Letters to the Editor
- We completely agree with Dr Lang.1 Lingering misperceptions held by patients, physicians, and advanced practice providers continue to inhibit them from using safe and effective pharmacotherapy for tobacco dependence. There is also a misperception that we have conquered the tobacco epidemic. This is also not true, although we have made great progress. In the United States, we continue to have 30 to 35 million adults who use tobacco regularly and tobacco causes tremendous excess mortality beyond the diseases commonly associated with tobacco use such as cancer, cardiovascular disease, and chronic lung disease.
- We recently read with interest the review by VanDolah et al1 in Mayo Clinic Proceedings, summarizing the emerging landscape of commercially available cannabidiol (CBD) preparations, which are now subject to consumption by the general public because of the purported health benefits of CBD. We agree with the authors in that an open discussion exploring patient use of such substances is necessary for a complete history as well as for establishing patient rapport. We would add a word of caution about the use of products and would also suggest readers of Mayo Clinic Proceedings consider additional factors when discussing commercial CBD use with patients.
- We recently read with interest “Medical cannabis for obstructive sleep apnea: premature and potentially harmful” by Kolla et al1 competently summarizing the current evidence for the recent approval of obstructive sleep apnea as a certifying condition for the use of medical cannabis in the state of Minnesota. We share the authors’ doubt to the scientific validity of this recent action. It would be helpful for the readers of Mayo Clinic Proceedings to know additional background relating to the evolving medical and legislative landscape of medical cannabis.
- We thank Drs Sung and Kimball for their interest in our recent article.1 In their letter, they argue that some skin disorders may be major drivers of disability. In particular, they discuss inflammatory skin disease (eg, psoriasis) and nonmelanoma skin cancer. In addition, they argue that teledermatology and teledermatoscopy may not be a strategic alternative to a direct patient interaction with a specialist.
- We thank Dr Cobb for his comments regarding our article. He is correct that smokers have many comorbid psychiatric conditions,1 particularly anxiety, depression, and other substance use disorders. Approximately 40% of patients in our residential program have 1 or more of these diagnoses. We do not target treatment at these conditions, but we do desire comorbid mental health problems to be under good control before we admit patients to our program. It is unclear how much tobacco dependence arises from self-medication of psychiatric symptoms vs a common predisposition to both tobacco dependence and a mood or anxiety disorder.
- To the Editor: We are currently emphasizing the understanding and use of likelihood ratios (LRs) in our teaching of evidencebased medicine to internal medicine residents and medical students.1 However, readers might be confused by the different formulations of the LRs in the literature.