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Sunday, July 15, 2007

FEVERED IMAGINATION?

India is once again going through the cycle of deaths and misery from tropical bugs that cause fever in a huge sprawl of urban and rural population. There are some old bugs like malaria and typhoid fever. Others, like Chikunganya, Dengue and Leptospirosis are also old diseases, but less known in India. There are some important issues why these disease lead to such a huge cost on India's health and wealth:

1. Fever is universally treated by GPs with antibiotics. In the instant era, people don't have the patience to wait for five to seven days for the fever to subside. GPs feel it is better to treat with antibiotics just in case. This, of course, is absolutely regressive and unjustifiable, as antibiotics are not exactly harmless, and can cause drug resistance (which is a major problem in hospitals across the globe). As a doc, you do what is right and scientific. If the patient can't be with you in this, let the patient go. However, my experience tells me the reality is different. It is not so much the patient who puts a gun on the doctor's head and extorts a prescription for kill-all antibiotics. It is the weakness of the physician who does not know how to tackle an obscure or atypical fever. Of course, in India, most fevers are probably treated by non-physicians, like quacks or pharmacist-oids.

2. There are no easily available tests that detect viruses, which would make life for the febrile patient (and his doctor) easy.
So one has to rely on clinical patterns, including the flavors of the season. Many docs don't have the time or mindset to sniff out diagnoses that don't hit them between the eyeballs, so they give empirical antibiotics.

3. The bulk of the fault lies with State policies, where civic infrastructure is so pathetic that it fosters all these diseases. It is now known that the bulk of tropical killer diseases like malaria are a direct indicator of poverty and development. In fact, the countries (mainly in Africa and Asia) where people are slaughtered by these germs are morbid examples of State-sponsored massacre. People die because of misguided and corrupt policies. For a simple example, look at the state of drainage in the cities. If that is attended to, one source is taken care of. Do you see that happening? It would take a fevered imagination to imagine the State changing anytime soon, is it not?
UPDATE (16th July 2007): Read about 'Tomato fever' in Kerala

2 comments:

Mahendra Palsule said...

If antibiotics are not the answer to fever, what is? It would help us common folks if you also teach us that - maybe the next time we visit a GP, we'll be better informed!

B. Ramana said...

Mahendra,
Fever may be caused by viruses which are never affected by antibiotics. These fevers last seven days without treatment, and with the best treatment they last one week. :-)
Unless a specific bacterial infection (as a urinary infection or a lung infection) occurs, antibiotics should not be prescribed.
Now when is a fever a viral one, and when is it a bacterial one: how does one tell? That is where you need a doctor to judge that correctly.