WEB EXTRA!
To the editor:
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(This letter responds to a story in the June FP Report -- "ABFP Strives to Put Best Foot Forward on MC-FP" -- about the American Board of Family Practice's Maintenance of Certification Program for Family Physicians.) I have to agree with Dr. (Richard) Feldman. Additionally, I think certificates of added qualifications are a mistake. These, too, send the message that "what we have been doing is meaningless."
MC-FP is unnecessary. What about the 50 credits we need yearly to maintain our licenses? This will be another fee and another piece of paper that does nothing to get to the root of poor outcomes.
If we really want to improve the quality of medical care, let's work for the millions of uninsured. Why are we being so civilized about the seriousness of tobacco's effects on the nation's health care? The national effort of the AAFP (Tar Wars®) is a kind and gentle way to introduce this subject to children in the schools of this country. Use the national spotlight that our organization enjoys to really go to WAR with this national tragedy and to address other fundamental health issues.
Why are medications so expensive in this country? We all have patients who could go hungry if they took all the medications they needed. So what happens? We give them samples or they go without. Why is this happening? These drug companies give "discount" cards and then raise their prices.
Wake up Medicare, please. It is killing family medicine. Young doctors are avoiding our specialty, and we're kidding ourselves if we think otherwise. If nothing changes -- if we're not paid more -- it won't matter if we're asked to do more CME credits, because there won't be a specialty to care about!
James Goodwin, M.D.
Washington, N.J.
To the editor:
(This letter responds to "A Trend? Other Specialists Crowd Primary Care Picture, Study Says " in the June FP Report.) I sadly watched my neighbor, a 50-year-old wife and mother of three, carried from her home three days before Christmas after dying in the arms of her husband. The autopsy proved coronary artery disease. Six weeks before her death, her gynecologist -- doing primary care -- advised her to repeat her cholesterol in April. The woman's personal and family histories were full of red flags.
Earl Carstensen, M.D.
Aurora, Colo.
To the editor:
The recent launch of the National Breastfeeding Awareness campaign will go far in helping women understand the importance of breastfeeding their infants. However, I am concerned about the nearly simultaneous FDA warning against the use of domperidone to increase breast milk supply.
There was no scientific basis for this warning, and no new or urgent data require a new warning at this time. Many drugs have language in their commercial materials saying that breastfeeding women should not take this drug or should consult their physicians; this is a product liability rather than medical issue. Domperidone is the safest, most effective galactagogue available. Many of us who focus our practice on breastfeeding medicine use it to assist our patients. Most of us use American compounding pharmacies, though occasionally I have patients choose to order it from outside the country due to cost.
The FDA announcement includes the comment that women should consider using formula instead of using domperidone for low milk supply. Some of us in the breastfeeding medicine community are concerned that this announcement, and particularly the timing of it in close proximity to the start of the National Breastfeeding Awareness campaign -- despite the fact that there is no new evidence about domperidone-- stem from a political agenda, possibly related to formula company lobbying with profits threatened by the campaign, rather than from truly health-related goals.
Anne Montgomery, M.D., FAAFP, FABM
Member of the
AAFP Breastfeeding Advisory Group
Olympia, Wash.
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