China introduces ‘social’ punishments for scientific misconduct


Offending researchers could face restrictions on jobs, loans and business opportunities under a system tied to the controversial social credit policy.

 

Xi Jinping smiles during a state banquet at the Malacanang Presidential Palace in Manila on November 20, 2018

Chinese president Xi Jinping has said people who lose trust in one area of society should face restrictions in other areas.

Researchers in China who commit scientific misconduct could soon be prevented from getting a bank loan, running a company or applying for a public-service job. The government has announced an extensive punishment system that could have significant consequences for offenders — far beyond their academic careers.

Under the new policy, dozens of government agencies will have the power to hand out penalties to those caught committing major scientific misconduct, a role previously performed by the science ministry or universities. Errant researchers could also face punishments that have nothing to do with research, such as restrictions on jobs outside academia, as well as existing misconduct penalties, such as losing grants and awards.

“Almost all aspects of daily life for the guilty scientists could be affected,” says Chen Bikun, who studies scientific evaluation systems at Nanjing University of Science and Technology.

The policy, announced last month, is an extension of the country’s controversial ‘social credit system’, where failure to comply with the rules of one government agency can mean facing restrictions or penalties from other agencies.

The punishment overhaul is the government’s latest measure to crack down on misconduct. But the nature and extent of the policy has surprised many researchers. “I have never seen such a comprehensive list of penalties for research misconduct elsewhere in the world,” says Chien Chou, a scientific integrity education researcher at Chiao Tung University in Taiwan.

Although some penalties for misconduct existed before the new policy — research programmes can be suspended; offenders can be barred from promotions — drawing them together under one framework makes them much more powerful, says Yang Wei, the former head of the National Science Foundation of China who is now a researcher at Zhejiang University in Hangzhou.

“This sends a clear signal that curbing misconduct should go beyond the academic community or individual morality. Legal punishment can be also applied,” says Li Tang, who studies science policy at Fudan University in Shanghai.

Whether the system will reduce misconduct will depend on how it is enforced, say some researchers. Others, including Chen, are certain it will work. “Without doubt, it will be effective,” he says.

Big brother

The social credit system, which was introduced in 2014, has had a large effect on life in the country. Failure to pay debts or fines can be recorded on the system’s website and lead to restrictions when applying for a credit card, insurance, or even train tickets.

As of April, the number of times people were denied airline tickets as a result of the system reached 11 million, and train tickets were denied on 4.2 million occasions. More than two million people have paid debts or fines after facing these restrictions.

President Xi Jinping described the rational for the system at a meeting of the Chinese Communist Party in 2016 as: “Lose trust in one area, face restrictions everywhere.”

The new misconduct policy also refers to “loss of trust”. And those who commit scientific misconduct will now be named and shamed on the social credit system’s website.

Misconduct focus

Chinese leaders have been increasingly focused on scientific misconduct, following ongoing reports of researchers there using fraudulent data, falsifying CVs and faking peer reviews. In May, the government announced sweeping reforms to improve research integrity. One of those was the creation of a national database of misconduct cases. Inclusion on the list could disqualify researchers from future funding or research positions, and might affect their ability to get jobs outside academia.

The punishment system appears to chime with that goal. “It shows that China takes research integrity very seriously,” says Max Lu, a chemical engineer and president of the University of Surrey in Guildford, UK, , who has previously advised the Chinese government on science policy.

Lu thinks the system’s success will depend on how it is enforced. “There is always the risk of lacking the necessary resources and qualified managers for enforcing the very draconian and large number of rules,” he says.

Tang says the government is likely to focus on punishing the most egregious cases first, such as repeat offenders, those whose fraud creates a social uproar, and those whose fraud has major consequences. “This is such a daunting task that the government will start with a few major misconducts,” she says.

But the government needs to define what actions constitute major research misconduct, and how penalties will apply, says Chou. “It should be clear for researchers,” she says.

Addressing misconduct in China will also require more than punishments, says Tang. Educating researchers, particularly those in the early stages of their career, will also help cultivate an ethical research system, she says. Mandatory courses on research integrity are becoming more common, but more could be done, she says. “Educating lab PIs and younger generations is extremely important,” she says.

“This is a timely and resolute policy that will no doubt strengthen the whole ecosystem of science and research in China,” says Lu. He thinks other countries may look to the punishment system as an example of how to enforce responsible research conduct.

