Episode Details

Episode 37: Honey in Medicine. 

Smoking cessation update. Honey in medicine. Uses, precautions, honey-related terms. Macroglossia and presbycusis are defined. Jokes about honey. 

Today is January 15, 2021. 

The American Thoracic Society approved a clinical practice guideline regarding pharmacologic treatment of tobacco dependence in adults. This guideline was published in May 2020 in the American Journal of Respiratory and Clinical Care Medicine. Seven recommendations about initial medications used in smoking cessation were given, five are STRONG recommendations and two are CONDITIONAL recommendations.

Let’s start with the STRONG recommendations for tobacco-dependent adults in whom treatment is being initiated:

Varenicline over a nicotine patch is recommended. Remarks: Be prepared to counsel your patients about the relative safety and efficacy of varenicline compared with a nicotine patch.

Varenicline over bupropion is recommended.

In patients who are not ready to quit smoking, treatment with varenicline rather than waiting until patients are ready to stop tobacco use is recommended.

In patients with comorbid psychiatric conditions, including substance-use disorder, depression, anxiety, schizophrenia, and/or bipolar disorder, varenicline over a nicotine patch is recommended.

For tobacco-dependent adults for whom treatment is being initiated with a controller, extended-duration (>12 weeks) over standard-duration (6–12 weeks) therapy is recommended. A controller is a medication with a delayed onset of effect that reduces the frequency and intensity of smoking (i.e. varenicline), whereas a reliever is a medication with acute effect to reduce cravings (i.e. nicotine gum). 

CONDITIONAL recommendations:

Varenicline plus a nicotine patch over varenicline alone is suggested (conditional recommendation, low certainty in the estimated effects).

Varenicline over electronic cigarettes is recommended. Remarks: serious adverse effects of e-cigarettes have been reported. The recommendation will be reevaluated if these reports continue. 

Quotes about honey: 

You catch more flies with honey than with vinegar.

No bees, no honey; no work, no money.

Honey is sweet but bees sting.

Be like the honey bee, anything it eats is clean, anything it drops is sweet, and the branch it sits upon does not break (Iman Ali, Pakistani actress)

When you go in search of honey you must expect to be stung by bees (Joseph Joubert, French moralist)

Life is the flower for which love is the honey (Victor Hugo, French poet)

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Claudia: Today we have a special episode to honor those with a sweet tooth. We will talk about the ultimate nature candy: honey. Yes, we will talk anything related to honey in medicine.

But... what is honey? It is a sticky, sweet, clear yellowish-brown fluid made by bees. How? you might wonder; well they collect nectar in their honey stomach or what they call the “crop” and as you might be guessing they create honey by vomiting this digested nectar. 

Hector: Let’s start with honeycomb lung. 

Claudia: Honeycomb lung — This is something many medical students and residents might hear for the first time and think huh? Unfortunately hearing a patient has honeycomb lungs is not at all “sweet news.” Honeycomb lung is indicative of end-stage pulmonary fibrosis, and many disorders such as Idiopathic Pulmonary Fibrosis, sarcoidosis, hypersensitivity pneumonia, and eosinophilic granuloma can progress to end-stage fibrosis, but cannot be detected by pathologists at this stage of the disease. For that reason, biopsy of extensive honeycomb lung is not helpful and should be avoided.

This Honey-co