Compare and Contrast

Compare and Contrast

Inappropriate use of antibiotics is a significant problem. It increases costs and drives antibiotics resistance. There are many reasons physicians give antibiotics when they are not needed: the urge to do something (physicians more often than not err on the side of action), diagnostic uncertainty with a fear of missing a potentially serious infection, habit, time constraints (it is easier to write a prescription than explain to a patient why they do not need antibiotics), laziness and sloth. Doctors are not perfect.

Most upper respiratory tract infections in children are viral and only need tincture of time to get better. Treat a cold, it gets better in a week, do nothing it gets better in seven days. The fact that antibiotics are usually not needed for a viral URI does not necessarily mean they are avoided.


One of the curiosities of France is (2)

homeopathic medicines are partially reimbursed by the National Health Insurance and are prescribed exclusively by a physician. Besides, patients must choose a ‘treating physician’, who will be responsible for follow-up and referral to specialists. This treating physician may be a physician specializing in homeopathy.

That’s just odd. Reality trained physicians specializing in fantasy based medicine. According to a paper (1) referred  to but not available to my Google-fu, 39% of French physicians prescribe homeopathic nostrums and 6 medical schools and all pharmacy schools teach homeopathy. I guess basic chemistry is not part of the curriculum.

However, it does give opportunity to compare the practice of physicians trained in medicine with those trained in medicine plus fantasy. And it turns out there is a benefit in being expert in fantasy. Those who were homeopaths prescribed less antibiotics and antipyretics, a classic example of doing the right thing for the wrong reason.

One of the potential benefits of treating viral infections in adults may be to prevent the occasional bacterial secondary infection (3). This may true in this study as well, as the homeopaths had slightly more bacterial superinfections.

I tend not to be an ends justifies the means kind of physician if the means are irrational or immoral, and homeopathy is certainly irrational. So I do not think using the homeopathically trained would be a good solution to the overuse of antibiotics.

References

(1) F. Bouchayer, “Alternative Medicines: A General Approach to the French Situation,” Complementary Medical Research, May, 1990, 4(2)4–8.

(2) Management of Upper Respiratory Tract Infections by Different Medical Practices, Including Homeopathy, and Consumption of Antibiotics in Primary Care: The EPI3 Cohort Study in France 2007–2008 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089990

(3)Ann Fam Med. 2013 Mar-Apr;11(2):165–72. doi: 10.1370/afm.1449. Risks and benefits associated with antibiotic use for acute respiratory infections: a cohort study. http://www.ncbi.nlm.nih.gov/pubmed/23508604 http://www.ncbi.nlm.nih.gov/pubmed/23508604

Points of Interest: 4/22/2014
Points of Interest: 04/21/2014