PESTICIDE EXPOSURE AND DEMENTIA
Bibliographic record
Abstract
To the Editor: Although Kamal-Bahl et al. 1 demonstrated that elderly patients commonly use propoxyphene, the authors stated that the use of propoxyphene is inappropriate for this population.Unfortunately, such statements are typical of long-standing misconceptions about propoxyphene.First, although the authors effectively employ 1998 Medicare Current Beneficiary Survey data, they neither provide epidemiological evidence of widespread detrimental effects associated with the proper use of propoxyphene nor cite references solidly demonstrating such purported effects.Second, the authors base their assumption on the works of Beers et al., 2,3 consensus publications that have significant methodological flaws, designed to fault only propoxyphene for adverse effects attributable to the entire class of opioids.The Kamal-Bahl et al. study 1 is but the most recent study among many that systematically exhibits these flaws.[4][5][6] A likely reason that some practitioners have considered propoxyphene inappropriate for elderly patients may be because it is believed to increase the probability of falls.Yet, in a recent survey of more than 8,000 community-dwelling women aged 65 and older, multivariate analyses show that opioids are not associated with an increased likelihood of falls.7 As a rheumatologist with 25 years of clinical experience, I have treated many thousands of patients, approximately 60% of whom are aged 65 and older.I have used propoxyphene in many of these patients, achieving acceptable analgesic efficacy with only rare adverse experiences.By and large, except for occasional dose modifications for the extremely elderly, frail, or chronically ill, my patients tolerate full therapeutic doses.Propoxyphene, especially in combination with acetaminophen, is a safe, effective analgesicFa proven, established agent in the physician's armamentarium against pain.[8][9][10] Few analgesics have demonstrated 40-plus-year histories of safety and efficacy in elderly patients.Terms such as ''inappropriate prescribing'' need to be based on results of controlled clinical studies or outcomes research in which risks outweigh benefits.Dr. Morton serves on the advisory board of aaiPharma, Inc. (Wilmington, NC), which markets propoxyphene.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.010 | 0.010 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".