Our Surgeon General Tweeting Nonsense

Need General Surgery? Ignore The Surgeon General | American Council on Science and Health – By Josh Bloom — July 8, 2019

Over the 4th of July Weekend, our U.S. Surgeon General,  Jerome M. Adams, MD, MPHTweeted: 

U.S. Surgeon General – Jul 3
Putting in some work in the ORs. Got to help with some interesting cases and saw several people get Tylenol and other meds to help provide anesthesia and post-op pain relief with my minimal opioids. They all woke up comfy and happy!

U.S. Surgeon General – Jul 4
And here’s a study where 1000 mg IV Tylenol was found equivalent to IV morphine (based on body weight, but in some cases greater than 6 mg) Note, rib fractures are extremely painful!

This sure makes it sound like Tylenol works better than morphine. Josh Bloom from the ACSH evaluated the study and the Surgeon General’s conclusions.  

It is a terrible study. Here’s why.

Adams was referring to a 54-person randomized clinical trial of pain control following rib fractures, which are notoriously painful. The trial, which was conducted in an emergency department Iran, compared IV Tylenol (1000 mg) and morphine (0.1 mg per kilo of body weight).

The result? Tylenol worked as well as IV morphine for relief of pain from rib fractures, that is until you bother to read the paper, which was published in the journal Emergency (Tehran).

Thirty minutes post-administration of drug the mean pain score on a scale of 1-11 was 5.5 for the morphine-treated patients and 4.9 for the Tylenol-treated patients.

These two numbers make up the “evidence” behind Dr. Adams’ claims of equivalence of Tylenol and morphine.

Except the data aren’t even close to statistically significant – P = 0.23.

No, Tylenol is not equivalent to morphine; there is no way to tell from this study. Its numbers are meaningless.

Even the authors seem to acknowledge this fact,

“The success rate reported for this drug in this study was 80% that although [sic] did not have significant difference with morphine (58.6%), it had more improvement rate, clinically. “

I’m disgusted that this kind of gobblygook is now being published as a “scientific study”.

ACSH advisor, biostatistician Dr. Stan Young had this to say:

The rage these days is to say OTC pain med is as good as morphine etc. Here the authors claim victory if there is no difference. “Proving equal” is a different game. You just have to worry about statistical power. Just run a small, underpowered study and you can easily get no difference (victory).

It gets worse…

There was no control group, so we don’t know if either group got relief from the medicine or the reduction in pain score was due to a placebo effect.

The initial pain score of both groups was “the same” but with P = 0.19 this may or may not be true. The group that received the Tylenol could have come in with more pain, less pain, or no difference. We cannot tell from the data.

The success rate (defined as a 3 point reduction in pain score) was 80% for Tylenol and 59% for morphine. That isn’t significant either. P = 0.09. Even the authors acknowledge this:

When there was a treatment failure after 30 minutes (inadequate pain relief), morphine was given as a rescue therapy.

If morphine is no better than Tylenol, why was it used as a “rescue” therapy? Would Tylenol ever be used as a “rescue” therapy when morphine doesn’t work? The study contradicts itself here.

This automatically skews the results.

It’s like saying “Tylenol works as well as morphine except when it doesn’t.” Nor do the authors tell us how often this happened. 

Finally, we have this:
“Presentation of side effects was similar in both groups.”

All we’ve been hearing for a decade is how dangerous opiate analgesics are and there was no difference in side effects between the Tylenol and morphine groups?

All we’ve been hearing for a decade is how dangerous opiate analgesics are and there was no difference in side effects between the Tylenol and morphine groups?

This is what our Surgeon General used to “inform” us that IV Tylenol works as well as morphine – a 2015 paper in a journal with maybe two readers, which is filled with a whole lot of information, none of it valid.

I’m appalled that our Surgeon General can be so easily fooled.

This episode shows us how “studies” can be interpreted, even by a nationally respected “expert”, to support anti-opioid views when the studies are not actually finding problems with opioids.

A week later, Josh Bloom shows our Surgeon General backtracking:

Surgeon General Backpedals on Flawed Tylenol Study. Because of ACSH.By Josh Bloom – July 15, 2019

It appears that Dr. Adams didn’t bother to read the paper from which this conclusion was drawn. So I did. And it was a colossal mess, something I explained on July 8th (See Need General Surgery? Ignore The Surgeon General).

The study was so bad that it was impossible to tell whether Tylenol worked better than morphine, morphine worked better than Tylenol, or either drug worked at all

A few days later ACSH friend, Dr. Aric Hausknect, a New York neurologist and pain management expert, who has both written for and been interviewed by us) must have read the paper as well because his July 12th letter made what I had to say seem rather tame by comparison (See Dr. Aric Hausknecht Responds To SG Jerome Adams’ Tylenol Recommendation).

Apparently, we hit the mark because in subsequent Tweets Dr. Adams was backpedaling.

Below are Josh Bloom’s annotations of the Tweets he’s referring to:

What Dr. Adams did is no different than what PROP, certain members of the CDC, politicians, academic zealots, and various other self-serving individuals and groups have been doing for almost a decade –  making up a story and backing it up with faulty (or non-existent) research to “prove” a point. 

4 thoughts on “Our Surgeon General Tweeting Nonsense

    1. Zyp Czyk Post author

      Thanks to the corruption of scientific research by financial interests, scientific studies are often manipulated to show the desired results and are not as impartial as they used to be. But… this really is “over the top”. Anti-opioid zealots use these biased studies that are twisted to show how “useless” opioids are – we all have a tendency to believe information that fits out preset mindset.

      But before publicly announcing such dubious claims, you’d think he or someone else would fact-check it.

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    1. Zyp Czyk Post author

      I’m sure he believed he understood, and that’s exactly the problem: too many people believe they already know what’s causing so many overdoses, thanks to the media relentlessly repeating the story of “innocent victims prescribed opioids”, which “made” them addicted.

      He who repeats the most is believed – that’s just how our human brains operate. I guess it’s too much to expect that even designated “experts” would look critically at all the PROPaganda flooding the media.

      The idea that our country’s Surgeon General cannot distinguish medical facts from PROPaganda is both frightening and very, very sad. It breaks my heart to see our country turning away from science and reason to embrace the latest social trend (mob rule).

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