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As a physician who has done research, published, and spoken extensively on pain and its treatment, I found your article "Treating pain: Damned if you don't" [Nov. 19] both informative and worrisome. It demonstrated both the lack of physician understanding and the misperceptions of the general public about pain management.
To relieve the severe lower back pain of his hospitalized, terminally ill patient, internist Wing Chin prescribed Demerol rather than morphine for fear of causing respiratory distress. Demerol is actually the more dangerous medication.
After the patient had been discharged with a fentanyl patch to die in peace at home, Chin refused the pleas of the family for morphine to relieve the patient's severe pain. A jury later found the doctor guilty of elder abuse. However, Chin was correct in choosing fentanyl over morphine, since fentanyl is more potent.
It looks like we pain control educators still have a lot of work to do.
Randall Oliver, MDEvansville, IN
The fact that Dr. Chin was sued for his alleged failure in pain management is no surprise. The only surprising thing is that it took so long to happen. This may very well be only the first of several such actions by the Compassion in Dying Federation.
Contrary to the approach of Kathryn Tucker, director of legal affairs for that group, I do not believe that punitive lawsuits are the preferred means for teaching effective pain management. These legal witch hunts are more likely to discourage primary care physicians from remaining in an area where they are uniquely qualified to provide the personal care so urgently needed by those with intractable pain.
Our best course as a profession is to establish reasonable guidelines for pain management supported by careful scientific study. We should then use resources such as the AMA's Education for Physicians on End-of-Life Care program to spread the knowledge of how to deliver adequate terminal care.
With its low-cost access and ready market of millions, the Internet has become a favorite venue for unscrupulous marketers trying to peddle their so-called miracle treatments.
The brochure "'Miracle' health claims: Add a dose of skepticism" can show your patients how to spot exaggerated claims and outright scams. To order free copies for your patients (up to 500) from the Federal Trade Commission, call 877-FTC-HELP or go to www.ftc.gov . Click on "Consumer Protection," then "How to order printed copies of our publications."
Paula Kurtzweil WalterOffice of Consumer and Business Education
Federal Trade Commission
Editor's note: In our Jan. 11 issue, a letter from Terry Nye, MD, warned about the dangers of promoting "viruses' resistance to antibiotics." It should have read "bacterial resistance." We apologize to Dr. Nye for our error.
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Liz O'Brien. Letters to the Editors. Medical Economics 2002;4:8.