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How to get into U.K. medical school, part 2. March 17, 2016

Posted by drolarn in Uncategorized.
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In this section I will give hopefully useful advice for prospective medical students and although this will be aimed primarily at high school students in Thailand, much will probably be applicable to any candidate anywhere.

A long time has passed since I entered the medical school at Edinburgh University. Although much has changed, medical schools are still looking for bright students who will become good doctors. Their methodology in the selection process may have advanced, but they are still looking for very much the same qualities.

The first, although not the most important quality, is academic ability. This is also the easiest criterion for the medical school to judge as all that is needed are your predicted IB scores or A level grades. IGCSE scores are also important but not vitally so. You can find out what the medical school typically requires in terms of grades from the medical school websites. These typical offers are never absolute and if your predicted result falls a little short, you should still apply especially if you make up the shortfall with your other qualities.

What other qualities are these? Different schools will look for different things or ascribe different weightings to the various traits they want to see in a candidate. Almost every school look for passion for the subject, communication skills, capacity of empathy, team-player, leadership quality. Other highly valued traits include creativity, critical thinking skills, self-discipline and mental toughness. It is a challenge for the schools to assess these traits and qualities as it is a challenge for the candidate to demonstrate them. On their websites the school will list clearly if they require the BMAT or UKCAT test. They will of course scrutinise you personal statement and your teacher’s reference. If they like your application you will be invited for an interview or interviews and this may take various forms including the MMI.

All these things: your personal statement, teacher’s reference and interview performance are absolutely crucial and will determine your chance of success even more than your predicted grades. Remember the schools have no shortage of academically brilliant candidates. Getting 40+ points in your IB or A*A*A will almost guarantee your admission into any course but not medicine.

In your personal statement you will need to sell yourself without appearing too boastful arrogant and pompous. You really should not write your personal statement without help or guidance from your teacher or other sources. There are a lot of resources on the internet on how to write a good personal statement. Some medical school websites will even give you extensive tips on what they like to see in a personal statement so you should take advantage of all these resources but in the end make sure your personal statement is indeed personal. If it appears plagiarised your personal statement may be discarded out of hand.

 

If you find you are lacking several of the qualities and traits desirable in a doctor, have no fear! You can cultivate most of them. You only need to apply yourself. Really none of us are perfect. If you know yourself, you know what your deficiencies are, you can work on them.

Passion for Medicine

You will need to demonstrate your passion for the profession on your personal statement and at interview. Here are some ways you can do this. The best is probably to volunteer at a health care institution. Use your initiative here and find out what government health care facilities are near enough for you to go once or twice a week and write to them or go visit them. They will find something useful for you to do, even if it is only to chat to some lonely old folks. Or during your school vacation try going further afield. One example I can give is the McKean Rehabilitation Center in Chiangmai, which used to be a leper colony. You can learn a lot from places like this, you will learn that medicine is not just about prescribing the right pills or cutting off the right bits. This kind of actual exposure is now pretty much compulsory in your application. You will be a serious disadvantage if you cannot claim any experience in health care environment at all. Your application is likely to go nowhere. Some schools will insist that your work experience is verifiable and documented. They mostly do no specify how many hours you need, but a rough guide would be 70 hours. What is vital is you must be able to say how the work experience has benefited you. You are advised to keep detailed logs of what you have done and learned.

Shadowing a doctor is also really useful. Start with your family doctor if you know no-one else. Medical schools want to see that you know what life is really like for a doctor.

You also need to be aware of the health issues in your country and the world. Find out about health care provision in this country and compare it to the UK. Think about how health can be improved for the ordinary people. Is it more hospitals doctors and drugs or is it clean water and nutritional education? Acquaint yourself with the world’s pressing health issues, like the rise of antibiotic resistance, the threat of the superbug, the lack of vaccines for killers like malaria, and the rise of the anti-vaxers, people who believe vaccines are an evil invention. Some global news organisations like the BBC helpfully provide regular health related news and is a great starting point for further reading. Medscape provides doctors with much useful health news and although you will not have full access to Medscape articles, you can learn a lot just from the headlines and do more research on hot topics, like the Zika virus for example. You may be very well be asked at interview about community or world health issues and although you may not know all the facts, you should be able to demonstrate some awareness and make thoughtful comments on the topics.

