There has been a bit of a debate in the British press and online recently about the ethics and possible dangers of changes that have been made to children’s medicines, with the most commonly discussed example (at least in the versions that I have heard about) being liquid paracetamol suspension. Some products are coloured, sweet and fruit-flavoured, and they are presented in packaging which some claim is particularly appealing to children. A number of practitioners are arguing that this is dangerous in that it may encourage children to like the medicine and see it as a treat and thus increase the potential for accidental overdose.
Inevitably, the companies that make this are defending their decision, variously citing consumer demand, increased compliance and the fact that in some cases plainer varieties are also available, and journalists are busily finding people at the extremes of every viewpoint in order to share horror stories and whip up a more frenzied debate.
I’m finding it all rather interesting because this debate is partly about palatability, and the notion of palatability is something that I’ve discussed with a few people recently.
Although the word palatability is historically used in relation to taste, we also use it as an alternative to acceptability, for instance to describe the measures that are taken to make something that we don’t really want to take or undergo (like a medicine or intervention, perhaps) more acceptable to us. Mums and dads have been seeking ways of making liquid paracetamol more palatable for years, and although I can’t say I’ve ever tried it, I have it on good authority that it isn’t nearly as yummy in its original form as gripe water* was in the 1970s…
* For anyone who doesn’t know, gripe water is a very palatable liquid that children of my generation were given for all manner of ills. It is mainly sodium bicarbonate mixed with a bit of sugar, dill oil and water … oh, and about 3.6% alcohol, at least when I was little. As far as I am aware there is no evidence for its effectiveness, but I recall being rather fond of it…
So there is a perceived need for a medicine to be reasonably palatable in order that the recipient can be persuaded to swallow it, and a co-existing concern that, if it is too palatable, it then becomes an attractive option even to a child who doesn’t have a need for it, which may be problematic for a number of reasons.
The thought that the liquid paracetamol argument reminded me of was one that I’ve discussed with a good few women, midwives, doctors, and birth folk over the years. If a woman truly needs to have an induction of labour, caesarean section or other intervention that may not be especially pleasant in its raw form, then of course we want to find ways of making it as palatable as possible.
That’s part of what being woman-centred is all about.
All sorts of measures to that end have been proposed and implemented over the past few years, including family rooms for women undergoing cervical ripening, music in the operating theatre, the ensuring of skin-to-skin cuddling, delayed cord clamping, even lotus birth and even the family-oriented caesarean (Armbrust et al 2015).
Clearly, most of the concerns that are being expressed in relation to children’s use of medicines don’t apply to adult women who are making decisions about their birth. But I have heard people asking recently whether we are making interventions too palatable in some ways? Whether by doing too much to look at how we can make induction of labour or caesarean section a friendlier or more palatable or better experience, we might be glossing over the downsides and the fact that these often aren’t medically necessary?
I don’t know the answer.
As usual, that’s not going to stop me putting the question out there…
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Armbrust R, Hinkson L, von Weizsäcker K et al (2015). The Charité cesarean birth: a family orientated approach of cesarean section. The Journal of Maternal-Fetal & Neonatal Medicine. Posted online on January 9, 2015. doi:10.3109/14767058.2014.991917