Chocolate placebo?
Research from the Nestlé Research Center in Switzerland and published in the Journal of Proteome Research.
In a clinical trial made up of 22 men, half of which described themselves as "chocolate lovers" while the other half were "chocolate indifferent," participants ate chocolate or placebo over a five-day period. During this time, their blood and urine was monitored for various metabolite levels. The researchers found a "hallmark" profile in the men who described themselves as chocolate lovers: low levels of LDL-cholesterol and slightly raised levels of albumin protein. The same levels were found in the chocolate lovers even when they ate no chocolate. The researchers also noted that the activity of the gut microbes of chocolate lovers was distinctively different from the other subjects.
(They should have used women. :haw: )
But seriously… what the heck is a chocolate placebo? Wouldn't you know that you're not eating chocolate?
And thus it begins: Xyzal
The money being wasted on pointless research, that is. Xyzal (levocetirizine), is beginning to have some money spent on research proving that it's a good drug. I have no doubt it's a good drug. They've isolated the active isomer and decided to market it since the patent on Zyrtec (cetirizine) is running out.
Let's review, SAT-style:
Zyrtec:Xyzal::Claritin:Clarinex
Expect Zyrtec to go OTC as a means of ensuring continued profitability through marketing. (More people buy brand name Tylenol than the generic — same story for Claritin.)
Here's the bottom line: everything that Zyrtec works for, Xyzal will work for, and vice versa. Same side effects, too. And because this is so, you will never see a head-to-head study comparing Xyzal with Zyrtec, because the results will prove that it's just a waste of money. Like Clarinex. Oh sure, there will be a few isolated cases where Xyzal is 0.5% better for 0.1% of the study population, and these studies will be trumpeted, but remember that they're actually meaningless. You'll also see studies that show Xyzal is effective for some obscure condition that Zyrtec was never studied for. Just remember that this is done to make Xyzal seem like something more than a me-too drug, and that if someone bothered to spend the money, Zyrtec would work just as well.
So if you like to waste your time doing PAs or you feel an insane need to throw your patients' money away, prescribe Xyzal. Otherwise keep on using Zyrtec.
5.0 megapixels of salty goodness
This post is a mish-mash of unrelated stuff.
"He gets so excited he throws up"
"My son is 7 years old, and whenever something exciting happens, he throws up. We're supposed to go to the amusement park today if the weather clears up, and he's afraid — and so am I — that if we go, he'll throw up while we're there.
"I don't know what to do anymore. On the first day of school, he throws up. On the last day of school, he throws up. Waiting in line for a roller coaster, he throws up. If he gets really happy for any reason, he throws up. And he throws up because he throws up and worries that he's going to throw up again.
"Is there anything I can give him so he stops throwing up?"
Straight Face held firmly in place — with superhuman effort — I stopped to think about the problem.*
And lest you think me an insensitive clod, I can assure you that I did (and still do) feel awful for this kid. I wonder what his home life is like. I wonder if he's chemically imbalanced. I wonder if it's a phase he'll grow out of. I wonder how to help him in the short term, today, hopefully without robbing him entirely of the excitement that an amusement park brings. I wonder about abuse, too. I wonder if this behavior is conditioned in some way, and if it might be self-reinforcing, not unlike that destructive positive feedback loop that plagues those with panic disorder. I wonder if he'll grow up with anxiety problems. I wonder if he'll end up a well-adjusted adult, hopefully without the need to be on long-term psych meds.
Most of all, right now, I hope mom has a talk with the pediatrician about it.
Given that my options are severely limited by a lack of prescribing powers, the best solution OTC would be Benadryl to blunt the edge, with the side effect of probably making him very sleepy. Not optimal, for sure, but better than puking before you get on the ride, no? Some would think Emetrol, maybe, but that's a poor solution because that's not going after the actual problem. If the child is overexcited, better to take that down a notch than merely cover the side effects of being in that condition in the first place.
What do you guys think? What would you have done?
* When I was in junior high, my friends and I used to talk about the worst, most absurd "super power" to have. We decided it would be the superhuman ability to crap your pants every time you got excited. "Haha! Yay!… ohhhh…." This is where I coined the phrase "My bowels are aquiver with excitement."
I'd say this child's difficulty ranks right up there…