Letters

I find it more than a little disconcerting that 35 years after I received my pharmacy degree from Columbia, I am still not considered a "healthcare professional" by people who should know better-specifically, employees and their agents within the pharmaceutical industry. My brother, a physician, periodically receives invitations to lovely dinners at very good local restaurants where a guest lecturer will give a short spiel on a medical condition and the drugs used for its treatment. The invitations clearly state that the participants must be healthcare professionals (no spouses). On several occasions, I have had to argue that I should be invited, only to be told that I don't qualify as said professional! The latest invitation goes a step further, stating that "the pharma regulations restrict this seminar to physicians, physician assistants, nurse practitioners, and nurses." No, the pharma guidelines clearly include pharmacists, and I am expecting a negative reply from my response to this invitation and am, as the saying goes in the legal world, "loaded for bear." Any thoughts on this? Please direct your answer to my personal page at alanpeschiera@yahoo.com
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Alan E. Peschiera, R.Ph, M.S., JD
JASNE, FLORIO & FLORIO, L.L.P
White Plains, N.Y.

Mail-order savings illusory Regarding your April 18 article in Chains and Business, Dr. Michael J. Rudolph is correct on how little in the way of savings mail-order pharmacy offers. In fact, when mail-order pharmacies buy in bulk, they pass the bulk through a repackager and change the NDC and set their own high AWP. When they offer insurance executives a percentage off AWP, there is no way to tell that the final price is higher than it should be. Mail order does not save money for the organizations paying the bill. Just look at how much mail order costs the Veterans Affairs.

Gout afflicts all too many I am writing regarding your May 16 cover story on gout. The physician, H. Ralph Schumacher Jr., professor of medicine at University of Pennsylvania, was correct in saying that "gout is incredibly poorly managed." Most physicians are relatively uneducated in the treatment of gout. While most sufferers correct with indomethacin, colchicine, and/or allopurinol, there is a population that does not.

Gout pain has been described as one of the most excruciating known to man. It is debilitating, and its sufferers lose work time, jobs, and quality of life. Long-term gout causes irreversible damage to joints.

My husband, Randy, has had gout for 20 years. At the age of 28, he was a normal weight-for-height individual and held a full-time job in warehouse management. Randy's illness became quite severe, but he remained poorly or incompletely managed by several physicians over the years. He even had one physician who claimed that he was cured of gout when his uric acid level normalized, despite medication.

Because of his illness, he no longer could hold a steady job. Thus, he lost his insurance, which covered his medical expenses. At the time I met him, he had gout attacks in multiple joints that lasted for up to six weeks. During severe prolonged attacks, he would beg me to find a way to help him die.

One of the reasons I married Randy was so he could get medical insurance. We went through three physicians until we found a rheumatologist who was willing to push allopurinol to high therapeutic doses (800 mg/day). It took 18 months from the time of aggressive treatment until he had a significant break in his disease. He now lives with permanent damage to most joints and significant hearing/balance disability due to gout.

At no time did a physician explain to him that he needed allopurinol to correct the flares. He had only been prescribed colchicine. At no time did any pharmacist question why he did not have prescriptions for allopurinol or at least indomethacin for his gout. Early intervention and appropriate drug treatment could have given Randy back at least 15 years of his life, might have saved him from bankruptcy for medical reasons, and prevented the permanent damage.