After a newborn died of opioid poisoning, a new branch of pediatrics came into being. But the evidence doesnāt add up.
āThe case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue,ā Richard Horton, the editor ofĀ The LancetĀ for the past thirty years, wrote in the journal, in 2015. āIn their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours.ā
āThe fact that the paper still exists means that medical students, pharmacy students, and, presumably, genetics students are being taught this as if itās a real thing, and it has implications,ā Juurlink told Scherer. āThe scientific record now has this entire branch of pediatric pharmacology that has been made up out of whole cloth.ā KorenāsĀ LancetĀ article āis still used in a lot of textbooks,ā the independent expert said. āDoctors who are less trained in this specific topic still perceive this case to be relevant.ā
In the decades since Korenās first warnings concerning codeine and breast milk, public-health authorities and patient-advocacy services have issued guidance to new mothers that ranges from scientifically incoherent to potentially dangerous. A clinical report published by the American Academy of Pediatrics in 2013 cites theĀ LancetĀ case as a reason to avoid prescribing codeine to breast-feeding mothers but notes that morphineāits metaboliteāāappears to be tolerated by the breastfeeding infant.ā The same guidelines also recommend the use of hydromorphone, which is about forty times more potent than codeine and can be highly addictive. Meanwhile, the U.K.ās National Health Service categorically warns against taking codeine while breast-feeding but allows for the use of fentanyl.
The notion that opioids can pass through breast milk in sufficient quantities to kill a child has also seeped into American courtrooms. Korenās interpretation of Tariq Jamiesonās death has essentially served as a legal defense in at least two other cases that Juurlink believes most likely involved direct administration. During a review of other scientific literature, this summer, he discovered fourteen more, in Europe. āWho knows how many other babies have died at the hand of a caregiver and had it attributed to breast milk?ā he said. āI donāt know the answer to that. But itās not zero.ā