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‘Transmissible’ Alzheimer’s theory gains traction


Mouse tests confirm that sticky proteins associated with degenerative brain diseases can be transferred — but researchers say risks for humans are likely to be minimal.

 

 

Alzheimer's disease

A normal brain of a 70-year-old (left slice), compared with the brain of a 70-year-old with Alzheimer’s disease.

Neuroscientists have amassed more evidence for the hypothesis that sticky proteins that are a hallmark of neurodegenerative diseases can be transferred between people under particular conditions — and cause new damage in a recipient’s brain.

They stress that their research does not suggest that disorders such as Alzheimer’s disease are contagious, but it does raise concern that certain medical and surgical procedures pose a risk of transmitting such proteins between humans, which might lead to brain disease decades later.

“The risk may turn out to be minor — but it needs to be investigated urgently,” says John Collinge, a neurologist at University College London who led the research, which is published in Nature1 on 13 December.

The work follows up on a provocative study published by Collinge’s team in 20152. The researchers discovered extensive deposits of a protein called amyloid-beta during post-mortem studies of the brains of four people in the United Kingdom. They had been treated for short stature during childhood with growth-hormone preparations derived from the pituitary glands of thousands of donors after death.

The recipients had died in middle-age of a rare but deadly neurodegenerative condition called Creutzfeldt-Jakob disease (CJD), caused by the presence in some of the growth-hormone preparations of an infectious, misfolded protein — or prion — that causes CJD. But pathologists hadn’t expected to see the amyloid build up at such an early age. Collinge and his colleagues suggested that small amounts of amyloid-beta had also been transferred from the growth-hormone samples, and had caused, or ‘seeded’, the characteristic amyloid plaques.

Seeds of trouble

Amyloid plaques in blood vessels in the brain are a hallmark of a disease called cerebral amyloid angiopathy (CAA) and they cause local bleeding. In Alzheimer’s disease, however, amyloid plaques are usually accompanied by another protein called tau — and the researchers worry that this might also be transmitted in the same way. But this was not the case in the brains of the four affected CJD patients, which instead had the hallmarks of CAA.

The team has now more directly tested the hypothesis that these proteins could be transmitted between humans through contaminated biological preparations. Britain stopped the cadaver-derived growth hormone treatment in 1985 and replaced it with a treatment that uses synthetic growth hormone. But Collinge’s team was able to locate old batches of the growth-hormone preparation stored as powder for decades at room temperature in laboratories at Porton Down, a national public-health research complex in southern England.

When the researchers analysed the samples, their suspicions were confirmed: they found that some of the batches contained substantial levels of amyloid-beta and tau proteins.

Mouse tests

To test whether the amyloid-beta in these batches could cause the amyloid pathology, they injected samples directly into the brains of young mice genetically engineered to be susceptible to amyloid pathology. By mid-life, the mice had developed extensive amyloid plaques and CAA. Control mice that received either no treatment or treatment with synthetic growth hormone didn’t have amyloid build up.

The scientists are now checking in separate mouse experiments whether the same is true for the tau protein.

“It’s an important study, though the results are very expected,” says Mathias Jucker at the Hertie Institute for Clinical Brain Research in Tubingen, Germany. Jucker demonstrated in 2006 that amyloid-beta extracted from human brain could initiate CAA and plaques in the brains of mice3. Many other mouse studies have also since confirmed this.

Surgical implications

That the transmissibility of the amyloid-beta could be preserved after so many decades underlines the need for caution, says Jucker. The sticky amyloid clings tightly to materials used in surgical instruments, resisting standard decontamination methods4. But Jucker also notes that, because degenerative diseases take a long time to develop, the danger of any transfer may be most relevant in the case of childhood surgery where instruments have also been used on old people.

So far, epidemiologists have not been able to assess whether a history of surgery increases the risk of developing a neurodegenerative disease in later life — because medical databases tend not to include this type of data.

But epidemiologist Roy Anderson at Imperial College London says researchers are taking the possibility seriously. Major population cohort studies, such as the US Framingham Heart Study, are starting to collect information about participants’ past surgical procedures, along with other medical data.

