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Heart 96:15-18 doi:10.1136/hrt.2009.186056
  • Viewpoint

Pascal’s Wager, infective endocarditis and the “no-lose” philosophy in medicine

  1. D Shaw,
  2. D I Conway
  1. Dental School, Faculty of Medicine, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr D Shaw, Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ; d.shaw{at}dental.gla.ac.uk
  • Accepted 13 October 2009

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.

Footnotes

  • Funding This paper was internally funded by the University of Glasgow.

  • Competing interests None.

  • Contributors: This article was DIC’s idea, and he provided the clinical references. DS provided the theological, ethical and decision analysis and is the guarantor.

  • Provenance and Peer review Not commissioned; not externally peer reviewed.

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