OPINION
Letters to the Editor - Aug. 5, 2002
Smallpox prevaccination figure should be set higher -
Medicare drug benefit likely bad news for doctors and patients
- Plaintiff's expert witness should not be paid if the case is
lost, or no trial
Smallpox prevaccination figure should be set higher
Regarding "No broad smallpox vaccination" ( AMNews,
July 8/15): While the Advisory Committee on Immunization Practices has
promulgated advice on limiting prevaccination for smallpox to some 10,000 to
20,000 individuals on "smallpox response teams," they have missed the mark
on actual response needs in the event of a release of variola in a
bioterrorism event.
The number of prevaccinated medical personnel and first responders
clearly must exceed those figures. Such teams would need to be available
quickly, in essence on continual alert status, if this smallpox terrorist
threat is to be taken seriously.
If a variola release were very small scale, perhaps one or two cases,
this may be viable approach. But if dozens or hundreds of cases, or more,
present rapidly, similar to the Dark Winter exercise conducted last year,
such teams will be quickly overwhelmed. Further, I doubt that those infected
with smallpox will self-direct themselves to a designated smallpox isolation
facility. We are all aware that recognition of such an event will take time,
during which infected individuals likely will be admitted to multiple
facilities in a given area.
In addition, protecting public safety will become a complex issue. While
medical personnel agree that bioterrorism will not be a "lights and sirens"
event akin to the sarin attacks in Japan in 1994 and 1995, a policy of
vaccinating only medical personnel may leave other vital public safety
personnel feeling very vulnerable. That vulnerability could easily have a
negative impact on how a city or state responds to a smallpox outbreak.
The ACIP and the Centers for Disease Control and Prevention are to be
applauded for addressing this issue. But limiting prevaccination to such
small numbers in a country as large as the United States does not seem to be
the wisest approach, even given the proclivity of smallpox vaccine to cause
complications.
--Thad Zajdowicz, MD, MPH Chicago
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Medicare drug benefit likely bad news for doctors and patients
Regarding "Medicare drug benefit fight delays physician pay relief" ( AMNews,
July 1): One could reasonably expect that once a Medicare drug benefit
is provided, doctors can forget any hope of pay relief and should expect to
see reimbursements fall rather than rise.
Traditionally, when the government has provided any benefit, it has
attempted to shift the cost to anyone other than the taxpayers. This has
certainly been true of Medicare, and we can all recall the ruckus several
years ago surrounding the attempt to increase premiums to cover the cost of
a long-term care and a prescription drug benefit. There is no reason to
expect a different outcome this time.
The money to pay for prescription drugs for Medicare patients almost
certainly would come from reduced Medicare payments to physicians and
hospitals to let Congress avoid the unpleasant task of actually requiring
beneficiaries to pay for something they receive. As Medicare reimbursements
fall, we can expect to see a similar fall in reimbursements from insurers
since they tend to follow Medicare's downward pay spiral.
If the Medicare drug benefit is passed, the ultimate losers may be the
Medicare patients themselves. When the federal government became the largest
buyer of immunizations, they "cornered the market" and so reduced
reimbursements that many of the pharmaceutical companies withdrew from the
market, creating significant supply problems.
There is no reason to think the situation with prescription drugs would
be any different. Once the federal government is the largest buyer and once
that becomes such an unattractive market because of inadequate
reimbursements, drug companies will either focus their sales overseas or
otherwise steer themselves away from pharmaceuticals and into a more
profitable business.
--Edwin H. Charnock, MD DeSoto, Texas
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Plaintiff's expert witness should not be paid if the case is lost, or no
trial
We need to look at a less complicated method of tort reform. We should
ignore the trial lawyers and look at ourselves.
Let us make it more risky or "painful" to serve as a professional
witness. If the court's finding is for the defendant, the plaintiff's expert
witness should have to forfeit his or her fees, as should the lawyer. Also,
the expert and the lawyer should not get paid if there is no trial.
We are expected to do more and more, with less, and there will always be
a doctor willing to sell himself against another doctor for money. These
physicians in my mind are the true problem with malpractice.
They are always willing to show someone else did something wrong and they
are the "expert" and a much "better" physician than the defendant. I am not
commenting on the obvious cases -- wrong leg amputated, large tumor ignored.
You do not need an "expert" to decide that, and these cases will be settled.
I am talking about the other 99% of cases that are in whole or part
frivolous.
Doctors, police yourselves and stop deciding that someone else made a
mistake when you were not there.
--Mark Janes, MD Dubuque, Iowa
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Copyright 2002 American
Medical Association. All rights reserved.
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