Month: February 2021

For years, products containing acetaminophen, such as the pain reliever Tylenol, were largely viewed as safe to take during pregnancy. Hundreds of widely available over-the-counter remedies, including popular cold, cough, and flu products, contain acetaminophen. Not surprisingly, some 65% of women in the US report taking it during pregnancy to relieve a headache or to ease an aching back.

But recently, a group of doctors and scientists issued a consensus statement in Nature Reviews Endocrinology urging increased caution around acetaminophen use in pregnancy. They noted growing evidence of its potential to interfere with fetal development, possibly leaving lingering effects on the brain, reproductive and urinary systems, and genital development. And while the issue they raise is important, it’s worth noting that the concerns come from studies done in animals and human observational studies. These types of studies cannot prove that acetaminophen is the actual cause of any of these problems.

An endocrine disruptor

Acetaminophen is known to be an endocrine disruptor. That means it can interfere with chemicals and hormones involved in healthy growth, possibly throwing it off track.

According to the consensus statement, some research suggests that exposure to acetaminophen during pregnancy — particularly high doses or frequent use — potentially increases risk for early puberty in girls, or male fertility problems such as low sperm count. It is also associated with other issues such as undescended testicles, or a birth defect called hypospadias where the opening in the tip of the penis is not in the right place. It might play a role in attention deficit disorder and negatively affect IQ.

Risks for ill effects are low

If you took acetaminophen during a current or past pregnancy, this might sound pretty scary — especially since you’ve probably always considered this medicine harmless. But while experts agree it’s important to consider potential risks when taking any over-the-counter or prescription medicines during pregnancy, you shouldn’t panic.

“The risk for an individual is low,” says Dr. Kathryn M. Rexrode, chief of the Division of Women’s Health, Department of Medicine at Harvard-affiliated Brigham and Women’s Hospital.

Chances are pretty good that if you took acetaminophen during a pregnancy, your baby likely did not, or will not, suffer any ill effects.

The research on this topic is not conclusive. Some information used to inform the consensus statement was gathered from studies on animals, or human studies with significant limitations. More research is needed to confirm that this medicine is truly causing health problems, and to determine at what doses, and at what points during a pregnancy, exposure to acetaminophen might be most harmful.

Sensible steps if you’re pregnant

Three common-sense steps can help protect you and your baby until more is known on this topic:

• Avoid acetaminophen during pregnancy when possible. Previously during preconception and pregnancy counseling, Dr. Rexrode had warned patients against using NSAID drugs, such as Advil and Aleve, and suggested taking acetaminophen instead. “Now I also tell people that some concerns have been raised about acetaminophen use during pregnancy, and explain that its use should be limited to situations where it is really needed,” says Dr. Rexrode. In short, always consider whether you really need it before you swallow a pill.
• Consult with your doctor. Always clear acetaminophen use with your doctor, particularly if you are going to be using the medicine for a long period of time. They might agree that taking it is the best option — or suggest a safer alternative.
• Minimize use. If you do need to take acetaminophen during pregnancy, take it for the shortest amount of time possible and at the lowest effective dose to reduce fetal exposure. “This advice about the lowest necessary dose for the shortest period of time is generally good counseling for all over-the-counter medication use, especially during pregnancy,” says Dr. Rexrode.

While all of this is good advice for using acetaminophen, there are times when it’s riskier not to take it. For example, if you have a high fever during pregnancy — which can harm your baby — acetaminophen may be needed to bring your fever down. Provided it’s advised by your doctor, the benefits of acetaminophen use in this case outweigh the potential risks.

In all aspects of our lives, we rely on experts, from home repairs to weather forecasting to food safety, and just about everything else that’s part of modern society. There’s just no way to know everything about everything. Yet when it comes to medicine, people seem to be taking their health in their hands in ways they’d never consider if, say, their car brakes needed repairs and they weren’t auto mechanics.

What if your brakes were shot?

Suppose a well-recommended car mechanic tells you your brakes need repair. Hopefully, they explain why this is necessary and review the pros and cons of your options, including no repairs. You certainly could get additional opinions and estimates. But to make a decision, you’d have to accept that a mechanic has specialized knowledge and that their advice is sound. Quite likely, you’d get the brakes fixed rather than risk injury.

Would you berate the mechanic personally because they told you something you didn’t want to hear about your beloved car? Let's hope not. And unless you knew a lot about cars, you probably wouldn’t tinker with the brakes yourself, or take the advice of a neighbor to spray the tires with vegetable oil because a friend of his cousin said it worked for his car. And you wouldn’t take your car to a veterinarian — it just wouldn’t make sense, right?

Yet hundreds of thousands of people in the US are rejecting advice on getting a COVID vaccine from well-respected health authorities like the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). Healthcare providers have somehow become the target of taunts, hostility, and even death threats for encouraging people to protect themselves and others.

Fear of the proven and an embrace of the unproven

What’s driving this? It seems to be some combination of distrust ("these so-called experts don’t know what they’re talking about"; "they rushed the vaccines just to help the drug companies") and unfounded suspicion ("they’re trying to control us, experiment on us, inject microchips in us"). Some people see recommendations regarding COVID-19 as attacks on American values ("mask and vaccine mandates infringe on my personal freedom").

At the same time, many who dismiss the advice of true experts are embracing unproven and potentially dangerous remedies, such as ivermectin pills and betadine gargles.

How did we get here?

