Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I kind of feel the same way as the OP.
I have a primary doctor, but I don't go every year. I do get a lipid panel and metabolic panel every year and all those numbers are good. I can regulate my own diet and am good at exercising - doctors don't know much about that stuff, anyway.
I'm 78 and had a quadruple bypass in '21. About the only thing I learned from that was cholesterol levels really didn't have anything to do with blockage; mine never were high. Never smoked, drank almost no alcohol. Walked a lot. No blood pressure issues. Recovery from surgery was fairly easy and steady.
I'm 5'10"/ 185. Male.
My mother was like I am. She went to the doctor when she was injured, that's all. Died at 94.
The cholesterol theory was one that was observational by nature and initiated based on young men dying in their forties and fifties around the end of WWII. It wasn't intended for older individuals.
So as a personal philosophy that you want to install in somebody that is young one that embraces the exception or one that embraces the rule? There's problem with the exception and there is problems with the rule when used on any given individual.
One has heard of individuals living over the age of 100 give their anecdotal suggestions for living long. That is outcome based since they lived to be that age. The people who died much earlier are not around to talk but their story is the rule rather than the exception.
You make an assumption that a person is healthy and thus and adult need not concern themselves with it. By definition a healthy person is one without disease. If a person gets an initial infection then by definition they are not healthy and if they are not healthy then one can not predict their outcome based on your statement.
As far as strep goes the use of antibiotics is not just to stop a threat infection or symptoms pertaining to the throat infection. It is to minimize the antigenic exposure in trying to prevent autoimmune disorders.
"This systematic review found that antibiotic treatment of sore throat with accompanying symptoms suggestive of group A streptococcal (GAS) infection is effective in reducing the attack rate of acute rheumatic fever by 70%. Intramuscular penicillin appears to reduce the attack rate by as much as 80%. There was one fewer case of acute rheumatic fever for every 50–60 patients treated with antibiotics. These findings suggest that antibiotic treatment can be effective for preventing acute rheumatic fever in a population with suspected GAS throat infection."
That's got nothing to do with shortening the course of sore throat illness. I think one study showed a one day shorter course with antibiotics compared to no antibiotics which isn't much.
Another different kind of example is the routine use of antibiotics in UTI in patients without symptoms.
I am all for clinical studies showing the way on when and how to use antibiotics and when not to use antibiotics. Over use is a problem and recent studies with sinusitis are a good example based on outcome studies.
I am willing to change my mind on a case by case basis based on outcome studies.
What that study found was that you need to treat 60 patients with antibiotics to prevent one case of rheumatic fever. So on a cost-benefit side of things, if you never had an acute case of rheumatic fever by 18, you’re at very very low risk of rheumatic fever and therefore you need to consider the side effects of the medication.
I’m not aware of any studies definitively showing treatment with antibiotics reduces GAS titers, and if they don’t reduce symptom duration my best educated guess is this is minimal to none existent.
PS that meta analysis featured mostly unblinded, and none randomized studies which tend to exaggerate NNT. We need randomized blinded clinical trials for this question. I already know one confounder- patients who can tolerate a full course of antibiotics to be included in the antibiotic arm will be healthier.
In general, it seems like the US healthcare system is a trainwreck with hoards of uninsured horribly unhealthy people, where healthy people are treated like cash cows to fund the system for those that don't pay when they go in.
Yes, but people whose houses aren't on fire are also subsidizing people whose houses are on fire. That's how insurance works. Although I will add that my house insurance is $106/month while my family health insurance is $1400/month.
The good news is, there is no legal requirement for you to buy health insurance (although your mortgage lender will probably require you to have fire insurance).
What that study found was that you need to treat 60 patients with antibiotics to prevent one case of rheumatic fever. So on a cost-benefit side of things, if you never had an acute case of rheumatic fever by 18, you’re at very very low risk of rheumatic fever and therefore you need to consider the side effects of the medication.
I’m not aware of any studies definitively showing treatment with antibiotics reduces GAS titers, and if they don’t reduce symptom duration my best educated guess is this is minimal to none existent.
PS that meta analysis featured mostly unblinded, and none randomized studies which tend to exaggerate NNT. We need randomized blinded clinical trials for this question. I already know one confounder- patients who can tolerate a full course of antibiotics to be included in the antibiotic arm will be healthier.
The standard of care is to treat Strep A with antibiotics. If you can show studies suggesting otherwise then I would be more than happy to read those.
The standard of care is to treat Strep A with antibiotics. If you can show studies suggesting otherwise then I would be more than happy to read those.
I'm/was speaking for myself "I personally would not take antibiotics for Strep.".
For an individual patient who comes in with strep throat, it's probably fine given short time duration, possible benefit. And it should be noted that even if there is no benefit (as can be found in a clinical trial), my experience is that placebo effect is very real and effective. Patient who gets an Rx for antibiotics thinking these are the silver bullet to their misery will often recover faster.
