Whose advice would you trust?
n medicine, as in life, there are rarely hard-and-fast rules as what best to do in any situation; it all depends on the circumstances. Hence Giles Smith, a Suffolk family doctor, being “at odds with health chiefs”, as he put it in a letter to The Daily Telegraph last week, over the latest official guidelines on the treatment of acute ear infections in children.
To be sure, this may resolve without the need for antibiotics
– but it would be a brave doctor who would deny them to a child screaming in agony with an angry red eardrum when, as Dr Smith observes, a single large dose is all that is required and can make so much difference. Indeed, the proposal that such treatment be withheld unless the symptoms get worse, then treated with a weeklong course, seems positively perverse.
The problem here is the supposition that guidelines and protocols drawn up by “experts” somehow trump the clinical discretion of everyday medical practice. GPS, to their credit, don’t pay such guidelines much heed, with a third in a recent survey claiming to ignore them at least once a week. The difficulty comes when they are financially incentivised to meet specified targets – as illustrated by my comments last week on the marked increase in the number of patients admitted to hospital with coma or confusion from excess lowering of the blood sugar level (hypoglycaemia).
The blood sugar naturally rises with age, so the “normal” for those in their 70s and over is higher than the current cut-off point for diagnosing diabetes, resulting in their being labelled with a condition they do not have. Further, for those who genuinely do have diabetes, the optimum level for the elderly (an Hba1c of 8-9) is considerably higher than the treatment target (7.5), resulting in their being overtreated – and thus running the risk of hypoglycaemia.
Out on a limb
‘The difficulty comes when they are financially incentivised to meet specified targets’
The arresting photograph in this paper last month of two rather perplexed looking dogs receiving acupuncture in a veterinary clinic in Shanghai has prompted a reader to report that, following a disc injury that left her corgi with paralysis of the back limbs and incontinence, she has been taking her for regular sessions of the needling treatment involving a 150-mile round trip to Swansea. “She seems to enjoy it and her incontinence is much improved,” she writes.
This is not the only “alternative” remedy that might be of value in non-humans. Several years ago, this paper reported the response of a 25-year-old mare, April, to magnet therapy after a fracture of her cannon bone left her with a limp. Her owner, Mrs Gail Rawlings, feared she might have to be put down, but was persuaded to fit her with a pair of boots with powerful magnets.
A fortnight later, April was trotting around the paddock and subsequently qualified for the finals of the National Veteran of the Year competition. “It is like a 70-year-old woman with a broken hip suddenly making a full recovery,” Mrs Rawlings was quoted as saying at the time. The efficacy, or otherwise, of complementary therapies in animals is of particular interest, as it cannot be attributed (as in humans) to the placebo response.
A thorny issue
This week’s medical query comes courtesy of Mr ED of Bath, writing on behalf of his wife who, last year, thought she must have a thorn under her left thumbnail.
This proved not to be the case, but subsequently the tip of her thumb became very sensitive to the lightest of touch, “as if it was in burning fat” – though, curiously, it can be grasped firmly without increasing the intensity of the pain. Despite numerous consultations and investigations, essentially the situation remains unchanged: “There appear to be no further avenues to explore.”
Might anyone, he wonders, have had a similar experience?