Worth noting that this is a case study about one child. I'm not saying the science is bad or that you should blow cannabis smoke in your baby's face, but if the headline made you think there's an epidemic of babies dying due to exposure to cannabis, that's not the case.
So 1 baby dies and because myocarditis is rare and they assume "cannabis exposure" is rare that they are probably linked? This seems pretty far from anything like science.
They report this possible case. Maybe there is never another association and the issue is forgotten, because there is no causal link. But maybe, someone else, some place else, who never read this paper, notices something similar and reports it. And maybe this happens several more times. And then, along the way, one of these reporters does a detailed search and finds the other reports. He collects the cases and maybe contacts the doctors who wrote the reports and writes what we call a Case-Series on these.
Maybe a couple case-series get written independently in various places. Someone finds these series and convinces someone else to fund a Case Control study.
Usually with environmental exposure literature this is exactly how "science" happens. Medicine is messy and serendipity is more than involved.
> The progressive clinical presentation of this patient during the prior 24-48 hours, including symptoms of somnolence, lethargy, irritability, nausea, seizure and respiratory depression are consistent with previously documented, known complications of recent cannabis exposure in the pediatric population.
Their argument is “Specifc myocardial complications related to cannabis toxicity that are well documented in adolescence through older adulthood include acute coronary syndrome, cardiomyopathy, myocarditis, pericarditis, dysrhythmias and cardiac arrest.2-4 To date, there are no reported pediatric deaths from myocarditis after confrmed, recent cannabis exposure“, therefore “this pediatric patient with death due to myocarditis may have died because cannabis exposure caused that myocarditis.”
And yes, if you get a highly anomalous event, it’s not at all unreasonable to point out that it immediately followed a highly anomalous input. If you’re looking for causality, x -> rare Y Is more likely if x is rare than if it isn’t. It inherently explains why Y is rare.
No, they’re saying they’ve seen enough evidence to report to other doctors to keep an eye out for it. Reports of this nature are not unusual in medicine, someone just noticed this one because of the drug connection.
The implication this infant died of myocarditis due to cannabis exposure is horrifying. If I'm reading correctly, the cause of myocarditis is unclear but the association is confirmed.
Which leads me to wonder what was the mechanism of exposure? Was the infant given something to eat, inhale, or something worse (if such a thing is possible)?
I'm struggling to believe that this infant's caregivers did not knowingly dose this infant with cannabis.
There's no story from the parents as to what happened. The closest the paper gives to explaining the situation directly is at the end of the Case Report: "Additional history disclosed an unstable motel-living situation and parental admission of drug possession, including cannabis."
In the midst of the toxicological analysis, it mentions that the THC metabolites they observe were "most likely
secondary to ingestion" and it later says, given that they observed various metabolites but not the primary compound itself, "the authors deduce that cannabis
consumption occurred within the recent two to six days,
assuming this was a single, acute high-potency ingestion."
So, most likely what happened is that the parents carelessly left some edibles around, and the infant toddled over and put one in his mouth. Infants put everything in their mouths, so an accidental exposure sounds plausible- albeit criminally negligent. I'd presume the parents have been charged accordingly.
Thank you for replying with that information. I read the article but didn't see the "Additional history" note.
I also poorly worded the last paragraph of my previous comment. What I meant to say was more along the lines of "I want to believe this infant's caregivers did not knowingly dose this infant."
Negligence is bad but not nearly so bad and dispiriting as intentional exposure gone awry.
(Disclosure: I support medical and recreational cannabis for consenting adults.)
No, it's a case report. They looked for more normal causes of myocarditis and didn't find any. Note that they only claim an association, not that it directly definitely caused it.
It seems very plausible that cannabis is toxic to infants in ways that it wouldn't affect adults.
Here's a quote of the relevant part of the abstract:
> histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death
I'm sorry. Of the millions of babies who die within their first year globally, I find it hard to be suddenly concerned about cannabis's effect on them given the multitude of other factors.
That's not to say it isn't worth study, but it's unlikely worth a headline.
Whenever there's anything negative even possibly associated with cannabis, there are those who must reflexively shoot it down, or minimize it (i.e. your data is wrong, or, if it's not wrong, it's not as bad as alcohol, or if it is, it's a rare issue). It's like they can't accept that cannabis could ever be bad for any reason. I find this very odd.
Because negative news articles about cannabis are almost always flimsy studies trying to spread fear and push an agenda.
If cannabis was legal everywhere almost no one would care about these studies.
However, cannabis is illegal in most places and there is a battle for opinions where groups are trying to spread FUD about how "weed is killing babies".
