Compensation of Lawyers and Doctors

To the Editor: I recently saw two lawyers; one was my own attorney, who did some work for which he charged me $185 per hour; the second was a patient in ...

Abstract

To the Editor: Tibbles and Edelsberg (June 20 issue) 1 present a complete and cogent summary of the therapeutic usefulness of hyperbaric-oxygen therapy.However, their review contains a recommendation that is not supported by evidence.In the section on the treatment of carbon monoxide poisoning, the authors present a balanced discussion of studies demonstrating conflicting results.The available evidence does not guide us one way or the other as to the effectiveness of hyperbaric-oxygen therapy in this setting.Yet in a seeming non sequitur the authors state, we think that patients with severe carbon monoxide poisoning should receive at least one treatment with hyperbaric oxygen at 2.5 to 3.0 atmospheres; additional treatments may produce greater improvement in neuropsychological deficits.For patients with lesser degrees of poisoning, we advise consultation with a toxicologist to determine whether the administration of 100 percent normobaric oxygen for four to six hours, or until symptoms abate, would be adequate therapy.We find this recommendation incomplete at best, and misleading at worst.In a recent review, Tibbles and Perrotta stated that "no randomized, controlled, blinded clinical trial demonstrated a clear advantage of HBO [hyperbaric-oxygen therapy] over NBO [normobaric-oxygen therapy] in reducing morbidity and mortality in carbon monoxide poisoning." 2 An accompanying article in the same journal concluded that "the standard of care for pa-tients exposed to CO [carbon monoxide] is yet to be determined." 3We believe readers need to be reminded of these facts.