Letters to the Editor - Oct. 7, 2002
Recruitment for phase I clinical trials raises issue of
patient self-deception - Medical transcriptionist: Many
doctors are sloppy talkers - Physicians should give
ultimatum on direct-to-consumer drug ads - Private cord
blood bank: AMNews gave public facilities favored treatment
Recruitment for phase I clinical trials raises issue of patient
self-deception
Regarding "NCI, drug companies partner to recruit patients for trials"
(
AMNews,
Aug. 26): The story omits mention of what is one of the most critical
issues in recruiting cancer patients for phase I and phase II trials.
Phase I trials are designed so that they can be of little or no benefit
to the subjects who sign up. The purpose of the trial is to establish the
threshold of toxicity.
Consequently, subjects will either get a medication dose that is not
toxic or will stop the medication as soon as toxicity is reached. Since
the effective doses of most antineoplastic drugs are close to or at
toxicity, subjects with cancer are not likely to receive an effective dose
during the trial. Consequently, the only benefit they can derive from
participation is the knowledge that they have helped those who come after
them -- i.e., an altruistic reward but nothing for their own illnesses.
Most prospective subjects and even many physicians seem to
misunderstand this point no matter how directly it is explained to them.
If the investigator attempts to clarify the misunderstanding -- which is
the ethical thing to do -- he or she is in effect discouraging
participation. This is a difficult, if not impossible, dilemma for the
conscientious investigator.
The obvious answer is to give subjects a fair and meaningful monetary
reward in exchange for their taking a serious risk to benefit all the rest
of us. This has a major drawback in that it may exert undue pressure on
impoverished individuals to participate. But that is preferable to relying
on the self-deception of desperate cancer patients hoping to be cured.
--Jack Zusman, MD Tampa, Fla.
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Medical transcriptionist: Many doctors are sloppy talkers
Regarding "FP study highlights ripple effect: Harm flows from simple
errors" (
AMNews,
Sept. 23/30): I am a six-year veteran medical transcriptionist, and I
have transcribed for many physicians in multispecialty fields of medicine.
One of the major problems in the doctor's office with "simple errors" is
the sloppiness in the way the majority of physicians dictate their
patients' medical records.
They slur, gibber-jabber and try to break the speed of light with their
dictation; they eat, burp and many other things while dictating. That
leaves the medical transcriptionist to "guess" what they have dictated and
possibly enter something that could throw the diagnosis of a seriously ill
patient into something of a less serious concern and vice versa. If we
leave blanks, we get chewed out.
It is the responsibility of the doctor doing the dictating to make the
dictation accurate, clear and understandable by the person who is going to
translate those words onto paper. It is of the ultimate importance that
the patient's record is as accurate as possible, and that responsibility
lies with the dictation from the physician. This issue needs to be
addressed, and it needs to be brought to all physicians' attention as soon
as possible.
This is not a minor issue, and it does concern patients, because these
reports affect the condition of their health.
If physicians would simply slow down and dictate in their normal
speaking voices, this problem of sloppy dictators and inaccurate patient
records could be remedied altogether.
--Mary A. Dickey Hot Springs, Ark.
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Physicians should give ultimatum on direct-to-consumer drug ads
I have yet to meet a physician who has anything but contempt for the
present-day direct-to-consumer advertising by the drug companies. The ads
are slick promos designed not to inform and educate but to sell product.
The cost is immense, and it is borne by our patients in ever-increasing
drug costs.
So here is my proposal. We, all the U.S. physicians, give notice that
as Nov. 1, either the companies pull all DTC ads or face having detail
reps shut out of all of our offices. The dollars saved will go to lower
the cost of the advertised drugs.
Be your patients' advocate. Will you do it ?
--Dennis E. Sumski, DO Farmington, Mo.
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Private cord blood bank: AMNews gave public facilities favored
treatment
Regarding "Efforts under way to collect more umbilical cord blood" (
AMNews,
Sept. 9): Your article about cord blood banking provided some
interesting statistics and information about public cord blood banking.
I feel the article was unbalanced, though, because you used only the
views of representatives of public cord blood banks.
You said public cord blood banks face competition from family banks. As
a representative of the largest family bank, I don't see that competition
at all.
As you said in your article, the problems public banks face is entirely
due to lack of funding. Public banks receive money from grants, gifts and
bequests, and from selling their stored blood for transplants. Family
banks don't impact those sources of funding and they don't "steal" cord
blood away from the public banks.
You painted all family cord blood banks with a broad brush of distrust
when you quoted a public bank official as saying, "with a family cord
blood bank we don't know how well the product is being handled, tested and
stored."
Our blood processing laboratory (accredited by the American Assn. of
Blood Banks) uses state-of-the-art processes and testing in a facility
built specifically for cord blood processing. We cut no corners to save
money and are proud of our reputation as the leading family cord blood
bank.
One-fourth of our clients work in the medical field -- a ringing
endorsement of family cord blood banking and a confirmation of our
standing in the medical community.
--Amy Seirer Communications manager, Cord Blood
Registry, San Bruno, Calif.
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Copyright 2002 American Medical Association. All
rights reserved.
