Latest / Pharmacy Podcast Network / Acetaminophen in Pregnancy: Sorting Facts from Fears | MaternalRx

Transcript

Acetaminophen in Pregnancy: Sorting Facts from Fears | MaternalRx · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
• 0:26
  Speaker 2: In this episode of Maternal RX, we're bringing the data
• 0:30
  Speaker 2: to light about the latest claims about the adverse reactions
• 0:33
  Speaker 2: in pregnant women caused by a seta minifin the active
• 0:36
  Speaker 2: ingredient in thaile and all.
• 0:37
  Speaker 3: Our two expert.
• 0:38
  Speaker 2: Hosts bring their specialties together in this Pharmacy Podcast Network
• 0:42
  Speaker 2: exclusive podcast episode.
• 0:45
  Speaker 1: Hi there, Welcome to the Maternal RX podcast on the
• 0:48
  Speaker 1: Pharmacy Podcast Network.
• 0:50
  Speaker 3: This series is to empower.
• 0:51
  Speaker 1: Pharmacists to help turn around maternal morbidity and mortality rate,
• 0:56
  Speaker 1: which now constitute a public health crisis. Pregnant women often
• 1:00
  Speaker 1: fall into this whole of healthcare, especially antipartum care, and
• 1:04
  Speaker 1: farmsists are perfectly aligned to fill that gap. We are
• 1:07
  Speaker 1: the most accessible and trusted healthcare providers, but we want
• 1:11
  Speaker 1: to make sure the information that we are sharing is
• 1:14
  Speaker 1: accurate and true. So today I am digging deep into
• 1:18
  Speaker 1: a hot topic in our news and that is is
• 1:21
  Speaker 1: a SEDOM in Safe in Pregnancy. I'm your host, Doctor
• 1:26
  Speaker 1: Danielle Plumber, pharmacist and antipartum doula and really excited today
• 1:31
  Speaker 1: to have a co host. Mark. I'm going to let
• 1:34
  Speaker 1: you jump on and you are a pain specialist and
• 1:37
  Speaker 1: give us a little background about yourself.
• 1:40
  Speaker 4: Thank you very much, Danielle, and well those of you
• 1:43
  Speaker 4: that know me also on the Pharmacy Podcast Network from
• 1:45
  Speaker 4: the Pain Pod Here, I'm doctor Mark pain Guy. Growfully.
• 1:50
  Speaker 4: We'll stick with Mark for the rest of this, of course,
• 1:53
  Speaker 4: but pleasure to be here. I hope we have some
• 1:57
  Speaker 4: cross audience amongst the way, But can we get a
• 2:00
  Speaker 4: hotter topic today? Is that even possible, daniel.
• 2:04
  Speaker 3: I don't think it's possible.
• 2:05
  Speaker 1: This is when our president comes out and says something
• 2:09
  Speaker 1: and again it has to do with women's health and safety.
• 2:13
  Speaker 3: Let's dig deep and find out what's going on with it.
• 2:16
  Speaker 4: Absolutely, and you know, we all have to listen when
• 2:19
  Speaker 4: leaders speak. We've got to listen in here and then
• 2:22
  Speaker 4: we've got to do our due diligence in the background
• 2:24
  Speaker 4: as well too. So happy to be here today joining you,
• 2:28
  Speaker 4: you know, and this really pivotal topic in the big picture.
• 2:31
  Speaker 1: I do want to say one thing before we get started.
• 2:33
  Speaker 1: I have a couple of disclaimers. This podcast is for
• 2:36
  Speaker 1: education only. Please consult your healthcare providers for medical advice,
• 2:40
  Speaker 1: and everything I share on this podcast is strictly just
• 2:43
  Speaker 1: my own experience and education and not a reflection of
• 2:46
  Speaker 1: any company for where I work. So, now that that's
• 2:49
  Speaker 1: out of the way, let's dive deep into this hot topic.
• 2:54
  Speaker 1: Aceta innocent better known as tail and all. Is it
• 2:58
  Speaker 1: safe in pregnancy? And I have a few key points
• 3:01
  Speaker 1: that we're going to jump into, but let's talk about
• 3:05
  Speaker 1: this word correlation and how that differs from causation.
• 3:10
  Speaker 3: Would you like to get started on that, mark Ooh, that's.
• 3:14
  Speaker 4: That's a big one and often missed. You know, one
• 3:17
  Speaker 4: of my favorite scary pictures in the Halloween sense is
• 3:21
  Speaker 4: a jack o' lantern that states causation from correlation. That,
• 3:26
  Speaker 4: my friend, is scary stuff. There's an appreciable difference. It's
• 3:31
  Speaker 4: astronomical actually, So you know, causation is saying B happens
• 3:36
  Speaker 4: because of A. It is substantiated, it is concrete. Correlation
• 3:41
  Speaker 4: is saying, well, you know, when you have A around, B
• 3:44
  Speaker 4: might happen. There's a lot of correlation out there. I've
• 3:49
  Speaker 4: seen things like what's it you know, the temperature rises
• 3:52
  Speaker 4: in the summer, so ice cream sales go up. And
• 3:54
  Speaker 4: then crime goes up too. Are they related? Who knows,
• 3:57
  Speaker 4: Maybe they could be correlated. But causation, that's a whole
• 4:01
  Speaker 4: nother thing that requires more thought, more proof, It requires proof.
