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Prophylactic antibiotics

docrickfry at aol.com docrickfry at aol.com
Fri Apr 14 17:21:20 BST 2006

This list is really not a place to give a primer in the basics of the scientific method, which you apparently have no appreciation whatever of--it took me several years to understand it, you must just at this point realize how much you do not know and go from there to try to learn
-----Original Message-----
From: bensonblues at comcast.net
To: trauma-list at trauma.org
Sent: Fri, 14 Apr 2006 16:14:00 +0000
Subject: Prophylactic antibiotics

Dr. Rick,

The text is 1996, so it is a decade old. I'm very sorry to quote from the 
archives. It sounds like you are saying that in order to prove benifit, we need 
a controlled longitudinal clinical study of significant power. I agree with you, 
but doing the study? In Wayne County (and elsewhere), let's say you don't give 
A/Bs and patient gets septic and dies. Somewhere there is a retired surgeon with 
an impressive CV (before he began drinking and developed his gambling problem) 
that will testify to a jury of 6 laypersons (not peers) that the patient would 
have lived if A/Bs were given, facilitating a judgement against he physician. 
Again, you may be right in saying that simply because someone says this is so 
does not constitute evidence of benefit, but citing this text to the jury is 
enough for them. Proving that giving prophylactic A/Bs actually harms the 
patient, well, that's another story. We never used to give A/Bs for puncture 
wounds of the feet, but a generous award to a patient who d
eveloped osteomyelitis changed that...

One may ask why we rarely see rheumatic heart disease in this country. To prove 
the impact of the routine administration of antibiotics for otitis, pharyngitis, 
and URI to our children (which are most often viral) on the incidence of this 
disease would be impossible. Yet, this begs the question as to why RHD remains 
relatively uncommon.  

One last note: It is obvious that you are very bright and experienced, and no 
doubt your brilliance exceeds that of the common physician. Your words will have 
far more meaning if you avoid the arrogant adjectives which permeate your text. 
Truly, if you work in a teaching environment, compassion and tolerance of 
ignorance will make you a far better teacher, rather than someone whom the 
residents will try to avoid because of the likelihood of being humiliated by 
your dissertations. I mean no disrespect, as your knowledge and skill as a 
thinker is unimpeachable; but your crude and condescending comments mitigate 
against meaningful discussion. That is, of course, this is what you desire.

"I play with microbes. There are, of course, many rules in this play...but when 
you have acquired knowledge and experience it is very pleasant to break the 
rules and to be able to find something that no one has thought of...." Alexander 
Flemming, 1945.

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