This is the 183th #WILTW
Medical research is about doing things better for patients. It’s exciting to see new treatments and interventions develop (even when the evidence eventually suggests doing nothing at all is the best thing to do!)
Although I’m biased, in paediatric research simple changes can have quite profound effects on children and their families. Take a common condition such as asthma; treatment of acute exacerbations has traditionally taken the form of inhalers and a course of steroids (prednisolone) given over three days. The need for multiple daily doses, with the resulting challenges for families and children, has recently been challenged. It is proposed a single dose of strong steroid (dexamethasone) may be adequate. A brilliant review of a paper on this topic by the Skeptics guide to Emergency Medicine (SGEM) prompted debate this week about why practice hasn’t changed.
Inhibitor to KT is cost
— Damian Roland (@Damian_Roland) November 12, 2017
In the UK a bottle of dexamethasone is far more expensive than a packet of prednisolone tablets (which can be crushed to give to children) so the argument on the equity and equivalence of treatments will continue for some time yet I suspect. However in the comments section one of the blog’s authors highlighted a potentially far more challenging debate.
“Here is great graph looking at asthma rates and area in NY city. As you can see it is quite serioulsy overrepresented in the areas with the highest endemic poverty rates (or I can see it knowing the city, sorry)”
The relationship between deprivation and asthma (and many other medical conditions) is well described. Clearly the causes are multi-factorial but regardless, the variability in attendances and outcomes must be of concern.
The same unexplained variation equally applies in the UK
Clearly we need to continue to deliver the best treatments to children and young people most in need of care. But if there are underlying reasons behind why they need that treatment, we must not forgot to concentrate on ameliorating these as well.
What have you learnt this week? #WILTW