The 2015 revelation prompted pathologists around the world to reexamine their own cases of people who had been treated with similar growth-hormone preparations — as well as people who had acquired CJD after brain surgery that had involved the use of contaminated donor brain membranes as repair patches. Many of the archived brain specimens, they discovered, were full of aberrant amyloid plaques5,6,7. One study showed that some batches of growth-hormone preparation used in France in the 1970s and 1980s were contaminated with amyloid-beta and tau — and that tau was also present in three of their 24 patients.8

Collinge says he applied unsuccessfully for a grant to develop decontamination techniques for surgical instruments after his 2015 paper came out. “We raised an important public-health question, and it is frustrating that it has not yet been addressed.” But he notes that an actual risk from neurosurgery has not yet been established.

Shameless vaccine promoters now using zoo animals for propaganda: Baby gorilla “gets his flu shot”


Image: Shameless vaccine promoters now using zoo animals for propaganda: Baby gorilla “gets his flu shot”

As more Americans are wising up to the sham of vaccination, Big Pharma and the mainstream media are conjuring up pro-vaccine propaganda whenever they can. Now, the vaccine industry is stooping so low as to use zoo animals to fuel their  agenda. And at the Smithsonian’s National Zoo, a baby gorilla was just given his first flu shot — a prime choice for any industry looking to woo consumers. Who can resist cute baby animals?

Moke, a 7-month-old lowland gorilla, received the flu vaccine at the end of November, according to an update from primate keeper Melba Brown. Brown says that the vaccination was part of their usual “health care regimen” for gorillas.

“One day, flanked by both his parents, he turned around and hoisted that leg up, at which point the vaccine was successfully injected. He did not even flinch! True to his remarkable persona, Moke simply turned around and accepted a grape halve, as did Calaya and Baraka,” Brown writes in the update.

Animals are known for being notoriously good at hiding pain; it’s their instinct to avoid showing vulnerability. Surely Brown, an expert in wildlife, is aware of this fact. Just because Moke did not react in a way that a human would recognize as “pain,” does not mean the shot didn’t hurt him. Moreover, as an animal, Moke and other gorillas are not even able to consent to, nor truly understand, the process of vaccination.

At the time of Brown’s reporting, Moke weighed just 12.6 pounds.

It also makes you wonder, if gorillas need flu shots, then why aren’t the vaccine companies running around the world capturing all wild animals (elephants, whales, deer, zebra, wolves) and making sure they all get their flu shots? Furthermore, if flu shots are necessary for wild animals to survive, how did all these animals ever survive before the invention of human vaccines?

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Animals now being used to promote vaccine propaganda

What the National Zoo’s update on Moke’s flu shot doesn’t tell you is that flu vaccination is a highly controversial topic. While the mainstream media and other puppets of the vaccine industry, including the CDC, insist that flu vaccination is the best, most efficient way to prevent influenza, time and time again, we see that the flu vaccine for humans has an astronomical rate of failure and adverse events.

Natural News has repeatedly reported on the fraudulent and dangerous nature of the entire vaccine industry on many occasions, with founder Mike Adams recently declaring that the flu shot amounts to nothing more than “systemic healthcare fraud.”

The heavy politicization of Moke’s flu shot has nothing to do with the baby gorilla’s well-being, and everything to do with advancing so-called public health initiatives. Vaccine propaganda is everywhere, especially now that reports are showing most adults in the United States have not gotten inoculated this season.

A title from The Chicago Tribune reads, “A shot to save grandma: If vaccination rates rise just 1 percentage point, 807 won’t die from flu.”

The Washington Post‘s piece on Moke is titled, “Gorilla, susceptible like us, to flu, gets his shot at National Zoo,” — another attempt at subtly urging readers to get their own shot.

Cute animals are another tool of propaganda experts: Beyond baby Moke’s flu shot, there’s the left-wing media’s manipulation of “gay” penguins. Scientists have found that males will “pair” together out of loneliness and a lack of females within their colony. Every “homosexual” penguin pair studied has split up once more females become available — including the famed Silo and Roy, who were kept together for six years, until a new female was introduced to their colony. But the media continues to use and abuse these animals to suit their needs. Whether it’s forcing flu shots onto unsuspecting (and non-consenting!)  animals, or making penguins “gay” to advance their own agenda, it’s clear that the animals are the victims here.

Coincidentally enough, Moke’s vaccination story has been circulating at around the same time a Las Vegas man lost his vision, became partially paralyzed and lost his ability to breathe without assistance after getting his own flu shot.

Too Much Oxygen Is Harmful


A meta-analysis shows significantly higher mortality with liberal use of supplemental oxygen in acutely ill patients.

