Biology Reference
In-Depth Information
representative examples). Thus, unqualified commentary may subjectively sensa-
tionalize the mild, local effects of the bite (see Sections 4.5.1.4, 4.5.1.5, and 4.5.2).
This is not surprising when the victim gives a report describing their pain, edema,
and other sensations experienced after the bite, as the description will more likely
be colored by effects felt rather than observed. These deficiencies can also result in
unrecognized subtle, yet significant, alternative explanations for the observed symp-
toms and signs. Lack of analysis by an experienced clinician may result in failure
to recognize medically important signs/effects or misinterpretation of the results of
investigations. The importance of this flaw should not be underestimated. For exam-
ple, as described previously, bites by
B. irregularis
have, based on inadequate obser-
vations, been thought to occasionally cause neurotoxicity, including cranial nerve
palsies (see Sections 4.4.1 and 4.4.2). Similarly, the neurotoxicity of
M. monspessu-
lanus
had little documented support until the recent strong case reported by Pommier
and de Haro (2007; see Section 4.4.2). However, even though cranial nerve testing is
robust, traditional, and well-established, under some circumstances even experienced
clinicians can have difficulties with objective assessment of some cranial nerve func-
tions. Modification of several scales designed for assessment of cranial nerve VII
(facial nerve) has been proposed in order to aid objective examination of CN VII
function and decrease subjective interpretation (Kang et al., 2002). Thus, as experi-
enced physicians may have difficulty interpreting some clinical signs, it is clear that
such signs would be subject to probable misinterpretation by a casual observer.
Adding to this serious issue of excessively subjective and often medically unqual-
ified authorship is the common tendency to publish these reports in nonmedical jour-
nals, thus escaping review by medically qualified referees. Many reports have been
published in herpetological or natural history journals, and these are often obscure
periodicals. Obviously, without appropriate and qualified review, errors such as those
outlined above are published and perpetuated. Therefore, incorrect interpretation of
signs and symptoms may be introduced into the literature and gain provisional valid-
ity. This may propagate incorrect assignment of risk, and obfuscate evidence-based
assessment of the medical importance of a given colubroid species. Unfortunately,
cases of snakebite are often rejected by mainstream medical journals because this
subject is considered to be esoteric, only peripherally important, or irrelevant.
Therefore, although this limitation does not obviate the need for mandatory stan-
dards imposed on these published cases as they would be for any clinical report, it is
necessary to recognize this unfortunately narrowed access to appropriate outlets for
these reports.
Conclusions and Recommendations
It has been long recognized that the art of medicine injects subjectivity into the inter-
pretation of the results of physical examination (Clarke and Fries, 1992; Joshua
et al., 2005; Leder, 1990). It is essential that the attending physician maintains as much
objectivity as possible in reporting a patient's presenting signs/symptoms. In the event
of a lack of appropriate clinical training, as well as authorship of one's own case report,
this inherent subjectivity is exaggerated by lack of medical acumen. This can result
in misrepresentation of the objective effects of a bite. Even trained clinicians may
