Letters

Aspirin chemoprevention recommendations

To the Editor:

I would like to recognize Dr. Phil Mohler's effort to explain the challenging aspirin chemoprevention recommendation made by the U.S. Preventive Services Task Force (USPSTF). In "Weighing the Risks and Benefits of Clinical Interventions" [January 2004, page 53], Dr. Mohler states, " ... patients without known cardiovascular disease but with at least a five-year 3-percent risk for a CV event be treated with 81 mg of aspirin daily" and that the USPSTF "... gave this intervention its highest rating, an 'A,' meaning it is strongly recommended." While the USPSTF did give its aspirin chemoprevention recommendation its highest rating, it was not explicitly recommending aspirin's use, but rather recommending that "(C)linicians discuss [emphasis added] aspirin chemoprevention with adults who are at increased risk for coronary heart disease" and that these discussions "... should address both the potential benefits and harms of aspirin therapy."1 It is also worth noting that the USPSTF found no study that demonstrated a decrease in all-cause mortality using aspirin as chemoprevention.1

To put it another way, the USPSTF does not appear to recommend aspirin for primary chemoprevention for coronary heart disease per se, but rather recommends a discussion of the incidence of cardiovascular disease and the risks and benefits of using aspirin to modify cardiovascular disease risk. It should also be noted that both Dr. Mohler and the USPSTF recommend that the discussion between the clinician and patient be based on estimating the patient's risk of CAD, which can be done using the tools in the article. A worthwhile synopsis of the USPSTF's approach to shared decision making was recently published, explaining how risk can be individualized to help come to an informed decision in line with a patient's unique preferences.2

Richard Dressler, MD, MPH
Rochester, N.Y.

1. U.S. Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med. 2002;136:157-160.

2. Sheridan SL, Harris RP, Woolf SH, Shared Decision-Making Workgroup of the U.S. Preventive Services Task Force. Shared decision making about screening and chemoprevention: a suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. January 2004;26(1):56-66.

Not-so-white lies

To the Editor:

The title of the article "The Cost of White Lies" [March 2004, page 62] is highly misleading. Lying on your curriculum vitae (CV) about being a professor of anything, let alone medicine, does not fall into the category of a white lie. It is a boldfaced lie. A white lie is telling your wife you picked up the dry cleaning when you actually forgot. Do not whitewash a very serious topic such as CV-padding with poorly chosen words.

Dorothea Coiffe, MLS
New York City

Correction

The article "Understanding When to Use the New Patient E/M Codes" [September 2003, page 33] contained an error. In its definition of a new patient, Medicare describes professional services as face-to-face encounters, not just evaluation and management (E/M) services as the article suggested. Therefore, if you see a Medicare patient whom you have seen within the last three years, you must report the service using an established patient code even if you didn't report an E/M code for the service you provided during that time frame. On the other hand, if a lab interpretation is billed, but no face-to-face encounter took place, the new patient designation might be appropriate. Below is a corrected version of the decision tree that appeared with the article.