Team work

Being a team player is a vital quality that you must demonstrate. You can do this, obviously, by being part of a team or teams, like school sports team, or school orchestra or pop band, or school newspaper team. International schools in Thailand mostly provide you with many opportunities for team work, Thai schools not so much. If you feel your school does not provide you with anything you are interested in taking part in, then create your own group or club. No school newspaper? Start one up!

Leadership

It is not difficult to imagine why this is a crucially important skill to have. Again this is something you should be able to demonstrate in your personal statement and at interview. If you are blessed already with leadership drive and skills, that’s great, but what if you, like a lot of other people, normally prefer to be told what to do, and are reluctant to take on the responsibility of leadership? It’s certainly not in every person’s nature to be a leader, it’s certainly not in mine, but I am here to tell you that you can cultivate this skill. You can learn how to step up and take charge. You can try to do this by reading books on leadership, I have seen many in bookstores, although I have never read one. The best way learn leadership, I think, is to just do it. So if you are in a sports team, ask, (or even tell!) your team mates that you are going to be the team captain today. If you are in a school music band then select an ensemble piece and get your friends to agree to play it. If you are not in a school band, start one up. Become the editor of your school newspaper, or sub-editor if the editor position is not free. Better yet start up your own school newspaper and get your friends to contribute. If there is something you like but there isn’t already a club at school, for example photography, film, manga drawing (but NOT manga reading), then start one up. If you have several friends all interested in medicine, form a small group and go volunteering together. Really opportunities for leadership abounds, you just have to have the initiative drive.

Creativity

Creativity is a prized trait in just about for all courses at all universities. Even hard sciences and maths, being creative, and thinking outside the box, can give you a real advantage. Other than the traditional music, art, poetry etc also consider creating internet content like vlog on YouTube.

Time Management

We haven’t even reached the end of the article and you can already see that you have a lot to do to even have a slim chance with your application. You have to work hard at your studies to get the good grades you will need, you have to do the work experience, and you have to do several extra-curricula activities. You also need time to relax. Doctors are always having to juggle work commitments, weekend work, night duties etc and so medical schools wants candidate who can handle do of this without going crazy.

Communication skills/ The Interview

Among many other things you will be judged at interview is your communication skill. Yet another crucially important skill you must have. If you do not have it your must start acquiring it, as soon as possible. Being an introvert is a common thing. Many of us are reluctant to talk to strangers, or are no good at making small talk. But obviously as a doctor you will have to communicate will with your patients and your colleagues. I would say the best way to do this is just to talk to the patients you will see on your voluntary work period. Patients are often all too pleased to talk to someone who is empathetic. Don’t just ask about the symptoms, ask about how the illness has affected their lives. Again write down what you learn.

The medical school interview will be only the first of the interviews in your life that could potentially change your life. It’s natural to feel nervous and the nervousness can cause you to give a poor first impression. If you are a super-candidate all your 4 choices may invite you for interview, and by interview 4 you will probably do much better than at interview 1 because you will learn from experience. The sensible thing to do therefore is have practice interviews before interview 1. I can tell you that it really is possible to improve from being a flustered nervous wreck to a confident and engaging interviewee. You need to practice, and you need to switch off that switch in your head that makes you shy and nervous. Again there are now many resources on the internet to help you with interviews. You can even go on paid courses. It is truly worth investing much time and effort if not also money learning how to be good at being interviewed.

Being a well-rounded person

Medical schools do not want students who are weird or obsessive or too highly strung, no matter how academically brilliant. They know that someone who has no adequate outlet for their stress, does not know how to relax, and does not engage socially with the rest of the world will not become good doctors. Some may not even survive the medical course. I can tell you genuinely that I have seen medical students who got top marks in exams who did not last even a year in medical school because he wasn’t a “real” person and was far too obsessed with study. The stereotypical Asian student who regards the arts, sports, and socialising as wasteful distractions from serious study really does exist. Such character traits might even be a positive boon if you want to become a brilliant scientist, but they will not help you get into medical school. If such is your character trait, consider that you may be able to do much more for the world and for yourself by becoming a top scientist in a field you enjoy than becoming a doctor.

