|Advice on Paracetamol is Unscientific
Monday, 20 September 2004, 4:22 pm
Press Release: Ron Law
Ministry's Advice on Paracetamol is Unscientific and Unsafe
Ron Law http://www.scoop.co.nz/mason/stories/GE0409/S00084.htm
Beyond Alternative Solutions
"The Ministry of Health's advice regarding the use of paracetamol in children is unscientific and unsafe," says Ron Law, a risk and policy analyst.
There is no scientific evidence supporting the routine use of paracetamol to reduce fevers in children, and certainly not in fevers up to 39°C as recommended by the Ministry of Health.
It has been known for over a decade that routine administration of antipyretics such as paracetamol may interfere with the clinical evaluation of patients with infections, such as meningitis, that their use may prolong infection and reduce the antibody response in mild disease [and presumably following vaccination], and increase morbidity and mortality in severe infection.
There is also no scientific evidence that antipyretics prevent febrile convulsions... it's all part of medical folklore that the Ministry advice is based on.
So why is the Ministry of Health advising parents to give children paracetamol for "slight fevers" up to 39°C following vaccination with meningococcal B vaccination... [even fevers as low as 37.5°C] when there is no evidence to support such use -- and it can do harm?
Surely social responsibility requires the Ministry of Health to apply the cornerstone of the Hippocratic Oath; First Do No Harm?
"If similar advice was given by a dietary supplement company they would be prosecuted under the Fair Trading Act for fraud,"says Ron Law [09-832 4773]
Even the World Health Organisation advises against such use. They say that routine use of antipyretics such as paracetamol does no significant good, and may be harmful. The WHO says that fever represents a universal and usually beneficial response to infection, and its suppression under most circumstances has few, if any, demonstrable benefits.
On the other hand, some harmful effects have been shown to occur as a result of suppressing fever... they may result in an increase in morbidity and perhaps the occurrence of occasional mortality.
The World Health Organisation states categorically that antipyretics, such as paracetamol, should not be encouraged either in developing countries or in industrial societies. So why is the Ministry of Health encouraging paracetamol use when there is no scientific evidence of benefits, but scientific evidence of harm?
The Ministry of Health states that fevers greater than 39°C are "very rare." Using internationally agreed definitions, as used by the Ministry of Health itself, that means that less than 1 per 10,000 vaccinations would warrant the use of paracetamol; In other words, less than 10 children since the commencement of the Meningococcal B vaccination programme.
Besides the medical reasons for recommending against routine Paracetamol use for treating fevers, Paracetamol medications are by far the leading cause of poisoning in New Zealand children.
Interestingly, a leading brand of paediatric paracetamol provides no product safety information sheet in their product packaging, but offers a website. The website is parked and provides no information.
Even Medsafe's website has no datasheet for that brand -- What's the point of companies having to compile product information sheets if they are not available to consumers?
"Based on the scientific evidence available to the Ministry of Health, why is it putting young New Zealanders at greater risk from harm due to recommended paracetamol use than are harmed by meningococcal B itself?" asks Ron Law.
The Ministry of Heath's advice makes a mockery of its belief that it policies are evidence-based. The Ministry's advice is so unsound that the precautionary principle as applied to risk management practice requires that the Ministry advice to parents and healthcare professionals be retracted forthwith.
Note to editors: Ron Law is risk and policy analyst who has lectured widely in medical science and business management. He was an invited member of the Ministry of Health expert working group that advised the Ministry on the management of medical injury within the New Zealand health system. [email@example.com]