April 2000 • Volume 6 • Number 4
Grassroots advocacy efforts
To the editor:
The special section, "Grassroots Advocacy," in the March FP Report was terrific. I especially appreciate the report on what the Colorado AFP is working on. I will quote and circulate this in my efforts to obtain prenatal care coverage in Oregon.
Just one comment and one correction: (1) It is not only undocumented immigrants (i.e., those who have come here or stayed here without authorization) who are ineligible for Medicaid because of their immigration status. Even authorized ("legal" or documented) immigrant women, if they arrived after August 1996, when the Welfare Reform Act was passed, are ineligible. Thus, for any state to provide for their prenatal care requires state-only Medicaid funds (no federal share), just as for undocumented women. (2) It would be wonderful if the efforts of Drs. Carolyn Shepherd and Virgilio Licona and their colleagues succeed. However, it wouldn't make Colorado the first state to provide this coverage. California has done so for many years, as has Washington. Georgia and Texas have also made some of this coverage possible, though I don't know if the latter two states have been able to sustain it lately.
Tina Castañares, M.D.
White Salmon, Ore.
To the editor:
I read with interest the item in the March 2000 FP Report, "Gun Safety Finds Niche in Wisconsin, Hunter Haven."
I was pleased to read about the proactive preventive education stance portrayed in the article. Firearm safety is best obtained through education programs that seek to prevent accidents that occur out of ignorance or curiosity. Violence is glorified in today's mass media to the point that children's video games are scored by body counts. Is it any wonder that we see this violence spilling out onto our streets?
If the mass media is the only education this nation's children receive, this epidemic of violence will continue to spread. To counter this tendency, the AAFP should support mandatory firearm safety education in the school system. The National Rifle Association maintains an outstanding program for children, "Eddie Eagle," available on request.
There are political interest groups that oppose any firearm safety education for our children, arguing there is no such thing as firearm safety. A preventive firearm safety education program that succesfully reduces accidents would show the weakness of their stance.
Darryl Riegel, M.D.
Lompoc, Calif.
Antibiotic overuse
To the editor:
Concerning the March FP Report article, "Deadly Risks of Antibiotic Overuse Warrant Widespread Education," I have a few comments. We poor FPs are constantly bullied in the literature for doing too much of one thing and not enough of something else. The reason we often don't do as the prospective double-blind trials recommend is that, in the real world, we can't exclude patients from our daily experiments in life.
Specifically, the antibiotic resistance issue became a reform campaign based on little evidence. I have seen no studies showing that antibiotic use in outpatient-acquired infections in community practice leads to antibiotic resistance. On the other hand, several studies have shown statistically significant improved outcomes for treatment of even upper respiratory infections with antibiotics. In the United States, at least we restrict antibiotics to prescription only, unlike many other countries. Plus, I think antibiotic overuse in terminal patients in tertiary care institutions is by far the main cause of resistance.
Steve Kriebel, M.D.
Forks, Wash.
Doctors Ought to Care
To the editor:
The FP Report (December 1999) faced a daunting task in trying to compress the history of AAFP's efforts to curb tobacco into 1,500 words. I appreciate the allusion to difficulties I experienced in 1977 in trying to ignite the interest of AAFP leadership in confronting the tobacco industry, as well as references to Doctors Ought to Care.
However, the statement that "pressure (on the AAFP) to take a stand on tobacco also came from an ongoing grassroots movement among constituent chapters ... with FPs across the country crying out about tobacco's destructive impact on health" is misleading. The pressure was orchestrated entirely by DOC board members who were involved in the Academy at local, state and national levels. Beginning in 1978 and for the better part of a decade during the National Conference of Family Practice Residents in Kansas City, Mo., the DOC board met for the purpose of hashing out anti-smoking strategies.
With regard to Tar Wars, the current AAFP-endorsed tobacco use prevention program, both its concept and organization were wholly derived from DOC.
I am disappointed that the name of my colleague Dr. Rick Richards, a past member of the Congress of Delegates and a past DOC president, was omitted from the article. Between 1979 and 1998, Dr. Richards was invited to speak on tobacco at every NCFPR. He single-handedly attracted more students and residents to the fight against tobacco than any other AAFP member.
Alan Blum, M.D.
Tuscaloosa, Ala.
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