 

Supplemental oxygen can be a life-saving intervention for patients with hypoxemic respiratory failure; however, emerging evidence suggests that too much oxygen is harmful (NEJM JW Gen Med Dec 1 2016 and NEJM 2016; 316:1583). Small trials have shown excess cardiac arrhythmias, lung injuries, and other complications in hospitalized patients without demonstrated hypoxemia who receive oxygen or whose oxygen administration results in supra-normal partial pressures (i.e., hyperoxemia). Should we be doing more to turn down the oxygen when it’s not needed?

Investigators completed a meta-analysis of 25 randomized trials that included 16,000 acutely ill patients who were treated with either a liberal or a conservative oxygenation strategy. Oxygen targets and supplementation thresholds differed across studies. Median oxygen supplementation levels were fraction of inspired oxygen (FiO2) 0.52 vs. 0.21 (liberal vs. conservative).

Relative risk for death at 30 days was significantly higher in patients who received liberal oxygen (RR, 1.14), although no association was evident between mortality and either peripheral saturation or FiO2. Risk for disability, length of stay, and incidence of hospital-acquired infections, including pneumonia, were similar under both strategies.

Comment

All too often, a patient’s oxygen saturation is maintained at 100%. This is not only unnecessary but also probably harmful. It should become part of our practice to turn down the supplemental oxygen until we see oxygen saturations no higher than 95% for most patients and to stop oxygen use as soon as it is not needed. I suspect that we will learn that a target saturation lower than 95% is safe, but for now, avoiding hyperoxemia makes sense.

Effects of platinum and palladium nanocolloid on macrophage polarization in relevance to repigmentation of vitiligo


Abstract

Background

Elevated oxidative stress is accepted to be the initial event in vitiligo leading to the final pathological regulation of immune systems known as autoimmune reaction, which destroys melanin‐forming cells, melanocytes. Recently, we reported an efficient topical use of PAPLAL, nanocolloid of platinum and palladium, having intense catalase‐like activity to vitiligo patients. In addition, we found that PAPLAL has dual effects on the AhR and Nrf‐2 pathways in keratinocytes, and suggested its contribution to the recovery of immune state in vitiligo. The precise mechanism developing autoimmune reaction in vitiligo, however, remains to be clarified. It is important to clarify what kinds of cells play an essential role in the development of vitiligo.

Objective

To further understand the effective mechanisms of PAPLAL on immunity of skin, and to confirm a role of autoimmunity in vitiligo development, we studied the effect of PAPLAL on macrophage polarization and its activities which are recognized to play a pivotal role in immune and inflammatory reactions in many organs.

Methods

Rat and human macrophages were cultured and stimulated in vitro with both LPS and IFN‐γ for M1 polarization and IL‐4 and IL‐13 for M2 polarization with or without PAPLAL. Expression of typical M1 and M2 markers was determined at mRNA and protein levels.

Results

Simultaneous treatment with PAPLAL suppressed remarkably the production of M1 markers, iNOS, and TNF‐α; further, PAPLAL also suppressed M2 markers, mannose receptor (Man R), Chitinase 3‐like 3 (YM‐1), and iron regulatory protein‐1 (IRP‐1), at mRNA and protein levels, but less effectively compared to those of M1. PAPLAL, however, did not suppress phagocytic activity of M0, M1, and M2 cells.

Conclusion

These results indicate that macrophages may be involved in the therapeutic potential of PAPAL by altering immunological environment disturbed in skin, with the delicate shift of the M1‐M2 polarization, but without affecting on phagocytic activity.

Antibiotic and acid-suppression medications during early childhood are associated with obesity


Abstract

Objective Gut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated the association of antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood with a diagnosis of obesity.

Design We performed a cohort study of US Department of Defense TRICARE beneficiaries born from October 2006 to September 2013. Exposures were defined as having any dispensed prescription for antibiotic, H2RA or PPI medications in the first 2 years of life. A single event analysis of obesity was performed using Cox proportional hazards regression.

Results 333 353 children met inclusion criteria, with 241 502 (72.4%) children prescribed an antibiotic, 39 488 (11.8%) an H2RA and 11 089 (3.3%) a PPI. Antibiotic prescriptions were associated with obesity (HR 1.26; 95% CI 1.23 to 1.28). This association persisted regardless of antibiotic class and strengthened with each additional class of antibiotic prescribed. H2RA and PPI prescriptions were also associated with obesity, with a stronger association for each 30-day supply prescribed. The HR increased commensurately with exposure to each additional medication group prescribed.

