According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent. More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down. However, once saturation is reached, it will persist longer in ID than in other, older subspecialties. In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease. Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents. Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs. A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs. Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.

Education, Medical, Graduate↗

PubMedDate not supplied

Communicating infectious disease information to the public.

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Communicable Disease Control↗

PubMedDate not supplied

Intrathecal therapy in tetanus. A meta-analysis.

OBJECTIVE: --To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques. DATA SOURCES: --Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles. STUDY SELECTION: --Studies in English with concurrent controls treated without intrathecal therapy. DATA EXTRACTION: --Data were extracted by one author and verified by the second; conflicts were resolved by discussion. DATA SYNTHESIS: --No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established. CONCLUSIONS: --Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials.

Adult↗