Metoclopramide can be safely used during pregnancy

Even though nausea and vomiting are common effects during pregnancies, the most commonly used antiemetic, metoclopramide (Primperan®), is often avoided in these patients because it is considered to be associated with a higher risk of fetal malformations.

Not anymore. According to an article just published in the New England Journal of Medicine, metoclopramide is not associated with significantly increased risks of major congenital malformations (5.3% and 4.9%, respectively; odds ratio, 1.04; 95% confidence interval [CI], 0.89 to 1.21), low birth weight (8.5% and 8.3%; odds ratio, 1.01; 95% CI, 0.89 to 1.14), preterm delivery (6.3% and 5.9%; odds ratio, 1.15; 95% CI, 0.99 to 1.34), or perinatal death (1.5% and 2.2%; odds ratio, 0.87; 95% CI, 0.55 to 1.38).

The study which investigated the safety of metoclopramide use during the first trimester of pregnancy in a district in Israel, evaluated 113,612 singleton births. In this large cohort of infants, exposure to metoclopramide in the first trimester was not associated with significantly increased risks. This is an important conclusion because it will allow us to have a useful treatment against nausea and vomiting during pregnancy, which are often dealt with dubious treatments like doxylamine (NyQuil®).

Prostate cancer in NY is no better than in York

I had prostate cancer, 5, 6 years ago. My chance of surviving prostate cancer—and thank God, I was cured of it—in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine.

Rudolph Giuliani

During the last presidential primaries for the republican party, Rudolph Giuliani, former NYC mayor and prostate cancer survivor, compared the chances of surviving prostate cancer in the US and Europe. The end, obviously, was to criticize the socialized medicine of European countries that was defended by the White House candidate Barack Obama.

The data is quite breath-taking. An American has twice as many chances of surviving prostate cancer than a European does, right? Clearly, Giuliani is not a good epidemiology aficionado. The former NYC mayor used data from the year 2000 that compared the survival rates at 5 years between English and American patients. What he did not know, was the fact that this survival rate is quite useless when you compare two countries where prostate cancer is very differently diagnosed. In the US, PSA screening is common practice, while as in European health services it is not so common (with the permission of urologists...). This screening sets a bias in two senses: a) advances the age of diagnosis (lead-time bias) b) introduces among the diagnosed group patients with non-progressive cancer that will probably die of something else (overdiagnosis bias). Put in other words, the patients in the English group are quite older (they were not detected until they showed symptoms) and their cancers were 'worse' (because all non-progressive cancers, since they are not symptomatic , never get to be detected) .

Lead-time bias

Overdiagnosis bias

To sum up, te survival rate at 5 years in both groups is clearly different, but mortality is quite similar. For future campaigns, Mr. Giuliani or someone in his staff should read the excellent article by Gerd Gigerenzer of the Max Planck Institute in Berlin 'Helping Doctors and Patients Make Sense of Health Statistics'. A must, for all those who -willingly or not- deceive everyday our patients and for those who do not want to be deceived.

Disease Mongering

Since I cannot sleep tonight, knowing that WHO has finally declared the swine-flu pandemia (lions, tigers and panthers! oh my!), I will take the chance to write a few lines about a video I saw during the last Congress of Primary Care of Barcelona thanks to Dr. Ricard Maneu. It is called 'The New Epidemic' and it is based on an article first published in the April's Fool Day edition of the British Medical Journal. This funny and fake article which dr. Joan Ramon Laporte (esteemed beacon in this jungle of drugs of dubious use that we prescribe daily) had already mentioned and that for some reason some people thought to be true. The subject of the article was the discovery of a new condition called motivational defficiency disorder, which affects a great part of the population that had until then been considered just lazy. Thanks to a just marketed drug called Strivor, people affected with this disease can again do the tasks that they couldn't do for being so sluggish...sorry... because of their motivational defficiency.

Obviously, it's all a mockery of this new pandemia (and a true one this time) of disease mongering aka exagerated or just invented diseases. It is saddly a very common phenomenon in our times, propelled by the media, pharmaceutical companies and with the collaboration of a good share of doctors. We are constantly being informed abut new alleged conditions that affect a great part of the population and that condemn us to sick lives, unless we take the proper medication, of course. The list of such invented or exagerated conditions is endless: female sexual disfunction, chronic fatigue syndrome, fibromyalgia, restless legs syndrome, hyperactive children, sad people (not necessarily depressed), ... I could go on, but I think I have already alienated enough patient groups and colleagues.

I'll leave you with the video, but anyway, if you are not yet feeling well enough, if you have not reached that level of well-being that you no doubt deserve, don't worry. You will always have Panexa. If you have not heard of it yet, just ask your doctor for a reason to take it.