RESUMO
Loperamide (Imodium) is an opioid receptor agonist available over-the-counter and can be used for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, depression of the central nervous system, and cardiotoxicity. It may also be used for its euphoric effects and potentially to alleviate opioid withdrawal. Loperamide has a US boxed warning for torsades de pointes and sudden death. Loperamide has been reported to cause torsades de pointes, cardiac arrest, and death when higher than the recommended dosage is consumed. We report a rare case of ventricular arrhythmia provoked by accidental ingestion of loperamide to treat simple diarrhea.
RESUMO
In a recent edition of this journal Mikael Bask and Maria Melkersson suggested that moist snuff, snus to the Swedes, is not an effective tool in cigarette smoking cessation. The sole basis for this conclusion is their empirical findings concerning the cross-price elasticity of demand between cigarettes and snus. Specifically, they find that, "The cross-price elasticities are negative, which indicates that snus contributes to increased smoking. Thus, even if snus taking is less harmful than cigarette smoking, it is not advisable to encourage its use in smoking cessation programs." We find this conclusion to be unwarranted. It is based on a model estimated with inappropriate data; it is based on a misspecified model with questionable theoretical underpinnings; and no evidence is presented as to the statistical significance of the cross-price effects. Furthermore, even if we ignore these technical criticisms, their conclusions are unfounded because they are based on an inappropriate conceptual experiment. We first address some technical problems with the Bask and Melkersson analysis, and then we address the fundamental flaw in their reasoning.