• 4:08
  Speaker 4: I don't know your take on it, but that's you know,
• 4:10
  Speaker 4: a big difference there of causation is saying this happens
• 4:13
  Speaker 4: be directly and a lot of times exclusively because of
• 4:18
  Speaker 4: the offending situation overall.
• 4:21
  Speaker 1: Absolutely, and in the medical world and in research, we
• 4:24
  Speaker 1: call it confounders. So confounding describes a situation where the
• 4:28
  Speaker 1: observed relationship between an exposure, which is your independent variable,
• 4:33
  Speaker 1: and an outcome, which is your dependent variable, is distorted
• 4:36
  Speaker 1: by a third external variable, like I said, known as
• 4:40
  Speaker 1: a confounder. And this was the case with zofran or
• 4:42
  Speaker 1: on dancatron as well. And now we are here with
• 4:46
  Speaker 1: another what we thought was a very benign medication you
• 4:50
  Speaker 1: have pain time and all. For decades has been known
• 4:53
  Speaker 1: as like the one pain medication that we can take
• 4:56
  Speaker 1: during pregnancy. So, like I said, it's been the go
• 5:00
  Speaker 1: to pain reliever for millions of pregnant women worldwide. But
• 5:03
  Speaker 1: this recent media coverage has like stirred fear about possible
• 5:07
  Speaker 1: links to autism, and ADHD, what does the evidence really say?
• 5:13
  Speaker 4: Oh, there's a lot of evidence on there. And that's
• 5:15
  Speaker 4: the thing that's quite frankly, that's what kept me up
• 5:18
  Speaker 4: till two am every night of the last week and
• 5:20
  Speaker 4: a half point blank. You know, one of the first
• 5:25
  Speaker 4: questions for anybody is did you read the study? And
• 5:29
  Speaker 4: I mean that too. You know a lot of folks
• 5:31
  Speaker 4: not everyone has to read everything, by the way, but
• 5:34
  Speaker 4: you know, when taking advice from folks, it's really coming
• 5:37
  Speaker 4: up short if one, you know, not reading the studies,
• 5:40
  Speaker 4: but then also scrutinizing the studies. Now in the announcement
• 5:44
  Speaker 4: recently here, you know, the the review article of the day,
• 5:47
  Speaker 4: if not decade at this point, it was a review article.
• 5:52
  Speaker 4: But you know that's gonna innately be going over other studies,
• 5:56
  Speaker 4: other review articles, other case studies, you know, other information
• 5:59
  Speaker 4: from l squear. So you know, it's really not just
• 6:02
  Speaker 4: enough to read the review article, but you want to
• 6:05
  Speaker 4: really dive into all of the other studies as well too.
• 6:08
  Speaker 4: And rest as shirt folks, as you're listening here today,
• 6:11
  Speaker 4: we've got you covered. Okay, lots of time goes into
• 6:14
  Speaker 4: reading all of those, but it's incredibly important overall because
• 6:18
  Speaker 4: we as pharmacists and quite frankly all healthcare professionals, you know,
• 6:22
  Speaker 4: we can't pontificate. We can have our personal and professional opinions,
• 6:27
  Speaker 4: but they need to be founded on the science in
• 6:31
  Speaker 4: the background. And you know, saying science, it seems to
• 6:34
  Speaker 4: have evolved into well, you know, the reality that there's
• 6:37
  Speaker 4: one to three studies for every point of view on
• 6:39
  Speaker 4: this planet. But what are the studies, what's concrete about them?
• 6:44
  Speaker 4: And that's where we really get the We dive into
• 6:48
  Speaker 4: the fog oftentimes. And here we are today talking about paracetamo.
• 6:53
  Speaker 4: You know, me and the rest of the planet we
• 6:55
  Speaker 4: call it paracetamo, but US Americans we tend to call
• 6:57
  Speaker 4: it a stem. The way, yes, tomato, tomato, all the
• 7:02
  Speaker 4: same bucket. But there's a lot to unpackage, as you're
• 7:05
  Speaker 4: alluding to, you know, when it comes to the review
• 7:07
  Speaker 4: article itself, and you know, all of them contained within
• 7:12
  Speaker 4: in the big picture.
