I thought you might all be interested in an item that appeared in Pediatric
Notes (a sort of resume of articles in pediatrics).  In the June 15 issue
(volume 24, number 24), there is an item on fever (the original article is
Mayoral CE et al. Pediatrics May 2000;105:1009-12).

They surveyed treatment of fever amongst physicians (of which 2/3 were
general pediatricians).  I quote from the Notes "Fifty percent of
respondents reported that they advised parents to alternate acetaminophen
and ibuprofen....The authors point out that there is no scientific evidence
comparing the use of either agent alone with combined therapy, and there is
at least a theoretical possibility that the two might act synergistically
and cause renal tubular toxicity.  Incidentally, 29% of respondents cited
AAP (American Academy of Pediatrics) recommendations as the basis for their
antipyretic management practices.  However, it turns out the AAP has issued
no such recommendations on this topic".  The commentator says "The mere idea
of alternating antipyretics seems bizarre, to put it mildly".

Which only proves, I think, what I have said for years.  "Evidence based
medicine" is only for *others* when they don't agree with what you do.

Jack Newman, MD, FRCPC

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