This article is a work in progress, I will add more to it if I think of something else. I will close by saying that you never win if you don’t play the game, so give it your best shot, make it happen. I myself was far from being an ideal med school candidate. I still feel now that medical schools seem to expect seventeen-year olds to have the wisdom of a thirty-year old. I only hope that you will pursue this goal for the right reasons.

Do please leave a comment if you feel this has been helpful or not so helpful, and ask any questions.

 

 

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How to get in to medical school in the U.K., advice for students applying from Thailand March 8, 2016

Posted by drolarn in Uncategorized.
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So you want to be a doctor, and you want to go to a U.K. medical school, and eventually come back to Thailand to work? My advice can be summed up in just one word: don’t. I will tell you why you should not do this. I will also tell you later why you should do it and give advice on how you may achieve this but it is important to start by telling you the many reasons why you should not put yourself through the process.

Firstly, it’s extremely competitive. If you were a UK home student it would be very hard. As an international applicant it will be extremely hard. Medicine AFAIK, is the only course in UK university where international student places are strictly limited because the UK does not produce enough doctors for its domestic needs with many vacant jobs (the UK has to rely on many doctors from the EU and south Asia) . International students have to pay more tuition fee than home students and there is no possibility of a student loan, but even then the medical schools do not make a profit from international students. This mean there are major disincentives for UK medical schools to take on foreign student. . You will be competing against many candidates from all over the world, all of whom are capable of getting excellent exam grades. According to the Edinburgh university medical school website, the odds for an oversea student getting in is about 1 in 40. But it’s far from being all about academic excellence. Even if you are capable of getting the most extraordinary exam result your school has ever seen, you may find yourself with no offer from any of the 5 med schools you are allowed to apply to through UCAS. So the odds are very much against you and you must ask yourself if you are willing to do all that it takes (and it takes A LOT) to get in, and if you will be able to handle the disappointment if you fail.

If you do get in, you will be in for 5 or 6 years of hard graft. Medical students have very much less time than other students to enjoy university life. The hard work starts in year one and gets progressively harder. You will be staying in 6 nights of every week to study. In the last 2-3 years of med school you will not even have any end of term holidays. You will need much self-discipline and mental toughness to get through the course.

Once graduated you will spend some time working in the UK as a junior doctor. Recently junior doctors in the UK went on strike because they are forced to work long hours and weekends are unfairly compensated. If your heart is not truly in medicine, you will have a very miserable time as a junior doctor. There is a significant risk of burn-out. In the US by some estimates 50% of all hospital doctors will experience burn-out.

After getting some experience under your belt, or may be even some post graduate qualifications, you then return to Thailand, you will find that your hard won degree does not allow you to practice in Thailand. You must take a licencing exam. It has long been the strategy of the Thai Medical Council to make it really hard for foreign medical graduates to work in Thailand. The Thai licencing exam is designed to fail most foreign graduates because the TMC wants to screen out Thai doctors who could not get into a Thai medical school and got their degree from less than prestigious schools in neighbouring countries. If I understand correctly, the pass rate is well under 50%. You will be examined on every medical school subject including all the basic medical sciences you learned in year 1, up to all the clinical subjects. That is all the knowledge that you took 5+ years to learn will be examined at once.

And then there is the question of why do you want to be a doctor at all? Is it for the approbation of your parents? Is it for the bragging rights because only the cleverest people get into med school? Is it the promise of a secure, well paid job? These are all very bad reasons for becoming a doctor. First of all if you parents are wise, they would not push you into spending your life doing a job you don’t like. 5++ years of your life you would sacrifice to please your parents so mommy can tell auntie and all her friends that she has a doctor son (or daughter)? That would be foolish indeed. While it’s true that as a doctor you will probably always have a job it doesn’t always pay that well. Given the brains that you have chances are you will make more money in life as a business person. Be honest with yourself, look deep into your soul, do you really see a doctor there? A good doctor? Because there is no point in aiming to be anything less.