• 7:13
  Speaker 1: Really absolutely, And one of the ones that's being talked
• 7:16
  Speaker 1: about the most is this this study from Sweden. It
• 7:20
  Speaker 1: was a nationwide sibling control cohort published in jama in
• 7:24
  Speaker 1: twenty twenty four. Two point four eight million children looked
• 7:27
  Speaker 1: at and what I learned about the countries that have
• 7:30
  Speaker 1: socialized medicine, like those in Scandinavia. They have great records,
• 7:35
  Speaker 1: so it's easy to look bad, right to do these
• 7:39
  Speaker 1: studies and see but what they found was that when
• 7:43
  Speaker 1: they they did the control analysis with the slit siblings,
• 7:47
  Speaker 1: there actually was not an increased risk, unlike what the
• 7:51
  Speaker 1: original headline had led people to believe, and it was
• 7:54
  Speaker 1: it was a retrospective of respective review article, so looking
• 7:59
  Speaker 1: at like millions of babies born from ninety five to
• 8:02
  Speaker 1: twenty nineteen, with a follow up in twenty twenty one
• 8:05
  Speaker 1: that with that confounder looked at.
• 8:08
  Speaker 3: There was no increased risks.
• 8:10
  Speaker 1: We have some other studies to twenty twenty one European
• 8:14
  Speaker 1: Journal of Epidemiology looking at seventy four thousand children. Again,
• 8:19
  Speaker 1: when you dive deep into what was going on with
• 8:22
  Speaker 1: the studies and look at the confounders, not a diagnosis,
• 8:26
  Speaker 1: not the causation. Twenty nineteen JAMA Psychiatry biomarker study looking
• 8:32
  Speaker 1: at cord plasma of one thousand newborn So these are
• 8:35
  Speaker 1: all studies that were cited in this statement. Did you
• 8:39
  Speaker 1: want to jump on a feedback with any of those
• 8:42
  Speaker 1: or do you want to go on and what I
• 8:44
  Speaker 1: want everyone to understand coming out of this is what
• 8:46
  Speaker 1: do the authorities say?
• 8:48
  Speaker 4: Right? And it's really important on package things. So I
• 8:52
  Speaker 4: hope folks could appreciate that here of you know, what
• 8:54
  Speaker 4: you were just sharing, there was a very good, you know,
• 8:57
  Speaker 4: deep to Okay, what did the other studies say? Who
• 9:00
  Speaker 4: the Swedes? I tell you the half million babies in
• 9:05
  Speaker 4: people adults eventually actually but two and a half million
• 9:08
  Speaker 4: people in that study. Okay, you know at some point
• 9:12
  Speaker 4: we at all points, we have to respect statistical power. Okay,
• 9:16
  Speaker 4: when you have two and a half million humans, that's
• 9:19
  Speaker 4: pretty impressive, okay before you even dive into the statistics.
• 9:23
  Speaker 4: And you know, some other studies that maybe have some
• 9:28
  Speaker 4: you know, non congruent information do not have that many zeros.
• 9:32
  Speaker 4: So that's an important thing to keep in mind as
• 9:34
  Speaker 4: well too. You know, the I think it was within
• 9:39
  Speaker 4: headlines it was covered as like what conclusions were? Well,
• 9:43
  Speaker 4: really important to think about what did the study authors
• 9:45
  Speaker 4: say as well? You know that that twenty twenty four
• 9:48
  Speaker 4: it was published in jam and the Swedish study overall
• 9:52
  Speaker 4: that review the authors. You know, it's like when you're
• 9:56
  Speaker 4: doing the presentation, never supposed to read this slide, but
• 9:59
  Speaker 4: for the sake of how important it is, the author's
• 10:02
  Speaker 4: verbatim statement was acedamnifin use during pregnancy was not associated
• 10:06
  Speaker 4: with child children's risk of autism ADHD or intellectual disability
• 10:10
  Speaker 4: and sibling control analysis. And that last part, that's the
• 10:13
  Speaker 4: end of the quote. That last part is what you
• 10:15
  Speaker 4: were just alluding to and really hopefully trying to emphasize
• 10:18
  Speaker 4: there of when you account for something else pretty profound
• 10:21
  Speaker 4: like sibling control, familial concerns, all of a sudden poof
• 10:26
  Speaker 4: away goes the risk. And that's really really important. On
• 10:31
  Speaker 4: top of the tune about just short of two and
• 10:33
  Speaker 4: a half million humans being involved in that study. You know, Otherwise,
• 10:38
  Speaker 4: when some of those studies that were included in this
• 10:40
  Speaker 4: review of the review of the hour here, I believe
• 10:43
  Speaker 4: you mentioned the twenty nineteen jama psych It was a
• 10:46
  Speaker 4: biomarker study, So you know, there you're talking about looking for,
• 10:51
  Speaker 4: you know, a substance state of mi inifitt or even
• 10:54
  Speaker 4: metabolites within you know, the within the court plasm of newborns.
• 11:01
  Speaker 4: They had about a thousand, I believe, So when somebody
• 11:04
  Speaker 4: hears a thousand, you think big. You know, it's like oh,
• 11:07
  Speaker 4: you know, listen, a pro ten compared to met form
• 11:10
  Speaker 4: in five hundred milligrams depends on that, right, thousands born
• 11:14
  Speaker 4: sounds big, but pales in comparison to two and a
• 11:17
  Speaker 4: half million, right, So it's you know, relative the football
• 11:20
  Speaker 4: park we're in here, and when you're looking at you
• 11:24
  Speaker 4: know that's not necessarily outcomes. You mentioned the other study
• 11:26
  Speaker 4: from twenty twenty one European Journal of Epidemiology. They were
• 11:30
  Speaker 4: talking about symptoms of autism and or ADHD. That's different
• 11:35
  Speaker 4: than a diagnosis. It leads to it, but it is
• 11:37
  Speaker 4: not all encompassing along the way. So you know, there's
• 11:40
  Speaker 4: these concerns within some of the studies in the big picture.
