Far from it, and I've clarified that multiple times. This entire discussion between us has been in response to your statement "or he might have been repeating uninformed speculation. Most practicing physicians are not epidemiologists", which was an ill-considered suggestion for reasons discussed in this thread. To put it simply, that and subsequent statements on your part lacked substantial relevance in context and were collectively a transparent attempt to dismiss something you didn't like via a vague and unsupported attack on credibility. You ran with assumptions you were comfortable with, and the outcome was that your supposition of credibility in light of probable actual circumstances was demonstrated to be founded in ignorance.

Instead of taking an opportunity to contribute something of value to the conversation, you went the route detailed above. You could have used an inquisitive line to ask for more information on the scenario depicted, perhaps with some hypothetical lines of reasoning you might draw based on possible answers. If people are going to have production conversations on important matters, these things matter. You were called on it, and you've spent a lot of time trying to backtrack on it. Just put down the shovel.

Since you've referenced tuberculosis, perhaps you'd be interested in reviewing some relevant data from the CDC: Trends in Tuberculosis – United States

Here are some excerpts:

"How many cases of tuberculosis (TB) were reported in the United States in 2012? A total of 9,945 TB cases (a rate of 3.2 cases per 100,000 persons) were reported in the United States in 2012. Both the number of TB cases reported and the case rate decreased; this represents a 5.4% and 6.1% decline, respectively, compared to 2011*. The number of reported TB cases in 2012 was the lowest recorded since national reporting began in 1953. *Ratio calculation is based on unrounded data values."

"Is the rate of TB declining in the United States Yes. Since the 1992 TB resurgence peak in the United States, the number of TB cases reported annually has decreased."

"How do the TB rates compare between U.S.-born persons and foreign-born persons living in the United States? In 2012, a total of 63% of reported TB cases in the United States occurred among foreign-born persons. The case rate among foreign-born persons (15.9 cases per 100,000) in 2012 was approximately 11 times higher than among U.S.-born persons (1.4 cases per 100,000)."

You may also find the following information useful:

• Reported TB Cases, United States, 1982-2012
• TB Case Rates, United States, 2012
• Tuberculosis in Hispanics/Latinos

Given this data, please explain your simple solution for finishing up the job of TB eradication in the United States.

You certainly seem to be assuming a lot, but you don't appear to have much knowledge of the relevant topics. To avoid needless repetition and thread scope creep, please review the following related posts:

• Exhibit A
• Exhibit B
• Exhibit C

You have contributed nothing of substance to this conversation. In other words, your opinion is shit. Cheers.

I find it somewhat ironic that this is your "Homepage" URL.

Please reference the following resources:

• Antibiotic misuse
• Antibiotic prescribing rates by country
• Study shows overuse of antibiotics
• Antibiotic use in livestock - Use by country
• Scientists: overuse of antibiotics in animal agriculture endangers humans

• Antimicrobial resistance: global report on surveillance 2014

While these resources alone do not paint an absolute picture of the global problem of large scale antibiotic misuse, there is no question that the United States is indeed among the highest ranked nations and regions for these problems. As for the GP's second sentence regarding particularly nasty germs in hospitals versus hotels, his statement is overzealous at present, but the problem is rapidly worsening in the United States.

In light of this information, please explain why you believe the GP's statement to be speculative, wrong, stupid, "not nice at all" and wildly ignorant. Judging by your recent posting history, you appear to place higher value on your opinion of whether things sound "nice" and much less value on facts.

My old phone is an LG Thrill. Geat phone when it was released. Had a 3D camera so you could take 3D pictures. Reasonable 3D rendering ON THE PHONE. That's the problem. You could take 3D pictures but only people with another LG Thrill could view them in 3D. You couldn't even share just one of the two images from the stereoscopic image since neither image was actually "correct" when viewed alone. You had to view the 3D images on an LG Thrill. Dumb.

Oh yeah. It also had the ability to play 3D games. I don't play games so that was another useless feature. Also, I'm sorry but the idea behind 3D movies, games, what have you is to make the experience "immersive". It's really hard to feel immersed when you have this little teeny, tiny smartphone screen. Lifesized 3D on a wall sized 4K screen is immersive.

Cheers,
Dave

No, that would not be unusual, via direct experience and/or ongoing professional education and correspondence with other physicians. Where are you getting your information?

Precisely because we do not know that particular qualifications the person may or may not have, which I also believe you are placing undue stress on in light of epidemiological training receiving over the course of obtaining an MD/DO and compounded by a lack of undergraduate level epidemiology programs in general, I am cautioning you to temper your view of what the term "expert" would mean for such a person. I believe there is more gray area here than you are willing to accept, but it may simply be the case that our perspectives will differ on this point.