It's fighting for people to have a rational stance and pushing for policies that don't imprison people over a substance on par with alcohol that brings out the defenders on any article like this.
Detailed reports of observations are important, normal portions of the scientific process. They're just the first step. Where is the line? Is a hypothesis with an experiment design not science? Is a negative finding not science? Is a positive self-reported study not science? Is a positive double-blind study also not science (because it hasn't been repeated)?
Being dismissive of preliminary findings as "not science" is the same kind of attitude that cause people to not publish negative results, which is an incredible tragedy of modern scientific progress.
22 comments
[ 2.8 ms ] story [ 53.6 ms ] threadThey report this possible case. Maybe there is never another association and the issue is forgotten, because there is no causal link. But maybe, someone else, some place else, who never read this paper, notices something similar and reports it. And maybe this happens several more times. And then, along the way, one of these reporters does a detailed search and finds the other reports. He collects the cases and maybe contacts the doctors who wrote the reports and writes what we call a Case-Series on these.
Maybe a couple case-series get written independently in various places. Someone finds these series and convinces someone else to fund a Case Control study.
Usually with environmental exposure literature this is exactly how "science" happens. Medicine is messy and serendipity is more than involved.
Hierarchy of evidence: http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-11040...
> The progressive clinical presentation of this patient during the prior 24-48 hours, including symptoms of somnolence, lethargy, irritability, nausea, seizure and respiratory depression are consistent with previously documented, known complications of recent cannabis exposure in the pediatric population.
Their source is here: https://alanflashman.files.wordpress.com/2014/02/piis0196064...
Those symptoms are consistent with exposure - it's too bad the case report didn't include any data from the parents (maybe I missed that).
Their argument is “Specifc myocardial complications related to cannabis toxicity that are well documented in adolescence through older adulthood include acute coronary syndrome, cardiomyopathy, myocarditis, pericarditis, dysrhythmias and cardiac arrest.2-4 To date, there are no reported pediatric deaths from myocarditis after confrmed, recent cannabis exposure“, therefore “this pediatric patient with death due to myocarditis may have died because cannabis exposure caused that myocarditis.”
And yes, if you get a highly anomalous event, it’s not at all unreasonable to point out that it immediately followed a highly anomalous input. If you’re looking for causality, x -> rare Y Is more likely if x is rare than if it isn’t. It inherently explains why Y is rare.
Which leads me to wonder what was the mechanism of exposure? Was the infant given something to eat, inhale, or something worse (if such a thing is possible)?
I'm struggling to believe that this infant's caregivers did not knowingly dose this infant with cannabis.
In the midst of the toxicological analysis, it mentions that the THC metabolites they observe were "most likely secondary to ingestion" and it later says, given that they observed various metabolites but not the primary compound itself, "the authors deduce that cannabis consumption occurred within the recent two to six days, assuming this was a single, acute high-potency ingestion."
So, most likely what happened is that the parents carelessly left some edibles around, and the infant toddled over and put one in his mouth. Infants put everything in their mouths, so an accidental exposure sounds plausible- albeit criminally negligent. I'd presume the parents have been charged accordingly.
I also poorly worded the last paragraph of my previous comment. What I meant to say was more along the lines of "I want to believe this infant's caregivers did not knowingly dose this infant."
Negligence is bad but not nearly so bad and dispiriting as intentional exposure gone awry.
(Disclosure: I support medical and recreational cannabis for consenting adults.)
EDIT: spelling, disclosure.
[1] https://en.wikipedia.org/wiki/Post_hoc_ergo_propter_hoc
It seems very plausible that cannabis is toxic to infants in ways that it wouldn't affect adults.
Here's a quote of the relevant part of the abstract:
> histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death
That's not to say it isn't worth study, but it's unlikely worth a headline.
If cannabis was legal everywhere almost no one would care about these studies.
However, cannabis is illegal in most places and there is a battle for opinions where groups are trying to spread FUD about how "weed is killing babies".
It's fighting for people to have a rational stance and pushing for policies that don't imprison people over a substance on par with alcohol that brings out the defenders on any article like this.
Do a search for "Pediatric Myocarditis" and you'll see lots of results - it happens, unfortunately. I think it's far more likely that it's caused by a vaccination (http://www.vaxchoicevt.com/myocarditis-after-vaccination/) or one of the other causes mentioned here: https://emedicine.medscape.com/article/897591-overview
Being dismissive of preliminary findings as "not science" is the same kind of attitude that cause people to not publish negative results, which is an incredible tragedy of modern scientific progress.