• 11:44
  Speaker 4: Really though, I think to your original question, there is
• 11:47
  Speaker 4: the like, well, what about this review article. Everybody keeps
• 11:50
  Speaker 4: saying study, which yes, but review, you know, the one
• 11:54
  Speaker 4: of the hour, the one of the decade. As far
• 11:56
  Speaker 4: as what was utilized for the announcements last week, there's
• 12:01
  Speaker 4: a lot to in package with that one as well.
• 12:03
  Speaker 4: Would you agree there that there's just a lot going
• 12:05
  Speaker 4: on there. We touched on some of the studies included
• 12:07
  Speaker 4: in it, but even within in and of itself, there's
• 12:10
  Speaker 4: concerns along the way. Absolutely, and it's you know, one
• 12:15
  Speaker 4: of the first questions. I had many questions, and I'm
• 12:19
  Speaker 4: not going to say I hope that everyone else had them,
• 12:21
  Speaker 4: but I know you did. And by the way, the
• 12:24
  Speaker 4: response of healthcare professionals, both individually and as professional organizations, wow,
• 12:30
  Speaker 4: clap amazing. You know, there was a lot of purple
• 12:35
  Speaker 4: on social media feeds, the ACOG responses, the the a
• 12:39
  Speaker 4: lot of sharing of that, and folks stood up. And
• 12:42
  Speaker 4: it wasn't really a question of mine of whether folks would,
• 12:46
  Speaker 4: but it was when, and it was pretty quick and
• 12:49
  Speaker 4: pretty profound. So a lot is meant to be said
• 12:54
  Speaker 4: by that. But really one of the bigger questions with
• 12:57
  Speaker 4: the review article of the hour is well, like why
• 13:01
  Speaker 4: you know, like, there's what, I don't ten thousand medicines
• 13:05
  Speaker 4: out there, pretty much more than that, right, but let's
• 13:07
  Speaker 4: just go with that. Why paracetamol ceedomnifin? Why that one?
• 13:13
  Speaker 4: You know that that's a big question there. And you know,
• 13:15
  Speaker 4: this isn't necessarily investigative reporting. There's information that's been out
• 13:19
  Speaker 4: there now it's substantia, there's references for it, but like,
• 13:22
  Speaker 4: oh well, one of the first things is, oh well,
• 13:24
  Speaker 4: look at authors. Okay, anything going on there? Well? A
• 13:27
  Speaker 4: corresponding author, also the dean of the Harvard School of
• 13:31
  Speaker 4: Public Health, received just over one hundred and fifty thousand
• 13:35
  Speaker 4: dollars in expert witness fees in testifying that to the
• 13:41
  Speaker 4: claim of I hesitating even saying it, but to the
• 13:45
  Speaker 4: claim of a seedeminifin you know, causing autism overall in
• 13:50
  Speaker 4: a twenty twenty three I believe it was hundreds of
• 13:53
  Speaker 4: court cases put into one multi district litigation MDL. We've
• 13:56
  Speaker 4: seen this in the opiate crisis. But don't get me
• 13:58
  Speaker 4: going there, folks, the same thing where it's all the
• 14:02
  Speaker 4: cases put together. And then one judge said, you know what,
• 14:04
  Speaker 4: there's no evidence, so he tossed the case out, the
• 14:06
  Speaker 4: case being hundreds of cases, hundreds of thousands of dollars.
• 14:09
  Speaker 1: By the way, And Mark, can I pause you there
• 14:11
  Speaker 1: for a moment, because is this a normal fee for
• 14:14
  Speaker 1: an expert witness?
• 14:15
  Speaker 3: I know pharmacists, at least in the US, like a
• 14:17
  Speaker 3: lot of them, are looking for side jobs or other things.
• 14:19
  Speaker 3: We have this amazing.
• 14:20
  Speaker 1: Knowledge, what else can we do with it? And a
• 14:23
  Speaker 1: lot of them want to become expert witnesses. But one
• 14:25
  Speaker 1: hundred and fifty thousand dollars.
• 14:28
  Speaker 3: That the same excess, right, that's up.
• 14:30
  Speaker 4: There for salary even. Yeah, by the way to to
• 14:34
  Speaker 4: what you're saying there too, you know, expert witnesses within
• 14:37
  Speaker 4: the healthcare field deserve and earn a very appreciable compensation
• 14:44
  Speaker 4: along the way. It's not so much the amount, although
• 14:48
  Speaker 4: it's up there in this case, it's more so that
• 14:51
  Speaker 4: you know, the answer was the judge saying there's no evidence,
• 14:53
  Speaker 4: and then all of a sudden an author publishes a
• 14:56
  Speaker 4: review article that you know is stating to be the
• 14:59
  Speaker 4: evidence of but include studies that say the contrary. That's
• 15:04
  Speaker 4: where it's really at.
