I have not been reading the journal articles, and so cannot comment about
them, but  I do want to say that having the discussion of them on Lactnet is
hugely educational even with out it -- I am really enjoying it.

Carol's comments on VL's article reminded me of something from my childhood.
When I was a kid (maybe still now) pediatricians in our area did or didn't
culture for strep based on whether it "looked" like strep to them -- if they
thought it was, they would culture to be sure, even though they'd start abx
first, and if they thought it wasn't they didn't bother with the culture.

The large peds group our family used was curious about that, and did a study
one winter in their own practice.  They did their usual procedure in terms of
guessing, starting treatment or not on that basis -- but then they cultured
*every* kid that presented with sore thoat or fever or both, and compared the
culture result to their guesses.  They were amazed to find that their success
rate was right around 50% -- flipping a coin would have done as well as their
years of professional judgment!   After that they basically cultured
everybody.

It may be that, especially as god willing insurance co's get to recognize LCs
more and thus be more ready to reimburse on their recommendations -- and
maybe also as the integration between the support side of LC work and the hcp
side gets further worked through as the profession evolves -- that it will
become much more routine to culture things without waiting to treat them on a
hit or miss basis for such a long time.

(Personally, with my first child, I had horribly cracked and bleeding nipples
for SIX WEEKS -- I betcha now that my hospital-suctioned child gave me some
nasty bug, and I had to fight it off myself in the absence of any treatment
from anybody at all...)

Elisheva Urbas in NYC
who has spent a whole lot too much time on Lactnet today!

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