Reassurance Medically Unexplained Physical Symptoms 英文参考文献.docVIP

Correspondence Reassurance: Medically Unexplained Physical Symptoms Multidrug-Resistant TB in the Philippines: Totem and Taboo Bill Anderson Jose Luis Portero, Maria Rubio Escobar et al.’s discussion of medically unexplained physical symptoms is useful, and could trigger a renewal of how the medical profession works [1]. We are in transition at the present, and what we have been trained for is less and less relevant. This disjunction between our training and practise has given rise to a generation of unhappy doctors. Tupasi et al. [1] show the feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis (MDR-TB) in a resource-limited setting. These conclusions could lead to error since the tertiary hospital where the pilot project was carried out is not representative of the average health-care setting available for the Filipino tuberculosis patient. Resch et al. [2] highlight that this analysis is not an independent evaluation and that the intervention was set in ideal conditions. In the ?eld, this pilot project will ?nd serious dif?culties in implementation within the government- run Filipino National Tuberculosis Program (NTP), where the majority of tuberculosis patients are diagnosed and treated. Moreover, in recent years Filipino tuberculosis health policy has not supported the development of capacities for mycobacteria culture and susceptibility tests in the public regional laboratories, missing the opportunity to strengthen competence on tuberculosis resistance management in the whole country. Taking into account the geography (an archipelago) and the structure of the NTP, a community- based pilot project carried out by the governmental health centers closer to the patients would have been more appropriate to study the feasibility and the real cost- effectiveness in a resource-limited setting. The selection of 118 patients out of 171 eligible may bias the ?nal results increasing the cure rate, since the most dif?cult patients to treat, by