• 15:06
  Speaker 1: Absolutely, and I want to bring up a point that
• 15:08
  Speaker 1: every pharmacy student is trained on, every pharmacist counsel's on
• 15:14
  Speaker 1: what is the dose, the duration, what is the reason
• 15:18
  Speaker 1: you're taking the medications? Everything we ingest, whether it's a
• 15:22
  Speaker 1: medication or a supplement or even just food could be
• 15:26
  Speaker 1: just a vegetable for that matter. There's risk versus benefits,
• 15:30
  Speaker 1: and there's nothing that's black and white statement saying this
• 15:33
  Speaker 1: is safe or this is not safe. And that was
• 15:37
  Speaker 1: missed in the discussion of this publication. The authors of
• 15:41
  Speaker 1: that review did go on to say, while there is
• 15:44
  Speaker 1: no causation found, we recommend always using the lowest effective
• 15:49
  Speaker 1: dose for the shortest duration of time under the medical
• 15:53
  Speaker 1: guidance and supervision tailored to that individual. Was that message
• 15:58
  Speaker 1: conveyed to the American public? I cannot see it, right.
• 16:04
  Speaker 4: That's that's the easiest question anybody's going to hear today, right.
• 16:08
  Speaker 4: And and you bring up a very good point there
• 16:11
  Speaker 4: of you know, tempering the information, providing it succinctly yet comprehensively.
• 16:18
  Speaker 4: And you know, I appreciate you having me on, you know,
• 16:21
  Speaker 4: as a co host here for this podcast, but by Gully,
• 16:24
  Speaker 4: I wish I wish I was one of the authors
• 16:27
  Speaker 4: to be able to just say that of you know,
• 16:30
  Speaker 4: it's different than what was conveyed overall. And that's very
• 16:33
  Speaker 4: very important and appreciable along the way. And you know,
• 16:37
  Speaker 4: we have to keep that in mind in the big picture.
• 16:40
  Speaker 4: One of the other big things I think you just
• 16:41
  Speaker 4: unraveled there was that, you know, all medications have baggage.
• 16:46
  Speaker 4: You know, we call it safety and efficacy. We have
• 16:49
  Speaker 4: you know, efficacy intended effects and then safety involving things
• 16:52
  Speaker 4: like even side effects. It's a philosophical statement really the
• 16:56
  Speaker 4: substance itself, the chemical, the medication is like here, I
• 16:59
  Speaker 4: am here, I'm going to do these things. We call
• 17:03
  Speaker 4: them side effects and whatnot. But all medicines have that.
• 17:06
  Speaker 4: It is our charges healthcare professionals, particularly you know, even
• 17:11
  Speaker 4: licensed pharmacist medication experts of course, to to you know,
• 17:15
  Speaker 4: dive deeper into that of what's anticipated. And you know,
• 17:19
  Speaker 4: I've heard lots of reports or not reports, but reminders
• 17:22
  Speaker 4: from folks of like, oh well, there's you know, there's
• 17:25
  Speaker 4: like about fifty thousand people that end up in the
• 17:28
  Speaker 4: er from a sedum infit in each year. I've done
• 17:31
  Speaker 4: studies and posters even including that information. I have my
• 17:36
  Speaker 4: own story that was published in an APHA book talking
• 17:40
  Speaker 4: about a patient that had overdosed on aceeedam in if.
• 17:42
  Speaker 4: And the point being is that those situations, you know,
• 17:47
  Speaker 4: that involves taking a lot more than medicine, not the
• 17:50
  Speaker 4: lowest needed dose for the shortest duration overall, to take
• 17:54
  Speaker 4: care of a situation such as a pregnant patient with
• 17:57
  Speaker 4: a fever, like think about that, right, I know what
• 18:02
  Speaker 4: podcast we're on here an with a fever. Yes, that
• 18:06
  Speaker 4: is a very concerning situation. It needs to be mitigated
• 18:11
  Speaker 4: right like that. That's one of the biggest questions of
• 18:14
  Speaker 4: the day here, really.
• 18:16
  Speaker 1: Fever absolutely family history of autism. Ten I read online.
• 18:22
  Speaker 1: Did not the fact check this one. But I tend
• 18:25
  Speaker 1: to have more pain in pregnancy. There's so many other
• 18:28
  Speaker 1: things that can cause pain in pregnancy. Mark. If somebody
• 18:31
  Speaker 1: is afraid to take tail and off for a day
• 18:36
  Speaker 1: within the approved dosage for pain, what other options do
• 18:39
  Speaker 1: we have.
• 18:42
  Speaker 4: Well, there's a creek and we have a canoe, and
• 18:46
  Speaker 4: we might not have a paddle.
