primary outcome and should not be inappropriately used for hypothesis testing. We chose a primary outcome that was a clinically meaningful time point and would minimize the sample size required, which is consistent with the ethical principle of beneficence. 5 In contrast to the depiction by Borek et al of the "higher risks" of Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV), these risks are known to be quite low. 6 Cost is important and varies greatly between individual patients. We support shared decisionmaking, including discussions of risk, benefit, and cost with the patient.We also would like more evidence. However, 20 years of research has consistently shown FabAV to be effective and safe. The results of this study, in the context of the existing evidence, demonstrate that the balance of risk and benefit favors treatment, even in a group with low clinical severity. We believe that the decision to treat copperhead envenomation is no longer solely a physician decision but should be made with the patient in a manner consistent with his or her individual values.
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