Then there is the very considerable risk that no matter how good of a doctor  you are, you will be sued by a patient. You don’t even have to make a mistake to be sued (although we all make mistakes). If outcome is anything less than perfect, some clever lawyer can persuade your patient to sue you, after all lawyers get paid win or lose. Being sued by your patient can be soul-destroying. Many doctors have their spirit broken from being sued, even when they don’t lose. In the US a very large chunk of your income may be even half, will be spent on malpractice insurance. It is not as bad as that in Thailand, but it is definitely heading that way. There are all too many examples of doctors in this country who are burned out, only going to work for the income, and all the while wishing they had got an MBA instead of an MD degree.

You should be very sure that medicine is what you want to do. It is ok if you are not sure that you have the abilities to become a doctor but you should be sure that you want to become a doctor. Try talking to any doctor that you know, may be even ask if you can shadow them for a day or two. Try to get a real feel of what life is like as a doctor in Thailand. Many Thai doctors will tell you they regret their decision to go into medicine, and how their lives would be much better now if only they had gone business school instead.

Medicine is a vocation. If you feel it in your heart that this is what you want to do then all the negative things I have talked about so far will not put you off. If helping people recover from sickness, helping them avoid getting sick, saving lives even, if these are the things that gives you satisfaction, and gives you meaning in your life, then I urge you to do what it takes to become a doctor. The world needs more good doctors, every country needs more good doctors. Given determination and requisite academic ability, you can win through. You might not get into your dream medical school, you may have to  look elsewhere other than the UK, but you can win through and I wish you all the best and I hope the sections to follow may be of some help to you in achieving your dream.

 

 

ADHD treatment myth busted December 1, 2015

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Ritalin is commonly prescribed to children with real or imagined Attention Deficit Hyperactivity Disorder. For a long time it is believed to be not only effective but very safe which has led to many doctors without expertise in the disease prescribing it for children whose parents feel are a bit naughtier than average or performing below expectation at school.

Here’s what experts say after reviewing the evidence for Ritalin:

A comprehensive Cochrane Review shows there is very low-quality evidence to support the use of methylphenidate (Ritalin,Concerta, other brands) in children with attention deficit hyperactivity disorder (ADHD) leading the reviewers to urge more caution when prescribing the stimulant.

“The evidence is not as convincing as many clinicians have believed regarding the benefits of methylphenidate,” lead authors Ole Jakob Storebø, PhD, clinical psychologist, Region Zealand, Roskilde, Denmark, and Morris Zwi, MBBCh, consultant child and adolescent psychiatrist, Whittington Health, London, UK, told Medscape Medical News.

“In general, our findings raise concerns about how much we should expect of this medicine, and there needs to be more caution when prescribing methylphenidate. I think it probably calls for a change of mindset more than a change in practice,” the investigators note.

The review was published online November 25 in the Cochrane Database of Systematic Reviews.

Even though the authors couched their conclusion in the usual cautious respectful scientific medical language, the message is clear: it doesn’t work, stop prescribing it.

My scepticism about this drug is now confirmed. The solution to children’s behavioural problems does not come out of a bottle.

 

Crib bumper deaths: call for ban on crib bumpers. November 26, 2015

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Reuters news article on rise of crib bumper deaths.

Journal of Pediatrics article (Free abstract)

Background: NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of the dangers of crib bumpers (Free)

More dire warnings on antibiotic resistance: “Antibiotic Apocalypse” BBC November 21, 2015

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Very strongly worded warnings from experts continue to largely fall on deaf ears in this country where antibiotic over-prescribing still runs rampant. The day is approaching when all we can get from doctors for a serious infection are a few kind words.

http://www.bbc.com/news/health-34857015

Public Confused About Antibiotic Resistance, WHO Says November 21, 2015

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(Medscape article Nov 2015) Misconceptions about antibiotics and the health threat posed by antibiotic resistance are common around the world, according to findings from a multicountry survey from the World Health Organization (WHO) released today.

