Letters to the Editor
DOCTORRICK
Published Letters: 16 Editor's Choice: 4
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antbiotics otc, NO!
[Read the article: Where have you gone, Marcus Welby?]
[Read more letters about this article: Here]I can not think of a worse idea that putting antibiotics over the counter. Studies show that 30-50% of antibiotics prescribed by doctors are unnecessary. How high would those numbers go if you didn't need a prescription? In the winter I would say I go through my "why viruses don't need antibiotics spiel" at least 5 times a day, and often 10-15 times. Antibiotic resistance is a huge problem, and injudicious use is a major contributor. Why they are over prescribed is a whole different issue, and is at least partially due to PCP's not having adequate time with patients. This easiest course of action is always to write the script for amoxicillin.
This leads to another point, medicine is extremely complex, and in many ways, more complex than people realize. I do like my patients to read up on their medical issues, as we can they discuss what they have read about. A large percent is often shit, but there is certainly good info out there. With a good doctor patient relationship, you can work together to sort out the good from the bad.
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very compelling review
[Read the article: Are breast self-exams worth it?]
[Read more letters about this article: Here]Just to clarify, this is not a new study, but an analysis of several older ones. The Cochrane Database reviews clinical question by pooling data in a statistaically rigorous way, to increase the power of any one study.
The overall evidence is very compelling. I have long since stopped recommending breast self exam for my patients, although I don't specifically recommend it.
I have yet to have a patient find a very early cancer through systematic breast self exam.
To an earlier point, although breast cancer awareness is high generally, few women perform breast self exam regularly the "right" way. In one of the studies, women were given specific and significant education in these techniques. Despite that, there was absolutely no increase in detection.
And, as noted, a very significant increase in invasive testing (biopsies/surgeries/etc).
Thus, this is not a case of what's the harm, might as well do it. There are very specific reasons to think there is a downside, with studies indicating no upside at all.
That all being said, no doctor or study would indicate that a woman finding a lump (in the shower/during sex, whatever) should ignore it. The point is that regular, systematic self exam has no benefit.