November 2000 • Volume 6 Number 11
Pro/con pain relief bill
To the editor:
After reading the September FP Report regarding the "pain relief bill," H.R. 2260, I am confused. I wonder if AAFP leaders are discussing the same bill as William Toffler, M.D., author of a letter in the September issue. The bill is in response to the dangerous and unfortunate assisted suicide law in Oregon. I have to agree with Toffler's comments -- the Academy is on the wrong side of this issue.
AAFP's opposition to the bill seems to stem from concerns about unwarranted restrictions on the professional autonomy of physicians. The profession has failed to live up to its responsibility and to its ethical code in this area.
The House bill addresses two failures by the medical profession. The more recent failure is not consistently providing adequate and compassionate end-of-life care. The bill addresses that by provisions for CME to disseminate knowledge of state-of-the-art pain relief and by protecting physicians from prosecution for deaths possibly related to the "double effect" of large doses of narcotics needed to control terminal pain.
The other failure is a weak response to the challenge of the culture of death that assisted suicide represents. I believe we would not now be where we are regarding this legislation, had the medical profession not caved in to pressure from nonrepresentative cultural élites to participate in legalized abortion.
Roger Kimber, M.D.
Lancaster, Pa.To the editor:
In a letter expressing his disapproval of AAFP's opposition to the Pain Relief Promotion Act, Dr. Toffler writes of the "specter of agents interfering with medical practice." His "specter" is in fact written into the proposed legislation, which creates programs to train law enforcement personnel, both federal and nonfederal, in the "legitimate use of controlled substances in pain management." That provision, inviting federal agents to second-guess the intent of physicians caring for the terminally ill, may not scare Dr. Toffler. It did scare the majority of the houses of delegates of both the Oregon Medical Association and the Oregon AFP. Both organizations are on record as opposing the bill.
Dr. Toffler writes, "The truth is that the PRPA provides no new authority to the Drug Enforcement Administration." In fact, according to the legal counsel of the OMA, the bill authorizes the DEA to make rules to implement the "legitimate medical purpose" of alleviating pain. This provision appears to supersede what in the past has been the responsibility of state licensing boards.
Apart from the provision of a paltry $5 million for physician training in palliative care, the bill, now supported by the AMA, is in substance the same bill as the AMA opposed a year before. I applaud the AAFP's stand.
Peter Goodwin, M.D.
Portland, Ore.Chiropractic subluxation: for real?
To the editor:
WE WANT LETTERS
Address letters to:
FP Report
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672
fax to (913)906-6089; call (800) 274-2237;
or contact pbinder@aafp.org via e-mail
Please keep your letters to a maximum of 200 words; all letters are subject to editing.The tone of the September FP Report story about partnering with the chiropractic ("Chiropractic: From Taboo to Partner in Care for Some Physicians") does not reflect my views. Ever since formulating a lecture presentation in 1994, "The Unquenchable Quest for Questionable Cures," I have been awaiting the then-promised research proving the contention that the chiropractor's theory of subluxation has basis in reality.
Most recently when I researched the Web site http://www.chiroweb.com/forum/important.html, I was again told ongoing studies just yet cannot substantiate the basic premise of this lay alternative to health care ... i.e., subluxation resolution. Until chiropractors have definitive proof of their "cures," I remain skeptical of the nonscience they practice. I encourage other discerning family practitioners to do the same.
I am of the opinion subluxation does not even occur in the first place. If my opinion is correct, the U.S. health care dollar is too precious to expend in partnering with the chiropractic.
John Records, M.D.
Franklin, Ind.In support of birth control services
To the editor:
We were appalled by the letter "Birth Control Services" in the September FP Report. According to the American Medical Women's Association, more than 50 percent of pregnancies in this country each year are unintended, and more than half of all unintended pregnancies end in abortion. Inadequate access to birth control methods is at the root of this public health issue. Clearly, the AMA House of Delegates (the only "force" that the AAFP is aligned with on this issue) sees the wisdom in this position. It recently passed a resolution upholding access to "pregnancy prevention services" in the face of mergers and/or acquisitions of health care systems ("AAFP Speaks up for Access to Reproductive Care," August FP Report).
Catholics for a Free Choice reports that in approximately one-third of the mergers of Catholic and non-Catholic facilities in 1996 and 1997, all reproductive health services were discontinued at the non-Catholic facility. In addition, CFFC reports that the number of Catholic "sole provider" hospitals (a federal designation) rose by 65 percent between 1994 and 1997. Some serve counties where Catholics make up less than 1 percent of the population. According to the Religious Coalition for Reproductive Choice, "When a provider with restrictive religious rules dominates most or all health care services in one market, patients are in danger of losing their access to the full range of health services -- regardless of their religious affiliation. In a nation founded on religious freedom, it is fundamentally wrong for one religion to impose its beliefs on all citizens."
Rebecca Keim
Kelly Ramsey, M.P.H.
Medical students
Milwaukee, Wis.
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