The survey, conducted online and in person, asked nearly 10,000 adults about use and knowledge of antibiotics and antibiotic resistance. It was conducted in 12 countries (two countries per WHO region): Barbados, China, Egypt, India, Indonesia, Mexico, Nigeria, the Russian Federation, Serbia, South Africa, Sudan, and Vietnam. Among the common misconceptions highlighted by the WHO:

Three quarters (76%) of respondents think antibiotic resistance happens when the body (not bacteria) becomes resistant to antibiotics.

Two thirds (66%) believe individuals are not at risk for a drug-resistant infection if they personally take their antibiotics as prescribed. Nearly half (44%) of respondents think antibiotic resistance is only a problem for people who take antibiotics regularly.

More than half (57%) of respondents think there is not much they can do to stop antibiotic resistance, and 64% believe the medical community will solve the problem before it becomes a serious threat.

Nearly two thirds (64%) say they know antibiotic resistance is an issue that could affect them and their families, but how it affects them and what they can do to address it are not well understood.

Nearly two thirds (64%) of respondents believe antibiotics can be used to treat viruses, and one third (32%) believe they can stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment.

The End of Modern Medicine?

Release of the survey findings coincides with the launch of a new global WHO campaign, “Antibiotics: Handle With Care,” during the first World Antibiotic Awareness Week, November 16 to 22. The aim of the campaign is to raise awareness and encourage best practices among the public, policymakers, and health and agriculture professionals to avoid the further emergence and spread of antibiotic resistance, the WHO said.

“The rise of antibiotic resistance is a global health crisis,” Margaret Chan, MD, WHO director-general, said during a media briefing. “Antimicrobial resistance is on the rise in every region of the world. We are losing our first-line antibiotics. This makes a broad range of common infections much more difficult to treat, and replacement treatments are more costly, more toxic, and need much longer durations of treatment,” she noted.

“With few replacement [antibiotics] in the pipeline, the world is heading towards a postantibiotic era in which common infections will once again kill. If current trends continue, sophisticated interventions, like organ transplantation, joint replacement, cancer chemotherapy, and care of preterm infants, will become more difficult or even too dangerous to undertake. This will mean the end of modern medicine as we know it,” Dr Chan added.

Thankfully, “more and more governments now recognize the importance of this issue as one of the greatest threats to health today,” she said. A global action plan to tackle antimicrobial resistance was endorsed at the World Health Assembly in May 2015. One of the plan’s five objectives is to improve awareness and understanding of antibiotic resistance through effective communication, education, and training.

Precious Commodity

Overuse and misuse of antibiotics in people and animals are the “fundamental” drivers of antibiotic resistance, Keiji Fukuda, MD, special representative of the director-general for antimicrobial resistance, noted during the briefing. Antibiotics are a “global good that we need to handle with care,” which is the theme of the WHO campaign, he added. “We believe that everybody, this means the general public, health workers, farmers, policymakers, everybody, has a critical role in turning this around.”

Health professionals, added Dr Chan, “need to treat antibiotics as a precious commodity and try to resist the pressure from individual patients who come in with a cold or flu or viral infection asking for antibiotics. It will be important for doctors who are very trusted by their patients to explain to them why for any viral infection antibiotics are not needed. And when they do prescribe a full course of antibiotics, they need to remind patients to take the full course,” she said.

More information on the survey and WHO campaign are available on the WHO’s website.

Antibiotics also make you fat October 23, 2015

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Children Who Take Antibiotics Gain Weight Faster Than Kids Who Don’t
October 21, 2015
BALTIMORE, Md — October 21, 2015 — Children who receive antibiotics throughout the course of their childhoods gain weight significantly faster than those who do not, according to a study published online today in the International Journal of Obesity.

The findings suggest that antibiotics may have a compounding effect throughout childhood on body mass index (BMI).

“Your BMI may be forever altered by the antibiotics you take as a child,” said Brian S. Schwartz, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. “Our data suggest that every time we give an antibiotic to kids they gain weight faster over time.”