• 18:48
  Speaker 1: And that's that's my point exactly right, Let's remove the
• 18:51
  Speaker 1: fear of taking You are the pain expert, and if
• 18:56
  Speaker 1: we don't, at the top of our head come out
• 18:58
  Speaker 1: and say, well, you could take this, this, this, that.
• 19:01
  Speaker 3: What does that leave us?
• 19:02
  Speaker 1: Yes, there are some maybe some topicals or some other things,
• 19:05
  Speaker 1: but as far as we know know en SAIDs or eyebuprofen,
• 19:09
  Speaker 1: you know, or diclophanac or anything in that category.
• 19:12
  Speaker 3: Like, let's stay away from those.
• 19:13
  Speaker 1: And even aspirin at low dose is the best thing
• 19:16
  Speaker 1: you can do to present preclamsy, but at high doses
• 19:19
  Speaker 1: can cause problems in formations while the baby's being developed.
• 19:23
  Speaker 3: So thailanol is that one that has been used for decades.
• 19:27
  Speaker 1: I want to bring up another point that the within
• 19:30
  Speaker 1: the pharmacist community, the ones that are saying what, they're
• 19:36
  Speaker 1: digging deep, saying what could possibly cause this, And they're
• 19:40
  Speaker 1: looking at the relationship of higher doses of tile and
• 19:44
  Speaker 1: all being metabolized through the liver. As you mentioned, you know,
• 19:47
  Speaker 1: we do have these patients coming into the emergency room
• 19:50
  Speaker 1: and in the hospital because of the liver effects. And
• 19:52
  Speaker 1: that's why when I was in pharmacy school, they said
• 19:55
  Speaker 1: three thousand macs a day miligrams, not four thousand.
• 19:58
  Speaker 3: Now I see on a short term four thousands.
• 20:00
  Speaker 1: Fine, But they say it has to do with the
• 20:02
  Speaker 1: glutathione from the liver. But again we're talking dose dependent
• 20:07
  Speaker 1: here and the condition of that patient's liver. So keep
• 20:10
  Speaker 1: those in mind before you refuse to take tunnel because
• 20:14
  Speaker 1: of a fever or acute pain during pregnancy.
• 20:19
  Speaker 4: Absolutely, I've heard, actually we've all heard a lot of
• 20:22
  Speaker 4: concerning things over the last little bit of time here
• 20:25
  Speaker 4: in the on the chronological timeline of our planet here.
• 20:29
  Speaker 4: But you know, some of the things are you know,
• 20:32
  Speaker 4: this is getting extrapolated into folks being an enemy, anyone
• 20:37
  Speaker 4: being concerned with the constant of taking acetaminefin or as
• 20:41
  Speaker 4: the restaurant calls of paracetamol for your common elements of
• 20:45
  Speaker 4: pain fever as well, and that that is a huge
• 20:50
  Speaker 4: concern because that is, you know, there's so many misapplications
• 20:54
  Speaker 4: of the studies within this review study of the hour
• 20:57
  Speaker 4: and in of itself as well, but minimally involved looking
• 21:01
  Speaker 4: at you know what, what medication was utilized by a
• 21:05
  Speaker 4: pregnant mother. So to extrapolate that beyond that situation to
• 21:09
  Speaker 4: just saying anyone with you know, let's say a patient
• 21:11
  Speaker 4: and pain of any patient, any pain that we have
• 21:15
  Speaker 4: to watch for, Okay, And that's really important thing to
• 21:19
  Speaker 4: keep in mind overall of like, you know, one do
• 21:22
  Speaker 4: the due diligence with these studies, but then let's not
• 21:25
  Speaker 4: extrapolate further that that just becomes a web of concern overall.
• 21:31
  Speaker 4: I don't know if you've heard of anyone with that,
• 21:33
  Speaker 4: and again they will be anecdotally anyway, but I've already
• 21:36
  Speaker 4: talked with healthcare professionals that we're hearing that, you know,
• 21:39
  Speaker 4: beat from the street, I guess of Okay, we need
• 21:42
  Speaker 4: to nip this right off the right of the gate here,
• 21:45
  Speaker 4: hopefully in efforts like this quite frankly, you know, just
• 21:48
  Speaker 4: going into what's at stake here, what's at hand? If
• 21:53
  Speaker 4: so many folks have heard me even talk about you know,
• 21:55
  Speaker 4: when you get into the pain management realm, it's all
• 21:57
  Speaker 4: about having a diverse treatment plan. There's lots of options overall,
• 22:01
  Speaker 4: and just going over everything, you know, with each individual
• 22:04
  Speaker 4: patient along the way. One of the things that comes
• 22:06
  Speaker 4: up though is is and I think it may have
• 22:09
  Speaker 4: been jumping here, but you know the idea of well
• 22:12
  Speaker 4: who how do we trust? And who do we trust?
• 22:15
  Speaker 4: I mean by gully as pharmacists and a lot of
• 22:17
  Speaker 4: healthcare professions, we're always at the top there with near
• 22:19
  Speaker 4: the top around the top for being a trusted profession.
