Pascal's Wager, infective endocarditis and the "no-lose" philosophy in medicine

Shaw, D. and Conway, D.I. (2010) Pascal's Wager, infective endocarditis and the "no-lose" philosophy in medicine. Heart, 96(1), pp. 15-18. (doi: 10.1136/hrt.2009.186056)

Abstract

Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal's Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the "no lose philosophy" in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal's Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the "belts and braces" approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal's Wager, are based on faith rather than evidence.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Shaw, Dr David and Conway, Professor David
• Authors: Shaw, D., and Conway, D.I.
• Subjects: R Medicine > RC Internal medicine
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• Copyright Holders: Copyright © 2010 BMJ Publishing Group
• First Published: First published in Heart 96(1):15-18
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher

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