For the study, the researchers analysed Geisinger Health System’s electronic health records on 163,820 children aged 3 to 18 years from January 2001 to February 2012. They examined body weight and height and antibiotic use in the previous year as well as any earlier years for which Geisinger had records for the children.

At age 15, children who had taken antibiotics 7 or more times during childhood weighed about 1.4 kg (3 lbs) more than those who received no antibiotics, they found. Approximately 21% of the kids in the study, or almost 30,000 children, had received 7 or more prescriptions during childhood.

Dr. Schwartz said that the weight gain among those frequently prescribed antibiotics is likely an underestimate since the children did not stay with Geisinger throughout childhood so their lifetime antibiotic histories, including antibiotic use outside the health system, would not have been recorded and because the effect of certain antibiotic types was even stronger than the overall average.

“While the magnitude of the weight increase attributable to antibiotics may be modest by the end of childhood, our finding that the effects are cumulative raises the possibility that these effects continue and are compounded into adulthood,” he said.

Dr. Schwartz said he thinks that physicians are becoming more judicious in their antibiotic prescribing, but it can be a difficult task. Often parents demand antibiotics for apparent cold viruses and other ailments that will not be helped by them. There have long been concerns that excessive antibiotic use is leading to bacterial strains that are becoming resistant to these potentially lifesaving drugs. But this study suggests that antibiotics can have long-term effects in individual children, he says.

“Systematic antibiotics should be avoided except when strongly indicated,” said Dr. Schwartz. “From everything we are learning, it is more important than ever for physicians to be the gatekeepers and keep their young patients from getting drugs that not only won’t help them but may hurt them in the long run.”

SOURCE: Johns Hopkins University Bloomberg School of Public Health

Top 5 common drug misuse in paediatrics October 14, 2015

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We have many powerful medicines today that when used correctly can be of great benefit. In their enthusiasm to use these medicines, especially if they are exciting and new, some doctors will prescribe medicines which are unsuited to the symptom or disease they are trying to treat, often causing harmful side-effects. Here is a list of 5 drugs or group of drugs that are frequently misused. Not included in this list are drugs like Tamiflu which is usually correctly prescribed for the treatment of influenza, but has questionable effectiveness and/or is not actually necessary as the condition being treated often resolve without treatment. These misuses are common in this country, but hopefully less common in most other countries where people are more sensible about medicinal usage.

5. Ritalin® in naughty children
This is a drug in the treatment of ADHD (Attention Deficit and Hyperactivity Disorder). It is relatively safe and can be very effective. Some children who are perhaps more lively than average are put on this drug without taking due care to establish the diagnosis of ADHD. Side effects include anxiety, nausea and sleep disturbance.
4. Hyoscine eg. Buscopan® for stomach pain

Hyoscine by injection is a commonly used as a pre-operative drug to reduce saliva and other secretions. Oral hyoscine  relaxes the muscle of the gut and can be helpful in cases of irritable bowel syndrome in adults, where it provides some symptomatic relief but does not actually treat the causes of IBS. In children it is often prescribed for treatment of abdominal pain, most commonly due to gastroenteritis, where its effectiveness is highly dubious and its side-effects common and troublesome. Abdominal pain in gastroenteritis is due to the insult that the gut is being subjected to by microbial infection. Often the outpouring of fluids into the gut and the increased activity of the gut is the body’s effort at expelling the harmful content of the gut. Hyoscine suppresses gut muscle contraction thus retaining the microbial poisons instead of expelling them, potentially prolonging the illness. Hyoscine also causes blurry vision and dry mouth, and while it relaxes some muscle it causes other muscles to tense up, including the bladder valve, which can mean the affected child is unable to pass urine, thus hugely increasing the child’s distress.

3. Antihistamine group of allergy drugs including Zyrtec, Telfast, Aerius (all ®) and many others, in the treatment of the common cold.

