Letters to the Editor - March 14, 2005

Usefulness of drug samples extends beyond assisting low-income patients - The health care system "has simply not been very good to men" - Physicians have failed to communicate why the public should trust them - Medicare's entire premise is wrong

Usefulness of drug samples extends beyond assisting low-income patients

Regarding "Practice draws notice for its no-gift policy" (Article, Feb. 14): This article perpetuates the myth that physician drug samples only have value in helping needy patients afford treatment. As a specialist in a respiratory medicine clinic, we use samples of inhalers and nasal sprays to teach patients how to use the devices properly and let them administer their first dose in the clinic under supervision.

I also give the first dose of an antibiotic to patients from samples whether they are indigent or not as a way of initiating treatment rapidly. Many patients go back to work after leaving the clinic and don't fill their prescription until later in the day. This use of samples eliminates treatment delay -- a worthy medical goal.

Physicians are losing patience with the "one-size-fits-all" approaches forced on us by insurers and others not directly involved in patient care. Please highlight the clinical benefits of samples so that those who propose that patient-assistance programs can adequately substitute for physician drug samples understand that samples can be used at the point of care in other worthwhile ways.

--Michael O'Connell, MD, Denver

The health care system "has simply not been very good to men"

Regarding "Tailoring care for men" (Editorial, Feb. 21): It is wonderful to finally see men's health get some much-needed attention, but it is a mistake to blame the crisis in men's health on lack of participation by men.

Blaming the victims of a problem rarely by itself is an adequate approach, although this is quite current socially. Our health care system has simply not been very good to men. It does not adapt itself to care for their real needs and concerns itself too much with their supposed needs.

We need to study men and their health and social issues with compassion, empathy and caring. For example, it is quite impossible for men to get an evening appointment from the average primary care doctor. Nor are men encouraged to talk and open up to their doctors. All of this needs work.

Women are more accustomed to seeing their ob-gyn docs for menstrual and pregnancy issues and because of national cancer screening campaigns that are well-publicized. The record for women for cardiovascular diseases -- the largest killer of women, and far less publicized -- is dismal.

Of course, as you suggest, gender studies are useful but I think overly acclaimed because it is popular to do so and can be very wasteful of precious resources. It's more important for physicians to see the need to treat and protect all parts of our patient populations and not let disparities, such as those in men's health, occur.

--Arnold Robbins, MD, Cambridge, Mass.

Physicians have failed to communicate why the public should trust them

Regarding "Keeping the issue alive: How to keep medical liability in the news" (Article, Jan. 31): This demonstrates how little doctors understand about the fundamental issue causing inaction on reform, reimbursement and every other issue facing physicians. As long as the public's perception of physicians is still that of arrogant, overpaid, white men who drive BMWs, public sympathy for physician's issues will be minimal, and government leaders will have little political incentive to act.

The current PR campaigns ("Who will deliver your baby?") inspire some public concern but not the much-needed support. Indeed, the stories, banners and buttons seem more like threats from the powerful rather than cries from the victims.

Americans will never understand complex issues like medical liability reform, but they might be persuaded to support a trusted physician. Billboards and magazine ads abound praising nurses and others for hard work, compassion and sacrifice; yet when was the last time anyone recognized "Doctor Appreciation Day"? No wonder the public doesn't trust us -- no one is telling them to. The best PR strategy is to take back our role as hard-working, altruistic healers and teachers. Public support and a congressional mandate will soon follow.

--Fernando Leyva, MD, Panama City Beach, Fla.

Medicare's entire premise is wrong

Regarding "Fix Medicare's flawed pay system" (Editorial, Feb. 14): Your suggestion that "the defective sustainable growth rate be replaced with a system under which yearly payment changes are based on an assessment of practice cost increases ...," etc., is so much baloney!

The fundamental premise that government can determine the value of any service, let alone a medical service, is fatally flawed, and it should not have ever been allowed to go down this road in the first place. The market is much more efficient at determining the value of any goods or services.

Let's face facts: The United States cannot afford all the care people want until the day they die simply by virtue of their being citizens over 65 years of age.

Sanity would be vouchers for all care with a maximum amount per citizen per year. Period. Let the people decide how much or how little they want up to the proscribed limit and let them either augment this governmental safety net with additional private insurance or proceed to a teaching program for care should they be unable or unwilling to provide for themselves. Let the market determine the value of physicians' services. Insanity is continuing to tweak a system that is unsustainable because the foundational principles are all wrong.

--Gregory E. Polito, MD, Whittier, Calif.