The edition · Internal Medicine
Sibling comparison finds no link between prenatal paracetamol and autism or ADHD
A Hong Kong cohort of 700,000 mother-child pairs dissolves the paracetamol signal once families are compared with themselves; an updated review ranks weight loss across GLP-1 drugs; and GDF-15 predicts death far better than it diagnoses ischaemia.
The edition in brief
Using sibling-matched cohorts drawn from 708,020 Hong Kong mother-child pairs, prenatal paracetamol exposure was not associated with autism (aHR 1.00, 0.91 to 1.11) or ADHD (aHR 1.01, 0.93 to 1.08). Conventional analyses showed positive associations, but so did paracetamol taken before pregnancy, pointing to family confounding rather than a drug effect. An updated Annals systematic review of 38 trials (25,816 adults without diabetes) reports placebo-subtracted weight loss of up to 5.8% with liraglutide, about 14 to 15% with oral or injectable semaglutide, 12.4% with orforglipron and 19.0% with tirzepatide; gastrointestinal effects affected 76% vs 40% on placebo. In 3,379 patients investigated for suspected functionally relevant coronary disease, GDF-15 diagnosed ischaemia poorly (AUC 0.60) but predicted two-year death well (AUC 0.82), at least as well as troponin T. A network meta-analysis of 21 ICU trials found no nursing add-on, including music, acupressure or longer visiting, significantly better than regular nursing care for delirium.
Weight loss on GLP-1 drugs reached up to 6%–19% above placebo, depending on the agent
When starting a GLP-1-based drug for obesity, match the drug's expected weight loss to the patient's goal, and plan for gastrointestinal side effects.
GDF-15 predicted death well but diagnosed ischaemic coronary disease poorly
GDF-15 tells you how sick the patient is overall, not whether their coronary arteries are causing ischaemia.
No nursing add-on beat good standard care for ICU delirium in a network meta-analysis
For delirium, deliver the standard prevention bundle reliably rather than adding unproven single interventions.
Read the medication list backwards at every admission
At admission, ask what each drug is for; a drug without a reason, or one treating another drug's side effect, is a candidate to stop.
Comparing siblings removed the paracetamol-autism and ADHD signal entirely
Continue to recommend paracetamol for fever and pain in pregnancy; sibling data do not support a link with autism or ADHD.
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