Conclusions Antibiotics, acid suppressants and the combination of multiple medications in the first 2 years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.

J&J shares plunge 11% after report that the company knew for decades about asbestos in baby powder


  • Johnson & Johnson shares plunge 11% after a Reuters report said J&J knew for decades about asbestos in baby powder.
  • Reuters based its report on a review of documents and testimony.
  • It says that from 1971 to the early 2000s, J&J executives, mine managers, doctors and lawyers were aware the company’s raw talc and finished powders sometimes tested positive for small amounts of asbestos.

In this photo illustration, a container of Johnson's baby powder made by Johnson and Johnson sits on a table on July 13, 2018 in San Francisco, California.

Johnson & Johnson shares fall on report of asbestos in talcum powder

Johnson & Johnson knew for decades that its baby powder contained asbestos, Reuters saidin a report that drove the company’s shares down nearly 11 percent Friday.

Reuters based its report on a review of documents and deposition and trial testimony. It said the review showed that from 1971 to the early 2000s, J&J executives, mine managers, doctors and lawyers were aware the company’s raw talc and finished powders sometimes tested positive for small amounts of asbestos. Those involved discussed the problem but they did not disclose it to regulators or the public, Reuters’ examination found.

By late morning Friday, J&J stock was down 10.8 percent, on pace for its worst day in more than a decade, when its shares closed down 15.85 on July 19, 2002.

On top of likely being the stock’s biggest drop since 2002, the plunge was likely a shock for shareholders used to a boring consumer staple that moves in much steadier increments than the overall market and more volatile stocks. J&J’s stock beta over the last five years is 0.72, meaning that it swings much less than the market on a daily basis (a beta of 1 would mean it moves equal to the market and greater than 1 means it is more volatile than the S&P 500).

“Plaintiffs’ attorneys out for personal financial gain are distorting historical documents and intentionally creating confusion in the courtroom and in the media,” Ernie Knewitz, J&J’s vice president of global media relations, told Reuters in an email. “This is all a calculated attempt to distract from the fact that thousands of independent tests prove our talc does not contain asbestos or cause cancer. Any suggestion that Johnson & Johnson knew or hid information about the safety of talc is false.”

J&J referred Reuters to its outside lawyers, who rejected Reuters’ findings as “false and misleading.”

“The scientific consensus is that the talc used in talc-based body powders does not cause cancer, regardless of what is in that talc,” Peter Bicks told Reuters in an email. “This is true even if — and it does not — Johnson & Johnson’s cosmetic talc had ever contained minute, undetectable amounts of asbestos.” He dismissed the tests cited in Reuter’s article as “outlier” results, Reuters said.

The company has faced a wave of lawsuits alleging its talc baby powder products contain asbestos and caused ovarian and other cancers. Some juries have sided with J&J and others have been unable to reach verdicts. A Missouri jury in July ordered J&J to pay $4.9 billion in a case involving 22 women and their families. A judge affirmed the verdict in August and J&J vowed to appeal it.

J&J has filed thousands of documents in court proceedings, though most have been designated as confidential.

Transplanting Pig Hearts Into Humans One Step Closer


Professor Stig Steen’s heart preservation technology shows success in transplantating hearts from pigs to baboons.

 

Transplanting Pig Hearts Into Humans One Step Closer

 

The scientific journal Nature recently published an article from Munich University Hospital which describes the long-term survival of baboons that had received a heart transplant from genetically modified pigs.1 This is an important step forward on the way to being able to give humans porcine heart transplants.

Pig hearts are very similar in size, anatomy and function to human hearts, so are used to train medical students. Porcine hearts are the gold-standard in pre-clinical animal testing for all cardiovascular devices prior to use in humans to both test the safety and efficacy, and refine the implant procedures.

The article describes two requirements that have enabled the good results. One of these requirements is the introduction of non-ischemic heart preservation in accordance with the method using the products developed by Prof. Stig Steen and Swedish company XVIVO, and the other requirement is inhibition of post-transplantation growth of the heart, which otherwise would become too big for the primate.

XVIVO owns all commercial rights to the technology and is submitting an application to the Swedish Medical Products Agency as a prerequisite for a multicenter study on XVIVO’s products for heart preservation. The company plans to submit the application within approximately one month.