The new generation of allergy drugs are a great boon in the treatment of allergic rhinitis, eg hay fever, as they are highly effective, very safe and causes no drowsiness. Older antihistamines which cause drowsiness also have their uses, such as in the treatment of itchiness, and for mild sedation. The common cold is not allergy, the runny nose in the common cold is not caused by the same mechanism as when it is caused by allergy and so antihistamines are not effective in the treatment of the common cold. The usage, or misuse of antihistamines in the common cold has become so wide spread now that most children with the common cold are put on these drugs. While the drugs are very safe so usually no harm done and the placebo effect can often account for the perceived benefits of these drugs, to prescribe these drugs knowing that they are ineffective for the condition being treated, or to be ignorant of their proper use, is surely not the right way to practice medicine.

2. The brochodilators (asthma) drugs including Ventolin® (salbutamol) and Singulair®, in the treatment of cough.

The misuse of oral salbutamol is also so widespread that not to be given this drug for cough would be unusual. Yet many prescribers know full well that it is ineffective in the treatment of cough, in the absence of wheezing/bronchospasm, which is to say most cases of cough. Side effects are frequent and troublesome including heart palpitations, sleep disturbance and nightmares. Salbutamol by inhalation either via a nebuliser or as inhalers have also become widely misused. When administered by inhalation side effects are less troublesome and the placebo effect  much stronger, often resulting in demands from parents for this treatment when their child have simple common cold. The only effects on the body when salbutamol is given in the absence of wheezing are the side-effects and the placebo effect. Even when there IS wheezing, such as during an RSV infection, salbutamol is ineffective, or more accurately has 2% chance of being effective, in children less than 18 months of age. Singulair® (montelukast) is relatively new in the arsenal of asthma treatment. It is conveniently given by mouth just once a day and has far less side effect than salbutamol making it very popular. But again it is NOT a cough medicine, it is for treating asthma only and is ineffective when used to treat cough in the common cold. It also has more side-effect than previously thought with reports of neuropsychiatric disturbances in children given this drug.

  1. Antibiotics. To top this list of abused drugs there can be nothing else. Antibiotics, particularly the new, very broad spectrum, very expensive ones are so over-prescribed that most children are given several courses of antibiotic a year during the peak years for catching the common cold, about ages 2-4. It is impossible to know the true extent of the over-prescription but given that only around 1 in 20 episodes of respiratory tract infection is caused by bacteria, and that in some population this would be a gross over-estimate as nearly ALL respiratory episodes in children are viral, a reasonable estimate would be that antibiotics are misused 95% of the time, the true figure probably closer to 98%. Not only the frequency of misuse but the type of antibiotics being misused is a grave cause for concern. New, strong, broad-spectrum antibiotics invented to combat the ever increasing incidence of antibiotic resistance and aggressively marketed by drug companies as they have huge profit margins, are being prescribed with great abandon and very little regard for the increasing bacterial resistance caused in large part by irresponsible prescribing practices. The problem is approaching world crisis level but somehow the message is not reaching this country. A strept throat, the only bacterial respiratory tract infection which could be considered remotely common, can be very effectively treated by simple, inexpensive, penicillin or amoxicillin. The strept throat is the only type of bacterial throat infection any doctor is ever likely to come across but despite this well-known fact, doctors often favour very strong antibiotics like Augmentin® over amoxicillin. Worse still, Augmentin and most other hi-tech antibiotics are ineffective against the most common type of pneumonia found in middle-class population. The only type of pneumonia that a child living in good environment is ever remotely likely to catch is mycoplasma pneumonia, easily treated with inexpensive, old-fashioned macrolide group of antibiotic, and totally unresponsive to Augmentin, Omnicef and other popular, expensive medicines of these families.

It happens at the other end of the age spectrum too: patients are harmed by overtreatment September 19, 2015

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An article on Medscape 19/9/2015:-

“The greatest threat to older patients’ safety in primary care is the risk posed by treatment itself, not treatment error or negligence, according to an analysis of no-fault claims data from New Zealand.

These findings were published in the October issue of theAnnals of Family Medicine.

Katharine Ann Wallis, MBChB, PhD, MBHL, FRNZCGP, from the Department of General Practice and Primary Health Care at the University of Auckland in New Zealand, found that medication injuries were the main source (34%) of all treatment injuries among the elderly, and that within that category, antibiotics were, by far, the biggest culprit.