My goal is still to encourage you to review more materials on this topic instead of working to find means of discounting a view without further data. This might be a good start.

Why are you assuming the physician in question worked exclusively at the free clinic? This is quite unlikely. I have known many physicians who worked rounds at free clinics in addition to their duties at other medical facilities in various metropolitan areas, but I cannot recall having known a physician who only did free clinic work for any prolonged period of time. I have seen a couple of cases where doctors who were very financially secure (not the normal "paying off medical school, dealing with other debt as well just like everyone else" conditions) only worked free clinics in urban or very rural areas for a matter of months, this does not appear to be the norm. Residencies are also typically much more balanced in the demographic mix sense.

Even assuming a physician only works at a free clinic, it seems unlikely that he would have no communication with other physicians servicing alternate socioeconomic groups. This really goes back to my request that you perform a bit of research before voicing what appear to be unfounded suppositions.

This is a view that has come into vogue fairly recently, but in terms of practical impact it is generally considered unfounded. Johnson & Johnson has a long demonstrated history of massive spending on advertising and lobbying efforts promoting the safety of Tylenol, while working to suppress and discredit evidence of harm wherever possible. This has also extended into legal efforts such as this example from 1988 and large volumes of new litigation in 2013.

While I fully acknowledge the existence of people (who are in fact scum) who would prefer to see addicts die, their actual influence is minimal compared to the billions spent by companies like Johnson & Johnson. However, I do suspect there exists some overlap between the two groups.

Rather than repeat it in its entirety, I'll refer you to my other reply in this thread. My intention here is less to scold and more to encourage you to perform any measure of research before casting blind aspersions on the credibility of any (admittedly secondhand) physician statement. I freely note that I am not a medical doctor; are you? Presuming you are not, we both have access to a wealth of published materials and the opportunity to discuss them, including discussions on the merits with practicing physicians should we wish. It should be noted that many epidemiologists are physicians, but many hold alternate degrees in the sciences and public health in lieu of an MD/DO.

I've read the referenced publication twice in its entirety. You are attempting to minimize the key point "census tracts with lower median incomes, more racial/ethnic minorities, and more immigrants had higher rates of pediatric tuberculosis" by separating the factors for your convenience. I never stated that illegal immigration was the only factor, but it is nonetheless intimately linked with the rate of transmission of tuberculosis. I'll leave it to you to consult additional studies (CDC, etc) that demonstrate similar results. If you are inclined to disagree with the methodology and statistics associated with this or any other studies, you should cite specific objections and include contrary data or alternate interpretation of supplied data. Otherwise, nobody should take you seriously, as you're not adding anything to the conversation other than unfounded conjecture.

I'm confused why you seem to think I would disagree with your view that we should immunize everyone. In fact, I fully agree with that position, but you have again attempted to divert attention from a legitimate factor. I suspect this is because of your personal views on immigration, but I would encourage you to question where your priorities are in this case. Is reduction of disease transmission in the United States your actual goal here, or is there another agenda you feel ranks higher in terms of social good? If it is the latter, on what terms have you arrived at that decision, and have you considered tradeoffs and interrelated concerns involved with the picture as a whole?

Codeine is an opiate and is generally indicated for mild to moderate pain reduction, while paracetamol (acetaminophen) is a non-opioid analgesic. While acetaminophen is commonly combined with an opioid such as codeine or hydrocodone in many pain management medications (especially in the United States), choosing an opioid/ibuprofen combination is safer in terms of reduced risk for hepatotoxicity. In addition to its action as an analgesic, ibuprofen also has significant anti-inflammatory properties, although as with any medication various risks and side effects should be considered. Unfortunately, the PR/lobby/legal machines at Johnson & Johnson (maker of Tylenol, the most common acetaminophen brand) have gone to great lengths to downplay hepatic risks associated with acetaminophen and portay it as superior to ibuprofen. Results will vary on a case by case basis, but in my case acetaminophen in nearly useless for pain reduction. In contrast, I have found ibuprofen alone to be much more effective for many kinds of pain.

It should be noted that the GP cited potential respiratory complications but did not provide specifics, and thus any opioid medication (especially stronger formulations) might be contraindicated due to heightened risk of respiratory depression. All this said, I am not a medical doctor, and this is not medical advice; it is merely my own personal views on this topic. I believe the GP should perform as much personal research as possible, and then follow up with a physician to discuss his/her findings in detail before trying another medication. Any physician who is not receptive to such a detailed discussion should be avoided.

I can't decide if this should be modded "funny" or "insightful." Either way, I've already commented in this story, so I can't mod it.

You may be interested in publications such as this: "An ecological study of tuberculosis transmission in California." If you're going to question the veracity of a statement, you should invest some effort into fact-finding on your own. The referenced publication is one of many you can find without much trouble.