The provided text, primarily based on a diary entry by Dr. Michael Koch, critically examines divergences in medical practices between Germany and the rest of the world, particularly concerning the drugs Amiodarone and Metamizole. The author highlights how German guidelines for Amiodarone for cardiac arrhythmias differ significantly from international trends, which increasingly favor Lidocaine due to superior outcomes. Furthermore, the text addresses the widespread use of Metamizole in Germany despite documented, albeit rare, severe adverse events like agranulocytosis, with safety reviews and prescribing patterns in Germany contrasting sharply with other nations. Dr. Koch expresses profound concern that Germany's medical reputation is undeservedly high given its resistance to incorporating international evidence. suggesting an "institutional intransigence" that prioritizes tradition over evolving global best practices and patient safety.

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