Liam Farrell: If it looks like it's too good to be true

'I'm sending Mrs X up to you, she has delighted me long enough,' I said generously to our practice nurse, as if this was the Christmas present she had always desired. 'Could you do an FBC?'

She somehow suppressed her joy, but I could sense a certain nervous expectancy at the other end of the phone. 'And ...?' she said. I struggled, but the words rose unbidden. 'And ... ESR and U&Es.'

There was a satisfied silence, as if the natural order had been restored; the sun coming up every morning, the birds singing, the Tories wrecking the NHS by stealth, and the words 'FBC' being immediately followed by 'ESR and U&Es'.

Because some things just go together - bacon and eggs, Laurel and Hardy, homeopathy and snake oil, Fergie and prolonged injury time, Thatcher and devastated small communities.

But never in my wildest dreams would I have put antibiotics with low back pain. It sounds counter-intuitive, but science is always ready to throw out dogma in the face of new evidence. OK, sometimes it has to be dragged kicking and screaming.

The role of Helicobacter pylori in peptic ulceration seemed implausible at first, but we eventually got on board, especially when the drug companies realised there was a few quid to be gleaned from the fertile fields of our gastric mucosa.

Low back pain; common, often no objective findings, no definitive diagnosis, no satisfactory treatment. Antibiotics; tortured by patients because we don't prescribe enough, pilloried by everyone else because we prescribe too much.

So a report in the European Spine Journal, suggesting long-term antibiotics could help 40% of patients with low back pain, seemed to kill two birds with one stone, but read suspiciously like the email I received from a retired colonel in Nigeria who needs my bank account to park his millions. I suspect we'll find the findings are not repeatable.

Sadly, when something seems too good to be true, it usually is.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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