Letters: Readers comment on Medical Economics stories

Humble efforts and actions

I have read and re-read with great interest the article by Jennifer Frank, MD ("Fringe benefits," May 10 issue). Who of us has not slightly cringed while reviewing the medical history of a new Medicaid patient, immediately assuming he or she was looking for opiates? Then we find out once again that life and fate often do not equally divide the same benefits amongst us all.

Dr. Frank wrote with great humility, acumen, and empathy. And, as she described in the final passages, the patient, despite all that has gone against her, at least had the small peace of mind that any future chest pain or breast lump would not be the ruin of her-and that Dr. Frank would be in her corner. This is hope, this is solace, this is the dignity she so eloquently depicted.

RAYMOND F. RAMIREZ, MD
Roswell, Georgia

"Partners in care"

Kudos to Dr. Craig Wax for his recommendation on giving due recognition to our partners in medical care, pharmaceutical representatives (the detail people). ("Don't slam the door on drug reps," [From the Board], June 10 issue.)

I recognize, as my colleagues should, that these individuals are our partners in care. Realize that they should be complimented on the job that they do. Not only do they provide us with invaluable information, but they supply us with important samples as well as support to our educational programs.

I reiterate to my colleagues, "give our representatives a 'brake.' " My informed comments are based on a familiarity of 25 years with primary care and being past president for the state and county organizations as well as an active member of society.

STEPHEN M. SWETECH, DO, FACOFP
Clinton Township, Michigan

The cost of prescribing practices

I take issue with Dr. Wax's recommendation to continue to see pharmaceutical representatives.

His insistence that they do not directly change his prescribing practices has been shown not to be true. The companies would not have been spending millions if that notion was the case. At the very least, introducing samples of a new, not necessarily better (but definitely costlier) medication that after "sampling" would continue to be prescribed does change practice.

For years, the pharmaceutical representatives have attempted to substitute newer, more expensive medications for those generics that have gone off-patent. They have significantly raised the cost of American medicine.

In my career, I have worked with a number of practices, and I have not seen a drug salesperson in more than 20 years. I do not think my patients have had a disservice as a result.

DAVID KAUFMAN, MD
Florence, Massachusetts

An engaging article

I just read the article "A rocky road," by Elizabeth A. Pector, MD (June 10 issue). It was moving and so well-written. Dr. Pector is a talented and engaging writer.

JULIE HATTIER, MD
Millville, Delaware