The XVIVO products consist of a preservation solution which has the same composition as that clinically used in the heart transplant study ongoing at the University Hospitals of Lund, earlier pre-clinical studies and now pre-clinically used in Munich for heart preservation in xenotransplantation. The technology also includes a portable heart preservation machine incorporating a single-use component which has been constructed by XVIVO, in accordance with Steen’s technology.

According to the United Network for Organ Sharing (UNOS), a total of 3,133 heart transplants have occurred in 2018, while 3,832 patients are currently waiting for a new heart,2 highlighting the need for creative solutions. An average of 20 people die every day while waiting for an organ transplant.2

Top Ten Drugs Tied to Overdose Deaths


Deaths from drug overdose in the United States increased by 54% from 2011 to 2016 — with opioids, benzodiazepines (benzos), and stimulants the most commonly used drug classes involved, a new report released today by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), shows.

The report notes that there were 41,340 drug overdose deaths in 2011 vs 63,632 such deaths in 2016.

Although the opioid oxycodone was the most cited drug in overdose death records in 2011, heroin took the top spot from 2012 to 2015.

The story around fentanyl may be even more troubling. The rate of overdose deaths involving it or one of its analogs doubled each year from 2013 through 2016, when it finally took the lead in becoming the most mentioned drug. In 2016, 29% of all overdose deaths involved fentanyl (n = 18,335).

In addition, the stimulant cocaine was the second or third most cited drug in the overdose death records throughout the entire study period.

The CDC’s list of the 10 most frequently mentioned drugs also included the opioids methadone, morphine, and hydrocodone; the benzos alprazolam and diazepam; and the stimulant methamphetamine.

Of all 10 drugs, only methadone was associated with a decreasing overdose death rate from 2011 to 2016.

“While the ranking changed from year to year, the top 10 drugs involved in overdose deaths remained consistent throughout the 6-year period,” note the investigators, led by Holly Hedegaard, MD, NCHS.

“This report identifies patterns in the specific drugs most frequently involved in drug overdose deaths…and highlights the importance of complete and accurate reporting in the literal text on death certificates,” they write.

The data were published online in the December 12 issue of the National Vital Statistics Reports.

Rise in Overdose Death Toll

An NCHS report released last year showed the age-adjusted rate of US drug overdose deaths increased dramatically from 1999 (6.1 per 100,000 population) to 2016 (19.8 per 100,000).

Although several previous studies on drug overdoses have used National Vital Statistics System-Mortality (NVSS-M) information, this data is coded using the International Classification of Diseases, Tenth Revision (ICD-10); and these ICD-10 codes focus on broad drug categories rather than on individual drugs, note the investigators.

In answer to this, the NCHS and the US Food and Drug Administration “collaboratively developed methods to search the literal text from death certificates to identify mentions of specific drugs and other substances, and to search contextual terms to identify involvement of the drug(s) or substance(s) in the death,” the researchers write.

They defined “literal text” as written information from the medical certifier on cause or circumstances related to a death.

For the current report, they examined NVSS-M data from 2011 through 2016. These data were linked to electronic files containing death certificate information.

In addition to the top 10 drugs involved in overdose deaths, drugs that held the number 11 through number 15 ranking throughout the 6-year study period included diphenhydramine, acetaminophen, citalopram, carisoprodol, oxymorphone, tramadol, amitriptyline, clonazepam, gabapentin, and amphetamine.

Threefold Increase in Heroin Deaths

The involvement of heroin in overdose deaths rose threefold from 4571 deaths in 2011 to 15,961 deaths in 2016. This made it the second-most mentioned drug in 2016, behind fentanyl.

Mentions of cocaine increased from 5892 overdose deaths in 2014 to 11,316 deaths in 2016, giving it that year’s number 3 ranking.

The fourth most mentioned drug in overdose deaths in 2016 was methamphetamine. Its 6762 related deaths signified a sharp increase from the 1887 related deaths in 2011.

“An analysis of trends…showed that, for several drugs, the age-adjusted rate of drug overdose deaths increased considerably within a relatively short period,” the investigators write.

Heroin, cocaine, and methamphetamine all showed significant increasing trends for age-adjusted rates of drug overdose deaths between 2011 and 2016 (1.5 vs 5.1 per 100,000 population; 1.6 vs 3.6 per 100,000; and 0.6 vs 2.1 per 100,000, respectively; all, P < .05).