Some reasons we’ve seen erosion in trust placed in public health experts are

• Politics. COVID-19 quickly became a political issue in the US. For example, trust in the CDC varies markedly by political affiliation, with Democrats giving much higher marks to the CDC, FDA, and NIH than Republicans.
• Social media. Misinformation spread through social media is rampant, and much of it has been linked to a small number of people.
• "Pseudo-experts." Even impressive credentials don’t automatically qualify everyone to be experts in a pandemic disease. Recent examples include radiologists, cardiologists, and chiropractors who have made headlines with their controversial views.
• Personal gain. Some have profited financially, politically, or otherwise by deliberately spreading health disinformation and denouncing expert advice.

Confusing changes in message

Public health messaging about protecting ourselves from COVID-19 also affects trust. For example, recommendations around wearing masks were inconsistent early on, and have continued to change since then.

While some confusing, seemingly contradictory messages were true missteps, most are simply changes in recommendations based on a change in circumstances, such as spiking virus cases or a more easily spread variant causing severe illness, hospitalizations, and deaths.

Particularly in the early months, no one had all the answers. But as we have accumulated information from research and real-world experience, changes in recommendations should not only be expected but embraced. It’s usually a reflection of the close attention experts are paying to changing circumstances.

Doing your own research?

A wait-and-see policy can be risky — and not just when it comes to fixing your car brakes. The virus that causes COVID-19 was only discovered 18 months ago, and vaccines have been in use for less than a year. Yet already we have an enormous amount of data from research and real-world experience from many millions of people.

So, when someone says they want to "wait and see" or "do their own research" rather than accept the advice of their own doctors or public health experts, what exactly does that mean? Are they waiting to see if something bad will happen to those who were vaccinated? How long is long enough?

Unless you’re a cutting-edge virologist, immunologist, epidemiologist, or public health expert, doing your own research isn’t likely to provide more reliable data than studies published in peer-reviewed medical journals that guide the CDC and FDA. Of course, most people "doing their own research" are relying on others who are also not doing actual research, yet they discount the findings and recommendations of true experts.

It’s important to ask questions. But pose them to your doctor. Rely less on people who tell you what you want to hear, and more on those who trained in science and whose careers have been devoted to improving health.

Each time a wave of COVID-19 engulfs a community, overwhelmed hospitals wind up postponing elective surgeries. The schedule changes are needed to make room for COVID patients, allow all hands on deck for crisis care, and shield people in the community from unnecessary COVID exposure. This scenario may grow worse if the flu season isn’t mild this year –– a good reason to get that flu shot!

Postponement of an elective surgery is upsetting, and automatically presents you with two dilemmas:

• You’ll have to cope with your ailment while you wait for the all-clear.
• You’ll have to be prepared for your surgery when you get the call that’s it’s back on.

Read on for steps you can take to cope with both situations.

First, what’s considered elective surgery?

All surgical procedures involve cutting skin and tissue using a variety of tools and techniques. But unlike heart surgery done in response to blocked arteries, elective surgery is not an emergency. It’s a procedure that can be safely scheduled in advance. That’s not to say it isn’t important.

An elective surgery could be

• major, such as a hip or knee replacement, or surgery to repair a prolapsed (fallen) uterus
• minor, such as surgery to relieve carpal tunnel syndrome (an entrapped nerve in the wrist), or surgery to remove a cataract (cloudy lens) in the eye.

The determination of whether surgery is elective isn’t always clear-cut. Sometimes it depends on your health circumstances. For example, surgery to replace a heart valve might or might not be an emergency, depending on the person’s condition.

Coping while you wait for elective surgery

Waiting for your surgery has potential consequences. Maybe you won’t be able to work, or maybe your condition, pain, or anxiety about the situation — or all three — will get worse.

While you’re in limbo, here are four steps you can take:

• Keep lines of communication open with your health care providers. That could mean having important phone numbers for your physician on hand, or logging onto your patient portal and emailing your doctor or nurse. Ask your doctor how often you should check in. 
• Report changes in symptoms. When you scheduled your surgery, your condition wasn’t life-threatening. But things can change. Don’t wait until you experience an emergency; report symptom changes as soon as you notice them.
• Get prescriptions refilled. You don’t want to be without medications when you need them, especially if you’ll need your doctor to sign off on refills.
• Arrange for additional help. Perhaps a friend or family member can assist you with grocery shopping, meal preparation, housekeeping, or getting through daily activities. If you can afford it, consider hiring someone to assist you temporarily. Prices average about $25 per hour in the US, with a minimum of several hours per week.

When surgery is back on schedule

Eventually, you’ll get the call that your surgery is a go. That doesn’t mean it will occur soon. Most likely there will be a backlog of postponed surgeries, which may add more time to your wait. Prepare for the possibility that you’ll need to extend the arrangements that have been getting you through your waiting period.

It’s equally wise to prepare for the chance that your surgery will happen with little notice. Alert friends, family members, or your private-duty care agency about this possibility, so they can arrange to jump in to help when you need them.

And make sure you have the answers to these questions ready well in advance:

• How will you get to and from surgery? (Will you count on a friend, a ride service, or a hired health aide?) 
• How will you obtain medications prescribed after surgery?
• Which equipment (if any) will you need after your surgery? For example, if you’re going to have a joint replacement, you’ll need a walker and shower chair afterward. See if you can arrange to get it now, so you’ll have it ready.

It may not be easy dealing with your condition until your surgery takes place, but at least you’ll have both a plan A and a plan B. That preparation may give you a little peace of mind and a feeling of some control over your situation.