Letters to the Editor - Oct. 11, 2004

Calif. approach on pain medication good for doctors and law enforcement - Erectile dysfunction drug ads prompt abstinence from prescribing

Calif. approach on pain medication good for doctors and law enforcement

Regarding "California law eases threat to pain medication prescribers" (Article, Sept. 13): I am a retired DEA diversion investigator now employed by Buzzeo/PDMA, a consulting firm for DEA registrants and other professionals. I held many positions during my DEA career, although all of them were in the field of diversion control, which includes physician oversight.

I have said many times I felt like I spent half of my time trying to "lock up" the "bad docs" and half of my time "hand-holding" with the "good docs." It is a complicated field, and physicians (and pharmacists) deserve respect and admiration for working through the many difficult health care situations involving these abused and sought-after controlled substances.

I can say unequivocally that California's proposed legislation is a positive initiative for physicians and law enforcement alike.

I was pleased to see [the sidebar to the same story in] AMNews contained a reference to the DEA's partnership with the University of Wisconsin Pain & Policy Studies Group and Last Acts, a palliative care advocacy group. The booklet, "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel," was designed to offer balanced and well-informed information in the same collaborative spirit envisioned by California's new legislation.

I was part of the DEA team that developed the so-called "FAQs" for the booklet, and although the physician/law enforcement paradigms were periodically a little different, it was not difficult to reach consensus. The important thing was to get out a product that could help or protect honest and well-intentioned physicians while educating the affected parties and stakeholders on the needs and procedures for effective law enforcement.

--Robert Williamson, Richmond, Va.

Erectile dysfunction drug ads prompt abstinence from prescribing

Regarding "Viagra used more, especially by younger men" (Article, Sept. 13): Those of us in primary care have certainly seen increased visits prompted by drug company ads for erectile dysfunction. While there may be a benefit to this for the over-50-year-old man who may not otherwise schedule a health maintenance visit, it seems that some days I can hardly make any progress in public health for addressing erections and toenail fungus.

It amazes me to see how generously health plans continue to subsidize these treatments. Allowing direct-to-consumer marketing of pharmaceuticals has been a disaster that Congress should (but won't) reconsider.

The government regulatory and insurance company mismanagement issues aren't likely to bring relief from the scourge of mass-marketed diseases anytime soon, but I'm going to do my part to address this epidemic. For starters, I've written my last prescription for Levitra. Bayer and Glaxo can peddle their product in whatever way they think will deliver them the most market share, but since they have chosen to crassly promote Levitra as some sort of aphrodisiac, they can count me out!

--Matt Poling, MD, College Station, Texas