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EDITOR'S CHOICE: British Medical
Journal Pills, thrills, and bellyaches |
![[Read Rapid Response]](paracelsus_archivos/image001.gif){kind=small}
Remember Paracelsus and
keep the big picture in mind
Enrique J. Sánchez-Delgado, M.D., Prof. Dr. med. (20 February 2005)
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Enrique J. Sánchez-Delgado, M.D., Prof. Dr. med., Send response
to journal: |
The recent developments related to COX-2 anti-inflammatory drugs and SSRI antidepressants, should make us clear that facts, not fear, balance and long lasting experience, should lead our decisions when treating, counseling and educating our patients. Both, the FDA in USA and the EMEA in Europe, accepted that the risk of treatments with Cox-2 can be acceptable if you consider not only life expectancy but also the quality of life, and choose the proper type of patients that would become more help than harm. I have been advising my patients, pharmaceutical representatives, and my colleagues in the same line of reasoning and evidence, since the discussion about Cox-2 and SSRI began. In the case of SSRI, it was reasonable, from the beginning of the problem, to compare with the known risk of older antidepressant, the TCA. It was very well known that in the early periods of treatment there should be a vigilance to prevent suicides attempting. That was especially truth with young patients. The same precautions are necessary with SSRI, despite their relative less toxicity, which could make many doctors to feel too confident with the new drugs. The mathematical instruments of evidence based medicine, like RR, AR, RRR, ARR, RRI, ARI, RBI, ABI, NNT and NNH are wonderful and very useful for our daily work, but the same is true for long time validated concepts like that of Paracelsus that: "alle Dinge sind Gift, und Nichts ist ohne Gift, allein die Dosis macht, dass ein Ding kein Gift ist". That means, every treatment has beneficial and adverse effects and toxicity, and the appropriate indication, doses and potency, determines that the benefits outweighs the risks. Also, of similar importance, long term experience and intuition, continued medical education, the dedication to listen and treat the patients with real personal and humane interest, and keeping in mind the broad picture of not only to cure, whenever possible, but also to alleviate, to help to improve the quality of life, to counsel, to support, to encourage, to inform and educate our patients, all these are core elements of a quality medicine, not only in the industrialized, rich technological countries, but anywhere in the world. Competing interests: None declared |
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