How to scare parents

On 16th September the Daily Mail published an article with the headline “Babies given Calpol just once a month ‘are five times as likely to develop asthma'”.  This is of obvious concern to parents who wish to keep their children safe and healthy.  The article describes an article published in May 2012, there is no explanation as to why it has taken the Mail 16 months to get around to publishing this article.

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The article starts reasonably well, with well publicised figures that are can be verified easily. 

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The article states that the Patient Information Leaflet contains no information on health risks, this is demonstrably false – what the Mail meant to say is that ” the Patient Information Leaflet doesn’t contain the results of a study released on 29th May 2012″

 

The article then makes some rather unfortunate assumptions.  They appear to have not read the study correctly, as the study states that the the rate of self reported asthma symptoms increases as opposed to those diagnosed by their Doctor.  I have some concerns about the study itself and will critique that shortly however for the moment I’ll stay with the Mail article.

The Mail, while stating the the risk of asthma increases by 60%, doesn’t say what the overall risk is.  In addition it doesn’t state if the risk in Spain of having asthma is the same as the UK, which incidentally it isn’t, the rate of asthma is Spain in children runs between 1.1% – 2.7% depending on criteria being measured.  A 60% increase of these rates means a potential increase to 1.76% – 4.32%. In the UK the rate of asthma is already higher as it runs from 3.5% – 9.3%, so any percentage increase is significantly different.  The Mail completely fails to point this out.

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It is only right at the very end of the article that any balance is given, by this point worried parents may either have stopped reading entirely or may believe that because there is so little information rebutting the article that the study in question is gospel.  Unfortunately the Mail is either unaware of, or ignoring, medical best practice which is to review all the evidence available and the reliability of the evidence.  The article fails to mention how many articles are available discussing potential causes nor details the reliability of the article itself.

The study, Exposure to paracetamol and asthma symptoms, is a study which is entirely dependent on the recall ability of parents and children.  It asks parents of very young children to remember how often they gave paracetamol based medication during the first 12 months of the child’s life.  One of the questions asked is “In the first 12 months of life of your child, did you regularly give him/her paracetamol” the available answer to this question is yes/no.  My definition of ‘regular’ is different to yours I’m sure and will vary among most people.  It would be far stronger evidence to ask how often paracetamol was given during those 12 months rather than use a vague term with no parameters.  In addition the data obtained simply states whether there was any asthma symptoms at least once during the life of the child.  To extrapolate this to mean ‘asthma’ is disingenuous as there are a number of diagnostic tests that need to be completed to ensure the cause of the symptoms are indeed asthma related rather than any other respiratory disease.  While the key points show there is an increased correlation between paracetamol consumption and symptoms of asthma it (deliberately) fails to state if this is a cause of the asthma or simply because those who are asthmatic may be more susceptible to respiratory illness that could result in a raised temperature.  In addition the article clearly states “a causal relationship cannot be established”, what this means in plain English is that it cannot be said with any authority that paracetamol causes asthma.

Overall the Mail article is written in such a way that causes unnecessary panic in parents.  It fails to give any advice to parents nor assess the strength of the study and in fact it appears that the authors of the article have failed to read the study fully, or failed to understand the limitations of the study.

If you’re a parent reading this and are still unsure what to do then it’s summed up as follows: if your child is running a temperature, or is in pain then paracetamol solutions (such as calpol) are widely acknowledged to be safe as long as the instructions on the packaging are followed.  It is not advisable to give paracetamol to your child for reasons other than those it is indicated for (unless your Doctor or Pharmacist tells you to do so).  If you’re still worried please contact your GP or a nurse working at your GP surgery, Pharmacists are also excellent in providing information about medication and you can talk to them without an appointment.

If you need quicker (or more detailed) information on asthma then NHS Choices or Asthma UK are both excellent sources of information.

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