Of 294 medication injuries recorded in claims between 2005 and 2009 among patients aged 65 years and older, 150 of them (51%) were caused by antibiotics. Next highest among injury sources were nonsteroidal anti-inflammatory drugs (9%) and angiotensin-converting enzyme inhibitors (9%).

Antibiotics also topped the list for causes of serious or sentinel injuries for patients aged 65 years and older. Antibiotics caused 39% of such injuries in that age group, followed by warfarin (14%) and steroids (7%).

The serious/sentinel category was defined as having “the potential to result in” or “has resulted in” “unanticipated death or major permanent loss of function.”

In the elderly as in children, there are times when it is better to let a malady resolve on its own. Unnecessary interventions can cause harm while having little or no benefit. In the elderly it can be more difficult than in children to make a decision not to intervene, as children have much greater capacity for fighting off any illness. For most common illness episodes, children will recover without any treatment, often not any later than with treatment.

Over-prescribing in paediatrics is common, to be given 4 or 5 different drugs for a self-limiting illness is commonplace. In this country it is common  for an elderly patient to be put on upwards of 10 drugs simultaneously. Taking that many drugs side-effects are  almost a certainty. Indeed some drugs are given to treat the side-effects of other drugs, creating a chain of  sickness.  For example let’s say a drug is prescribed to treat high blood pressure. It causes nausea and insomnia so to treat these sleeping tablets and anti-nausea tablets are prescribed, which cause confusion and constipation, so a laxative is given which upsets the body’s chemical balance causing even more confusion etc etc.

Every day new drugs are being discovered which are ever more powerful. It is such a shame that instead of improving our lives we are frequently harmed by them.

 

Treating that pesky cough September 17, 2015

Posted by drolarn in Uncategorized.
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Here is a commentary written by Dr. Michael L. Ginsberg, MD and recently published on Medscape. :-

“Treating Cough in Children

An acute cough is defined as one lasting less than 15 days. Cough is the third most common reason that patients see a doctor and the most common acute complaint in primary care physicians’ offices.[1]As a practicing pediatrician, I would estimate that visits for acute cough consume roughly a quarter of my average daily schedule between the months of December and March. The vast majority of acute cough in children is caused by self-limited viral upper respiratory infections (URIs).[2] While some otherwise healthy children may have as many as 15 URIs in a year, the average child has a URI five to six times per year, which means that normal children between 6 months and 2 years old will be sick at least once per month during the winter.[3] Consider what this implies: In an extreme case, if an acute cough is 14 days long, and a child becomes ill twice per month during the winter, an unlucky child might have acute cough on the vast majority of days during a given winter. Even without such extreme assumptions, a typical child under 5 years might be coughing on roughly 1 out of 2 average days during the winter.

Cough makes parents worry, it fills my schedule, and it makes me feel like a broken record. I walk into the room to see a smiling, drooling, happy baby with a light cough and a mother who has terror in her eyes worrying that “my mother said he might have pneumonia.” There is evidence that pneumonia is vastly overdiagnosed in both children and adults in both acute and primary care settings alike.[4,5] True pneumonia affects only 5% of children in industrialized nations per year.[6] Of course, it’s our job as clinicians to recognize those rare cases of cough that are “more than just a cough.” But for acute cough, our job is to provide peace of mind. Peace of mind doesn’t need to take the form of a teaspoon of medicine. That’s why machines will never replace us, and that’s what makes me get out of bed and go to work every morning.”

I am quoting here only the first section of his commentary. He goes on to discuss the ethics of giving placebos versus giving nothing at all.

What I hope you will see from this is how common it is for children to cough for 2 weeks or more, and how rarely this is cause for alarm. It is entirely reasonable to have your child checked out if cough is taking a bit longer to resolve than you expect and hopefully your child’s doctor will correctly give you the reassurance that this is benign, or recommend appropriate tests or treatments. Be aware however that overuse of X-rays and blood tests can lead to confusion and the results may make the doctor feel compelled to prescribe medicines, and that all medicines potentially have undesirable side effects, which for many so-called cough medicines these side effects are common and troublesome.