This article gave me that “I told you so” feeling. Before I retired in 2008 I railed against younger doctors for advising parents to use alternate ibuprofen and paracetamol to bring their kids’ fevers down. My grounds were that fever is physiological and useful, not pathological (surprising how many docs haven’t clocked this), that drugs (especially NSAIDs) have side effects, and that no evidence existed that using two antipyretics does more than one. Indeed, at the time there was no actual research to show that using even one to reduce temperature reduced the only significant complication of fever, convulsion, though it’s highly probable they would.
As I got older I increasingly felt an endangered minority in my views, as not only GPs, but paediatricians and the Official National Help Line, NHS Direct (or NHS Dire as we doctors called it), began to propagate the alternate-drugs dogma. It became the consensus. If I hadn’t known I was retiring, I might have succumbed to changing my practice, if only to escape malpractice suits.
After this review of course I feel vindicated and can carp from my rural hilltop. Yet I can’t say my opinion was based on science – as in so much routine medicine the research just hasn’t been done. And where it has it’s often contradictory (as this early article of mine tried to show). Neither was there any practical way for me, as a working GP, to do the research myself amongst the hundred of similar questions. I was guided by the soft and subjective clinical experience and nous. As, I suppose, were those who formed the majority view.
The question to me is just how that consensus came to dominate a scientific community. Is it only in medicine that truth is dictated as much by fashion as evidence, or can such things affect more rigorous sciences like biology?