• 22:23
  Speaker 4: But that's saying profession and individuals here and there, you know,
• 22:27
  Speaker 4: can be deviating from that. So one of the things
• 22:30
  Speaker 4: I usually and I certainly welcome your thoughts here, is
• 22:33
  Speaker 4: just saying, you know, not just blind trust. Okay, we
• 22:37
  Speaker 4: have that proverbial line of like, oh, we'll talk to
• 22:39
  Speaker 4: your health care provider or pick a specific one, but
• 22:42
  Speaker 4: you don't know like what's their resources, what's their bias,
• 22:47
  Speaker 4: what's their opinions? Any individual present self included by the way,
• 22:53
  Speaker 4: is going to have that as a concern overall, it's
• 22:56
  Speaker 4: where you're getting your information from. You know what, studies,
• 22:59
  Speaker 4: what professes, groups, panels of experts that have been through
• 23:03
  Speaker 4: the riggor to even be in the room where it
• 23:06
  Speaker 4: happens in the first place. Right, I love anyone's thoughts
• 23:10
  Speaker 4: really on that of like the how do we go forward?
• 23:14
  Speaker 4: This trust thing is incredibly important overall, Mark.
• 23:19
  Speaker 1: You brought up such an important point, right, actually not
• 23:22
  Speaker 1: even right when it happened, but proactively. This is one
• 23:25
  Speaker 1: of the only times I have ever seen every health
• 23:29
  Speaker 1: authority say the same statement. And you can look up
• 23:34
  Speaker 1: any one of these Society and Maternal and Fetal Medicine Specialists,
• 23:38
  Speaker 1: American Pharmacists Association, the FDA, American College of Obstetricians and Gynecologists,
• 23:44
  Speaker 1: the World Health Organization, and the NHS over in the UK.
• 23:48
  Speaker 1: In Canada they have SOGC and ultimately the March of
• 23:53
  Speaker 1: Dimes literally like the og of Medication.
• 23:57
  Speaker 3: Safety and Pregnancy.
• 23:58
  Speaker 1: Right single one of these health authorities says there's no
• 24:04
  Speaker 1: evidence that tail and al is unsafe at the recommended dosage,
• 24:09
  Speaker 1: no direct link. It remains appropriate when indicated use the
• 24:13
  Speaker 1: lowest effective dose evidence is inconsistent. Avoid over interpretation from
• 24:19
  Speaker 1: the World Health Organization. Stick with our evidence based practice
• 24:23
  Speaker 1: NHS saying a SEEDAMN is the first choice painkiller in pregnancy.
• 24:28
  Speaker 1: Every single one of these and then March of times.
• 24:30
  Speaker 1: You can look online and see their announcement specific to
• 24:34
  Speaker 1: the White House's announcement linking acedom innifit to autism. Have
• 24:39
  Speaker 1: you ever seen any public statement where every leading healthcare
• 24:44
  Speaker 1: organization is on the same page.
• 24:47
  Speaker 4: Not only do my answer no, and I mean in
• 24:49
  Speaker 4: the nicest way possible, but not as quickly either. I
• 24:53
  Speaker 4: mean obviously the answers no, it's not as quickly as well,
• 24:56
  Speaker 4: but still like that. That's with emphasis there. We're talking
• 24:59
  Speaker 4: with twenty four hours and everything everywhere, right, It's incredible
• 25:06
  Speaker 4: and needs to be appreciated as well as you are
• 25:08
  Speaker 4: articulated there.
• 25:09
  Speaker 3: It's impressive, very impressive.
• 25:12
  Speaker 1: And I'd like to add a quote I read from
• 25:14
  Speaker 1: a colleague on LinkedIn, Shannon Fountain about autism. Autom is
• 25:18
  Speaker 1: not my specialty, so I wanted to learn more about it,
• 25:22
  Speaker 1: and as I mentioned, I read, one of the things
• 25:24
  Speaker 1: is that pregnant women who have autism may experience more pain.
• 25:28
  Speaker 1: Leading again confounders, but Shannon said autism is not a
• 25:32
  Speaker 1: disease and there's no evidence that is ciedom inefin causes it.
• 25:37
  Speaker 1: Despite extensive research, no single etiological factor has been identified. Instead,
• 25:44
  Speaker 1: autism spectrum disorder is understood to be a multifactorial neurodevelopmental
• 25:50
  Speaker 1: condition influenced by a complex interplay of genetic, epigenetic, and
• 25:55
  Speaker 1: environmental factors contributors, the mechanisms of which are not fully understood.
• 26:01
  Speaker 1: So how non non licensed people in our government can
• 26:08
  Speaker 1: come out and say that one medication like a CTEA
• 26:12
  Speaker 1: minefit in title and all paracetamniphal can cause this spectrum
• 26:17
  Speaker 1: or increase risk of your spectrum.
• 26:20
  Speaker 3: It's just mind blowing to me.
• 26:21
  Speaker 1: And if anyone can answer that question, please reach out
• 26:25
  Speaker 1: to us.
• 26:25
  Speaker 3: I would love to know.