Fentanyl showed a significant increasing trend between 2013 and 2016 (0.6 vs 5.9 per 100,000; P < .05).

The only decrease for a specific drug came from methadone, which was mentioned in 4545 overdose deaths in 2011 vs 3493 deaths in 2016 (1.4 vs 1.1 per 100,000). Still, it was the eighth most mentioned drug in 2016.

For the 2016 top 10 drugs, “the proportion of deaths involving both the referent drug and at least one other concomitant drug ranged from 50% for methamphetamine to 96% for alprazolam or diazepam,” the researchers report.

Finally, drugs most frequently recorded in unintentional overdose deaths in 2016 were fentanyl, heroin, and cocaine. The most frequently cited drugs in suicide by overdose were oxycodone, diphenhydramine, hydrocodone, and alprazolam.

Medication Omission Common Cause of Fatal Med Errors


Fatal medication errors are most common with anticoagulants and antibiotics, a new study shows. The most common types of medication administration errors (MAEs) were medication omissions, followed by administration of a wrong dose or wrong strength of medication. Half of the reported incidents involved a patient older than 75 years.

“Our findings show that more attention should be paid to the safe administration of medication especially when it comes to older people. It is important to make sure that the patient gets the right dose of medication at the right time and in the right way,” lead author Marja Härkänen, RN, PhD, postdoctoral researcher, Academy of Finland, University of Eastern Finland, said in a news release.

Härkänen’s and colleagues’ findings were published online November 22 in Research in Social and Administrative Pharmacy.

The researchers analyzed 229 fatal MAEs reported to the National Reporting and Learning System for England and Wales between 2007 and 2016. A total of 517,384 medication errors were reported.

Two thirds (66.4%; n = 152) of fatal MAEs occurred on hospital wards, and 41.5% (n = 95) of patients were older than 75 years.

The most common drug groups involved in fatal MAEs were cardiovascular drugs (20.1%; n = 46), drugs that affect the central nervous system (10.0%; n = 23), and antibacterials (n = 20). The most frequently involved drug types were injectable anticoagulants, antibiotics, and analgesics.

For anticoagulants, the difference between an effective dose and a toxic dose is small, making errors with these drugs more likely to cause death than errors involving some other types of drugs.

Most MAEs related to antibacterial drugs were omissions, those involving adverse drug reactions, and those that occurred in patients with a documented allergy. Drugs that treat infection were the most common drugs involved in MAEs in children younger than 12 years.

The most common types of errors involving medications that affect the central nervous system, including opioids, were those involving “wrong or unclear dose or strength, wrong drug, or wrong quantity,” the authors write.

Overall, almost one third of MAEs were omissions of a medication or ingredient (31.4%; n = 72), followed by administration of a wrong dose or at the wrong strength (10.5%; n = 24).

Omission of anticoagulants, insulins, and cytotoxic agents “can cause significant or catastrophic long-term patient impact,” the authors write. Possible reasons for medication omissions include staff shortages and delays in medication administration, inability of patients to take their medication, and medication unavailability.

The researchers encourage the implementation of “more active solutions” through the development of technology, improved work processes and information flow, verification systems, and drug availability.

They say it is difficult to recommend specific interventions, however, noting that a previous systematic review and meta-analysis found no clear effect of interventions, including nurse training and education, automated delivery systems, and barcode-assisted medication administration systems.

“Although all errors do not cause harm to the patient, it is important to work to prevent especially those that do. This requires sufficient human resources and competent staff, as well as technological and digital solutions that promote competence development among staff, and that ensure medication safety,” Katri Vehviläinen-Julkunen, PhD, RN, director of the doctoral program in health sciences at the University of Eastern Finland, said in the news release.

A strength of the study is that it was large enough to detect rare MAEs that resulted in death. A limitation of the study is that MAEs may have been underreported, the authors write.

“While incident report data are subject to under-reporting, under-reporting may be less likely for errors that result in death, and so this study also represents a useful approach to learning from reported medication incidents. It also highlights the importance of preventing the omission of doses, as these were commonly implicated in our data,” coauthor Bryony Dean Franklin, PhD, FRPharmS, FFRPS, from University College London and the National Institute for Health Research Imperial Patient Safety Translational Research Center, noted in the news release.