Pediatric Death Due to Myocarditis After Exposure to Cannabis

This is exactly how science works.

They report this possible case. Maybe there is never another association and the issue is forgotten, because there is no causal link. But maybe, someone else, some place else, who never read this paper, notices something similar and reports it. And maybe this happens several more times. And then, along the way, one of these reporters does a detailed search and finds the other reports. He collects the cases and maybe contacts the doctors who wrote the reports and writes what we call a Case-Series on these.

Maybe a couple case-series get written independently in various places. Someone finds these series and convinces someone else to fund a Case Control study.

Usually with environmental exposure literature this is exactly how "science" happens. Medicine is messy and serendipity is more than involved.

Hierarchy of evidence: http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-11040...

No.

Their argument is “Specifc myocardial complications related to cannabis toxicity that are well documented in adolescence through older adulthood include acute coronary syndrome, cardiomyopathy, myocarditis, pericarditis, dysrhythmias and cardiac arrest.2-4 To date, there are no reported pediatric deaths from myocarditis after confrmed, recent cannabis exposure“, therefore “this pediatric patient with death due to myocarditis may have died because cannabis exposure caused that myocarditis.”

And yes, if you get a highly anomalous event, it’s not at all unreasonable to point out that it immediately followed a highly anomalous input. If you’re looking for causality, x -> rare Y Is more likely if x is rare than if it isn’t. It inherently explains why Y is rare.

It seems like its more than that:

> The progressive clinical presentation of this patient during the prior 24-48 hours, including symptoms of somnolence, lethargy, irritability, nausea, seizure and respiratory depression are consistent with previously documented, known complications of recent cannabis exposure in the pediatric population.

Their source is here: https://alanflashman.files.wordpress.com/2014/02/piis0196064...

Those symptoms are consistent with exposure - it's too bad the case report didn't include any data from the parents (maybe I missed that).

There's no story from the parents as to what happened. The closest the paper gives to explaining the situation directly is at the end of the Case Report: "Additional history disclosed an unstable motel-living situation and parental admission of drug possession, including cannabis."

In the midst of the toxicological analysis, it mentions that the THC metabolites they observe were "most likely secondary to ingestion" and it later says, given that they observed various metabolites but not the primary compound itself, "the authors deduce that cannabis consumption occurred within the recent two to six days, assuming this was a single, acute high-potency ingestion."

So, most likely what happened is that the parents carelessly left some edibles around, and the infant toddled over and put one in his mouth. Infants put everything in their mouths, so an accidental exposure sounds plausible- albeit criminally negligent. I'd presume the parents have been charged accordingly.

Detailed reports of observations are important, normal portions of the scientific process. They're just the first step. Where is the line? Is a hypothesis with an experiment design not science? Is a negative finding not science? Is a positive self-reported study not science? Is a positive double-blind study also not science (because it hasn't been repeated)?

Being dismissive of preliminary findings as "not science" is the same kind of attitude that cause people to not publish negative results, which is an incredible tragedy of modern scientific progress.

No, it's a case report. They looked for more normal causes of myocarditis and didn't find any. Note that they only claim an association, not that it directly definitely caused it.

It seems very plausible that cannabis is toxic to infants in ways that it wouldn't affect adults.

Here's a quote of the relevant part of the abstract:

> histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death

No, they’re saying they’ve seen enough evidence to report to other doctors to keep an eye out for it. Reports of this nature are not unusual in medicine, someone just noticed this one because of the drug connection.

No, it is a case report.

Whenever there's anything negative even possibly associated with cannabis, there are those who must reflexively shoot it down, or minimize it (i.e. your data is wrong, or, if it's not wrong, it's not as bad as alcohol, or if it is, it's a rare issue). It's like they can't accept that cannabis could ever be bad for any reason. I find this very odd.