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In this installment of Med Op-Ed: Should an over-the-counter (OTC) antihistamine be prescription only; applying lessons from Sherlock Holmes in the clinic; and second-guessing the rush to invent medical technology for older adults.
Time to End OTC Diphenhydramine for Allergies?
Oral diphenhydramine should be withdrawn from OTC allergy products due to the risk for adverse reactions and the availability of newer medications that offer equally effective treatment with less harm, according to James H. Clark, MD; Eli O. Meltzer, MD; and Robert M. Naclerio, MD, writing in JAMA Internal Medicine.
The Context
- Diphenhydramine remains one of the most-used OTC antihistamines in the United States, despite second-generation alternatives being available OTC with comparable pricing and better safety profiles.
- Research has shown that diphenhydramine can cause more impairment during simulated driving tests than illegal blood alcohol levels.
- The drug’s anticholinergic activity contributes to delirium, dry eyes and mouth, constipation, and urinary retention. Epidemiologic studies demonstrated an association between long-term use of anticholinergic medications and increased risk for dementia.
In Their Own Words
“Although requiring a prescription would limit patient choice for those who prefer diphenhydramine over second-generation antihistamines, we believe this impact is outweighed by the substantial public health benefits.”
Read it: Remove Oral Diphenhydramine From OTC – End the Status Quo
From Baker Street to the Bedside
To better understand and teach abstract diagnostic concepts, consider turning to Sherlock Holmes, suggests Sherine E. Salib, MD, in the Journal of General Internal Medicine. The fictional detective’s deductive methods often parallel clinical reasoning, which makes sense, given his creator, Sir Arthur Ignatius Conan Doyle, practiced medicine before turning to writing.
The Context
- A Sherlockian approach to medicine can emphasize thorough data collection, careful synthesis of information, and the value of experience in developing cognitive shortcuts.
- Collaborative reasoning is encouraged, as sharing difficult cases with colleagues can provide clarity and different perspectives.
- To avoid the pitfalls of cognitive biases, clinicians might — as Holmes himself put it — make “a point of never having any prejudices and of following docilely wherever fact may lead me.”
In Their Own Words
“Clinical reasoning is, in actual fact, less of an algorithmic ladder of rationality, and more so a web of interweaving, multileveled, and multifaceted layers of complexity.”
Read it: Case Not Closed: The Sherlockian Approach – A Powerful Tool to Teach Clinical Reasoning
Are We Over-Relying on Tech for Aging Adults?
A growing emphasis on technology in healthcare for older adults with complex needs risks oversimplifying the challenges faced by this population, according to Kristina Kokorelias, PhD, and Lauren Lapointe-Shaw, MD, PhD, writing in the Journal of the American Geriatrics Society.
The Context
- Research publications on aging and technology surged from 2000 to 2024, and opportunities for research funding in this space also increased.
- Although digital tools such as medication management apps can support independence, they might be a source of stress for patients with cognitive impairment.
- Many persistent challenges in long-term care involve “body-centered issues,” such as continence, mobility, and chronic pain, which require human support, the commentary noted.
In Their Own Words
“Digital tools that promise to ‘ease burden’ can, paradoxically, increase it by assuming caregivers have the time, skills, and emotional energy to manage another platform, dashboard, or alert system.”
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