• 26:27
  Speaker 4: Absolutely, and and you know, i'd't even want to double
• 26:30
  Speaker 4: down on that of the you know, the incredible concern, yes,
• 26:33
  Speaker 4: but on the compassionate side, can you imagine and I'm
• 26:37
  Speaker 4: not there, but can you imagine being a pregnant mother
• 26:41
  Speaker 4: right now who happens to spike a fever? I the
• 26:46
  Speaker 4: the I hope that stops some folks in their tracks
• 26:49
  Speaker 4: right now. Quite frankly, i've already been or you know,
• 26:52
  Speaker 4: perhaps a patient you know with autism or a parent
• 26:56
  Speaker 4: thereof what's going through everyone else minds right now, right
• 27:01
  Speaker 4: like that's you know, we as healthcare professionals, we stand up,
• 27:05
  Speaker 4: we substantiate the evidence and translate it for everybody to
• 27:09
  Speaker 4: what is the bottom line? That's what we're here for
• 27:11
  Speaker 4: in the big picture, and we've done that, but in compassionately,
• 27:14
  Speaker 4: in the background, we also have to appreciate what folks
• 27:17
  Speaker 4: are going through and trying to navigate together. And lo
• 27:21
  Speaker 4: and behold, here we are again as healthcare professionals, as pharmacists,
• 27:25
  Speaker 4: being ready to help our folks in those in all scenarios.
• 27:29
  Speaker 1: Really, and that's the key point talk to your provider,
• 27:33
  Speaker 1: is that generic statement, don't believe everything you read online.
• 27:37
  Speaker 1: We've known for a long time, but when we have
• 27:39
  Speaker 1: our government coming out making a statement like that, we
• 27:43
  Speaker 1: should be able to believe it. And unfortunately now we
• 27:46
  Speaker 1: have to go to your leading healthcare organizations that have
• 27:50
  Speaker 1: really dived into the studies to find out, okay, what
• 27:53
  Speaker 1: is really happening, and we have all of them on
• 27:56
  Speaker 1: the same page. So I'd like to add some key
• 27:58
  Speaker 1: takeaways from our converse station today one is for our
• 28:02
  Speaker 1: pregnant women and our pharmacists. Consulting the pregnant women don't panic.
• 28:06
  Speaker 1: Acetam benefit is still considered safe and first line by
• 28:09
  Speaker 1: every major health body overseeing organization balance matters. Untreated fever
• 28:16
  Speaker 1: or severe pain and pregnancy can harm both mom and baby.
• 28:20
  Speaker 1: Best practices are use only when needed at the lowest
• 28:23
  Speaker 1: effective dose for the shortest time. We already said, consult
• 28:26
  Speaker 1: your providers, but include your pharmacists in that, your healthcare
• 28:30
  Speaker 1: team of course, your obgins, your midwives, and whoever you
• 28:34
  Speaker 1: trust with your care. And there is ongoing research. Science
• 28:37
  Speaker 1: continues to evaluate possible risks, but right now the benefits
• 28:41
  Speaker 1: outweigh theoretical risks. Mark, thank you so much for joining me.
• 28:46
  Speaker 1: Is there anything you'd like to add?
• 28:48
  Speaker 4: My pleasure and happy to be here in chatting with
• 28:51
  Speaker 4: you and hopefully reaching a lot of people out there
• 28:53
  Speaker 4: to you know, to temper the room a little bit
• 28:57
  Speaker 4: and get the correct information out there. As you mentioned
• 29:00
  Speaker 4: at the tail end, there the benefits out wing theoretical
• 29:04
  Speaker 4: risks at this point and have been. But just getting
• 29:07
  Speaker 4: the right information out there that I hope not only
• 29:10
  Speaker 4: healthcare professionals are listening, but also, hey, the late public,
• 29:13
  Speaker 4: our neighbors, our communities as well too, to really hear
• 29:17
  Speaker 4: this from trusted healthcare professionals.
• 29:21
  Speaker 1: Absolutely, and it's been my honor to have this conversation
• 29:24
  Speaker 1: with you today to get.
• 29:26
  Speaker 3: The word out.
• 29:26
  Speaker 1: And if any of our listeners found this helpful, please
• 29:29
  Speaker 1: do share it with those people, your patients, your colleagues,
• 29:33
  Speaker 1: so that everybody knows, do not stop taking one tile
• 29:38
  Speaker 1: and all for your fever and your babies.
• 29:42
  Speaker 3: We have this evidence to show and let's.
• 29:44
  Speaker 1: See what happens in the future with more studies to
• 29:46
  Speaker 1: come or more discussions on these studies that the government
• 29:51
  Speaker 1: used to make this statement that has caused this magnificent scare.
• 29:54
  Speaker 3: In our pregnant women and their families. So please do
• 29:59
  Speaker 3: comment and follow us and we'd love to hear your feedback.
• 30:03
  Speaker 3: Mark thank you again.
• 30:04
  Speaker 4: You're very welcome. I hope you all have a wonderful
• 30:07
  Speaker 4: day every day.