Letters To The Editors

Antibiotics: course of treatment or course of least resistance?

If most doctors practice medicine like the so-called experts quoted in "How to say No when antibiotics won't help" [Oct. 8], it's obvious why patients continue to demand antibiotics for colds and other viral infections.

"If someone seems like a tough nut, and you have a busy day, write the prescription for that patient and suggest you have a discussion about it next time," advises internist Sheldon Greenfield, whom you describe as an authority on doctor-patient relationships. And FP Richard Waltman concurs: "Sometimes when people demand antibiotics, I tell them this is almost certainly a viral process, and I give them the antibiotics anyway."

Their unspoken message—one surely heard by the patient—is that anyone who protests loudly enough can dictate his treatment, regardless of its therapeutic value.

When doctors ignore prescribing guidelines to satisfy their customers, they not only drive up the costs of health care and promote viruses' resistance to antibiotics. They also set the stage for future anger and confusion when patients finally meet the physician who properly refuses their demands.

Terry R. Nye, MDSpringfield, MO

Don't slow down, just scale back

General surgeon L.W. Ghormley deserves loads of credit for practicing medicine into his 70s ["Retire? Not likely!" Oct. 8]. Yet no matter how great he looks, he's still 75, and in the event of a bad outcome, his age leaves him open to a patient's charge that he's no longer fit to do surgery. It would be relatively easy for a plaintiffs' attorney to demonstrate that an older physician's dexterity is significantly less than the doctor believes it to be.

My advice to Ghormley: Stick to minor procedures or to consultations, where, by virtue of your years of experience, you are excellent. You have every right to be proud that you're still going strong, but you'd also be wise to take steps now to limit your liability.

Evelyn W. Bradford, JD
Waynesboro, PA

Defending America and the principles it's based on

I found two very disturbing elements in internist Donald Fox's guest editorial warning us to get ready for a mass biologic attack ["We must prepare!" Oct. 22]. The first was Fox's admission that our government secretly tested biological materials on its citizens during the '50s in Washington, DC, and San Francisco. Even though a "supposedly harmless" bacterium was substituted for anthrax in these experiments, many victims became ill and several died.

In view of this example of how the government once broke trust with its people, Fox's plan to shelve another of our civil rights is likewise troubling. He calls for a suspension of patent rights for medications to treat anthrax.

While this would enable generic drug manufacturers to rapidly produce the antibiotics we'd need in case of a major terrorist attack, it is still outright theft. And it undermines his appeal to the pharmaceutical industry to shift into overdrive to produce enough anthrax vaccine for our entire population. What company would want to produce anything knowing that its property could be confiscated by the government at will?

The defense of individual rights, such as property rights, is what distinguishes the United States from our enemies. In times of crisis, this principle must be upheld more strongly than ever, or what are we fighting for?

Gordon W. Dickerson, MD
Medford, OR

Edited by Liz O'Brien,
Associate Editor

Address correspondence to Letters Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to meletters@medec.com, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication. Also, let us know if you don't want your e-mail address printed with your letter.

Liz O'Brien. Letters to the Editors.

Medical Economics

2002;1:10.