Letters to the Editor
- To the Editor: I congratulate Mayo Clinic Proceedings for publishing the report by Hecksel et al. In the accompanying editorial, it is unclear how Berge and Morse derived their point that care of patients with AWS is best delivered by specialists in chemical dependency. The findings from the research by Hecksel et al are emblematic of the consistently low standards of identification of alcohol problems and their treatment across the entire health care system—not of the need for more specialists.
- To the Editor: After a decade-long decline, annual suicide rates in American children and adolescents increased in 2004. A report released in February 2007 described an 18% increase in the suicide rate in persons aged 1 through 19 years between 2003 and 2004.1 The incidence of suicide, the third-leading cause of death in 15- to 19-year-old Americans, increased from 7.3 to 8.2 per 100,000 persons in 2004.
- In reply: We appreciate the opportunity to respond to Dr Mieczkowski's suggestions for improving drug screening for methamphetamine. Debate about the usefulness of drug testing is ongoing in many arenas. Specific questions have been raised about the purpose and effectiveness of standard serum and urine drug assays in the emergency department evaluation, diagnosis, and management of substance-abusing patients. Emergency medicine physicians argue appropriately that emergency department management is dictated by the patient's clinical presentation, and the results of drug screens do not customarily influence emergency department management.
- We agree with the concerns raised by Amrutkar and Sansgiry. The challenges for both patients and physicians in evaluating the safety of medications purchased through the Internet are profound. A June 2004 report by the US General Accounting Office1 cited problems with the handling, authenticity, and FDA approval status of medications obtained from Internet pharmacies. The General Accounting Office (the audit, evaluation, and investigative arm of the US Congress) purchased 11 different medications from 68 Internet pharmacy Web sites.
- In reply: We appreciate Dr Levesque's letter, which expands the list of potential dangers that Internet shoppers could encounter when buying drugs without benefit of physician involvement. Our 4 cases involved consequences of addiction, suicidality, or a combination of both in patients who presumably received the actual drugs they ordered.1 We described important medical issues that are typically self-limited, assuming the patient survives the suicide attempt or the withdrawal complications. Dr Levesque's case introduces new wrinkles, including the acquisition of unknown sedating drugspresumably neurolepticsand the insidious advance of an irreversible condition associated with the mystery medication.