol levels done any more.

    You had kids in the mid ’70s, so they are well past teething age now.

    You quote anecdotes and opinions on teething from 1839, 1850, 1857, 1884, 1894, the 1970s, 1990s and early 2000s.

    You haven’t linked to any research into teething at all.

    It all seems very… superseded?

    Do you have a point that’s related to the topic?

  • For what it’s worth (if anyone is still reading!)

    My own kids liked to chew on raw onions when they were teething. I’ve no idea why, but they preferred them to apples, pears, carrots, rusks, etc.

    We never tried teething rings or similar. The kids would crawl or toddle into the kitchen and pick what they wanted from the fruit and vegetable rack, which was placed so they could get at it.