Letters to the Editor - Aug. 9, 2004

Physicians have EMR wish list for health information technology czar - Look beyond tempting SUV tax loophole - Drug companies' reimportation resistance rooted in wrong attitude - Time to rethink sleep apnea

Physicians have EMR wish list for health information technology czar

Regarding "Health IT chief: Public-private partnership needed for EMRs" (Article, July 26):

The physicians who visit the online forum that I administer welcome the appointment of a national coordinator of information technology. We hope, being a fellow physician, he will have our concerns central to any major plans he has.

A lot of physicians have expressed concern about having to carry the financial burden of electronic medical record selection and implementation, especially so with solo and small practices. Physicians are burdened enough as it is with HIPAA, and other regulatory pressures combined with reduced reimbursements and raising liability premiums. The last thing we would want is being forced to implement a technology, which, although proven, has so much variation, with no widely used standards to date.

Maybe the coordinator could help work with the government on physicians' behalf to achieve some progress in areas outlined below:

Help establish common standards for data exchange along the lines of the Continuity of Care Record and get the standards adopted by all EMR developers.

Help create minimum standards for EMR products, as well as establish guarantees about the products.

The government could help absorb the initial large cost of purchasing EMR products that meet government standards, which could be offset by taxation.

Help establish a secure e-mail network that can interconnect hospitals and physician offices and that is HIPAA-compliant. This e-mail module also should be part of the core standard that an EMR must have.

Involve physicians in the decision-making processes along the way.

My comments include sentiments expressed by fellow physician members of our discussion forum.

--Frederick Njuki, MD, Tyler, Texas

Editor's note: Dr. Njuki is the founder and administrator of an online discussion forum for physicians (www.docsboard.com).

Look beyond tempting SUV tax loophole

Regarding "A big SUV has tax benefits -- for now" (Column, June 21): Although a big sport utility vehicle may have some tax benefits, let us not forget the bigger liability they also pose.

Data clearly show that SUVs and other "light trucks" are more likely to be involved in an accident, and more likely to kill the occupants of a vehicle that is not in the light truck class. This is bad news for those inside the SUV and perhaps worse for any persons outside of the SUV.

The environmental impact is also heavy when one considers the poor fuel efficiency, and the contribution poor air quality makes toward hospital visits for asthma exacerbations -- if not many other diseases secondary to environmental toxins.

There are other ways to save a buck.

--Brent Jaster, MD, Denver

Drug companies' reimportation resistance rooted in wrong attitude

Regarding "Medicare demo project previews drug benefit" (Article, July 19): The pharmaceutical manufacturers have taken a "your money or your life" approach in ripping off senior citizens (of which I am one) and smoke-screening physicians with freebies.

The AARP just announced a 7.2% increase in drug prices by pharmaceutical manufacturers for the year ending in the first quarter of 2004. Doesn't that take care of much of the 10% to 15% that is "saved" with the Medicare drug discount cards?

Through a loophole, drug cost increases can eat up the annual cost-of-living allowance on Social Security benefits. How can U.S.-manufactured drugs shipped to Canada be considered "unsafe" for reimportation at one-third of the U.S. price? If we can trust the safety of our lives with the brakes of a Plymouth Voyageur made in Canada, why can't we trust the Canadian Health Protection Bureau's (the Canadian FDA equivalent) overview of Canadian drug safety?

If hospitals have DRG Medicare reviews and physicians accept Medicare discounted payments, for equal justice under the law, it's time for the pharmaceutical manufacturers to submit to equal "treatment."

--Thomas L. Kurt, MD, MPH, Dallas

Time to rethink sleep apnea

Regarding "Dream on" (Article, May 3): I have spoken with scores of patients and many colleagues who have been evaluated and treated for sleep apnea. Surely, sleep is a problem and snoring in particular is audible. But the trail might stop there.

Who knows a patient who continues to use CPAP for more than a few days after it has been tried? The device is interesting, but hardly conducive to restful sleep, unless you are a jet pilot.

A patient I spoke with recently was status post-two reconstructive throat surgeries for sleep apnea (he had never been overweight). When I spoke with him he was still having problems with sleep. Of course, he was still concerned about sleep apnea. He related that three years earlier while in the sleep lab, the technician was so alarmed he told him he had almost awakened him three times for fear he would die in his sleep!

Yet three years and two surgeries later, and quite alive, the patient was still looking for solutions to his daytime sleepiness. This anecdote is only one of scores of similar ones.

Perhaps some of us ought to rethink this condition a bit.

--James Spinelli, MD, Columbia, S.C.