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I often get pages from hospital nurses regarding a patient’s request for a sleeping pill. (Or is the request really from the nurse because a sleeping patient is less hassle? LOL.) My hospital’s formulary limits me to ambien, restoril, trazodone, benadryl, and melatonin. Of those, melatonin seems to be the safest in terms of adverse effects and drug interactions. But does it work?

Dr Harriet Hall over at SBM writes this:

The evidence is mixed and weak. There is some positive evidence for melatonin, and side effects are mild. I wouldn’t discourage anyone who wants to give it a try, but I think good sleep hygiene measures would be a better first step for treating insomnia.

Furthermore…

The optimum dosage has not been established. In studies, the doses have ranged from 1 to 12 mg. Supplements typically contain 1-3 mg. Dosages between 1 and 10 mg can raise melatonin levels to 3-60 times the levels normally found in the body.

Caution is advisable, since quality control is a documented problem. 71% of products did not contain within 10% of the labelled amount of melatonin, with variations ranging from -83% to +478%, lot-to-lot variability was as high as 465%, and the discrepancies were not correlated to any manufacturer or product type. To make matters worse, 8 out of 31 products were contaminated with the neurotransmitter serotonin.

If melatonin works by placebo effect alone, it will help ~10% of users, almost always without adverse effects. I dose it at 1.5 mg, with a repeat dose an hour later if needed.

Steve Parker, M.D.

Most of you don’t remember the 1976 flu epidemic. Early on, it appeared to be on track to equal the 1918 Spanish Flu death rates. Politicians and public health authorities felt like they better do something, anything, to avert disaster. Their response didn’t work out too well. COVID-19 isn’t the flu, but it’s a viral illness that often looks like the flu clinically.

From Discover magazine:

Vaccines were once thought of as an axiomatic good, a longed-for salvation in the form of a syringe, banishing crippling and deadly infections like polio, smallpox and tetanus. But within the past few decades we have seen the emergence of anti-vaccination movements and a rise in cases of childhood diseases that are entirely preventable with a quick jab to the arm.

Over the past five years, outbreaks of mumps, measles and whooping cough have cropped up throughout the country. And then, of course, there is widespread skepticism among the general public on influenza and the merits of a seasonal flu shot. Even as outbreaks of avian and swine flu have periodically emerged in this country, there are still people who resist vaccination against the flu. This seemingly pervasive opposition to flu vaccination is not without its historical and sociological roots.

Some of the American public’s hesitance to embrace vaccines — the flu vaccine in particular — can be attributed to the long-lasting effects of a failed 1976 political campaign to mass-vaccinate the public against a strain of the swine flu virus. This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiatives, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country.

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But while the World Health Organization adopted a cautious “wait and see” policy to monitor the virus’s pattern of disease and to track the number of emerging infections, President Gerald Ford’s administration embarked on a zealous campaign to vaccinate every American with brisk efficiency. In late March, President Ford announced in a press conference the government’s plan to vaccinate “every man, woman, and child in the United States” (1). Emergency legislation for the “National Swine Flu Immunization Program” was signed shortly thereafter on April 15th, 1976 and six months later high profile photos of celebrities and political figures receiving the flu jab appeared in the media. Even President Ford himself was photographed in his office receiving his shot from the White House doctor.

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The American public can be notably skeptical of forceful government enterprises in public health, whether involving vaccine advocacy or limitations on the size of soft drinks sold in fast food chains or even information campaigns against emerging outbreaks. The events of 1976 “triggered an enduring public backlash against flu vaccination, embarrassed the federal government and cost the director of the U.S. Center for Disease Control his job.”

One aspect of the fiasco was that of the 45 million U.S. residents hastily vaccinated against Swine Flu, 450 developed a severe neurological disorder called Guillain-Barre syndrome.

RTWT.

Steve Parker, M.D.