I'm just a tad bit more cynical on myself, and close family. For example, when my youngest daughter (who will turn 2 next week) had strep throat last winter season, I didn't give her with antibiotics as per my reasoning above.
You make an assumption that a person is healthy and thus and adult need not concern themselves with it. By definition a healthy person is one without disease. If a person gets an initial infection then by definition they are not healthy and if they are not healthy then one can not predict their outcome based on your statement.
As far as strep goes the use of antibiotics is not just to stop a threat infection or symptoms pertaining to the throat infection. It is to minimize the antigenic exposure in trying to prevent autoimmune disorders.
"This systematic review found that antibiotic treatment of sore throat with accompanying symptoms suggestive of group A streptococcal (GAS) infection is effective in reducing the attack rate of acute rheumatic fever by 70%. Intramuscular penicillin appears to reduce the attack rate by as much as 80%. There was one fewer case of acute rheumatic fever for every 50–60 patients treated with antibiotics. These findings suggest that antibiotic treatment can be effective for preventing acute rheumatic fever in a population with suspected GAS throat infection."
That's got nothing to do with shortening the course of sore throat illness. I think one study showed a one day shorter course with antibiotics compared to no antibiotics which isn't much.
Another different kind of example is the routine use of antibiotics in UTI in patients without symptoms.
I am all for clinical studies showing the way on when and how to use antibiotics and when not to use antibiotics. Over use is a problem and recent studies with sinusitis are a good example based on outcome studies.
I am willing to change my mind on a case by case basis based on outcome studies.
Also, untreated strep can lead to glomerulonephritis.
What that study found was that you need to treat 60 patients with antibiotics to prevent one case of rheumatic fever. So on a cost-benefit side of things, if you never had an acute case of rheumatic fever by 18, you’re at very very low risk of rheumatic fever and therefore you need to consider the side effects of the medication.
I’m not aware of any studies definitively showing treatment with antibiotics reduces GAS titers, and if they don’t reduce symptom duration my best educated guess is this is minimal to none existent.
PS that meta analysis featured mostly unblinded, and none randomized studies which tend to exaggerate NNT. We need randomized blinded clinical trials for this question. I already know one confounder- patients who can tolerate a full course of antibiotics to be included in the antibiotic arm will be healthier.
"It is estimated that 1% to 3% of patients with untreated group A streptococcus (GAS) infection, most typically GAS pharyngitis, will develop ARF, and of these, up to 60% of cases will result in chronic RHD [rheumatic heart disease]
When you talk about NNT, the severity of the disease and its sequelae need to be considered. Valvular heart disease and chronic kidney disease are not trivial.
"It is estimated that 1% to 3% of patients with untreated group A streptococcus (GAS) infection, most typically GAS pharyngitis, will develop ARF, and of these, up to 60% of cases will result in chronic RHD [rheumatic heart disease]
When you talk about NNT, the severity of the disease and its sequelae need to be considered. Valvular heart disease and chronic kidney disease are not trivial.
Even treated strep can lead to glomerulonephritis and ARF and these other immune mediated disorders. I don't see why antibiotics would reduce these incidences if they don't reduce disease duration or bacterial titers.
I'll post this here, because it's interesting:
Quote:
Results ARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1).
What we really need here is better studies. Everything we're using are just retrospective analyses. Having been burned by these types of studies in the past, I just now think 'interesting' every single time.
I want us to put on our thinking caps and use common sense.
ARF is an autoimmune condition caused by antibodies that both cross-react with normal tissue and group A streptococcus bacteria.
Typically, sore throat develops 3-5 days after infection with this bacteria. By then, an immune reaction has already been mounted. You would only begin to treat the patient with antibiotics after this point, as prior they would not seek physician care.
I want us to put on our thinking caps and use common sense.
ARF is an autoimmune condition caused by antibodies that both cross-react with normal tissue and group A streptococcus bacteria.
Typically, sore throat develops 3-5 days after infection with this bacteria. By then, an immune reaction has already been mounted. You would only begin to treat the patient with antibiotics after this point, as prior they would not seek physician care.
Those are not the only variables that one is talking about. It just proves my point that it is useless to make recommendations lacking clinical studies. There's variability of M proteins not only in this country but throughout the world. ARF is other countries is higher and differ in M proteins. M proteins alter phsyiology and outcomes.
There has been vaccine studies using M proteins. Antibody responses if one is talking about ASO antibodies is also variable. There's also over diagnosis based on simply stand alone titers. It is more optimal to see a rise in titer.
In either case until there are clinical studies showing outcomes then we can talk about that.
If you think that is all there is to health you are mistaken. If that were true there wouldn't be a medical profession at all.
THIS. Eating "healthy" and getting exercise are great for you. Getting fresh air and sunshine and enough sleep also. Dealing with stress in healthy ways. But there are many diseases you can get that have nothing to do with ANY of these variables. Just so you know that. We can all do our best, and then just hope for the best. Life can be cruel. Don't wait until it's too late to get symptoms checked out. If you want to live a long time, that is.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
