Skepticism or nihilism? A rant on a rant.

I worry that there is a trend moving us from healthy skepticism towards nihilism.

All comments refer to the rant on sucrose (https://first10em.com).  I will attempt to not suffer from “The Fallacy Fallacy – Presuming a claim to be necessarily wrong because a fallacy has been committed.”  (https://yourlogicalfallacyis.com)

 

“The idea of using sucrose to control pain has always sort of bothered me.” – First10EM

“Personal Incredulity – Saying that because one finds something difficult to understand, it’s therefore not true.”  (https://yourlogicalfallacyis.com)

 

“It requires us to believe that infants are fundamentally different” – First10EM

A correct belief, since differences include postnatal proliferation, migration and myelination.  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/)

 

“Sugar pills are synonymous with the placebo effect.” – First10EM

Placebo: “A medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect” such as a sugar pill.  For research: “A substance that has no therapeutic effect, used as a control in testing new drugs.”  Since sugar is not inert, it should not be seen as synonymous with placebo.  (https://en.oxforddictionaries.com/definition/placebo)

It is erroneous to imply that sucrose = sugar pill = placebo.

 

“I have been unable to find a single study indicating that sucrose decreases pain in adults.” – First10EM

Failure to provide proof of effect does not prove no effect.  More specifically, lack of supportive research in adults does not prove infant research is wrong.

 

“I don’t know any adults whose response to pain is to grab some sugar.” – First10EM

“Anecdotal – Using personal experience or an isolated example instead of a valid argument, especially to dismiss statistics.” (https://yourlogicalfallacyis.com)

 

If sucrose doesn’t control pain, why are there so many studies in infants that seem to conclude the opposite? (Harrison 2017; Gray 2015; Stevens 2013)” – First10EM

“The Texas sharpshooter – Cherry picking data clusters to suit an argument, or finding a pattern to fit a presumption.”  (https://yourlogicalfallacyis.com)

 

“However, none of those surrogate markers tells us anything about the neonate’s actual pain.”  “Now EEG is clearly a disease oriented, surrogate outcome.” – First10EM

On one hand you are dismissing clinical surrogate markers, then accepting a laboratory (EEG) surrogate marker.  Although it is appropriate to seek clinically-relevant outcome measures, in cases where these are not available (i.e. pain reporting in non-verbal patients), surrogate markers are acceptable.

 

“It strikes me as odd that sucrose stops working as soon as children are old enough to tell us that it isn’t working.” – First10EM

“Personal Incredulity – Saying that because one finds something difficult to understand, it’s therefore not true.”  (https://yourlogicalfallacyis.com)…

Additionally, as discussed previously, not only is the neonatal brain NOT the same as an adult’s, but also not the same as a child’s.

 

“I think it is essential to prove that sucrose has analgesic properties in verbal populations before exposing those who can’t communicate.” – First10EM

We have already discussed that fundamental differences exist between an infant’s brain and an older child/adult’s brain.  Additionally, as per Harrison (2017), there is already too much research on infants.

 

“We have better options that should be used.” – First10EM

“Black-or-White – Where two alternative states are presented as the only possibilities, when in fact more possibilities exist.” (https://yourlogicalfallacyis.com)

In this case using topical analgesia AND sucrose.

Bronchiolitis – are we doing it wrong??

Great podcast with the SGEM this week – see:  http://thesgem.com/2016/12/sgem167-the-management-of-bronchiolitis-in-community-hospitals/

Original article is at:  https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/div-classtitlemanagement-of-bronchiolitis-in-community-hospitals-in-ontario-a-multicentre-cohort-studydiv/0695FE4CF5FC7FEA3C09836CDB1D104A