Copyright 2000 Plain Dealer Publishing Co.
The
Plain Dealer
February 21, 2000 Monday, FINAL / ALL
SECTION: HEALTH & FITNESS; Pg. 4F
LENGTH: 546 words
HEADLINE:
DOCTOR CALLS RESPONSE A PRESCRIPTION FOR TROUBLE;
BYLINE: By JOE and TERESA GRAEDON
BODY:
Q. You recently answered a reader who was
furious because her doctor wouldn't prescribe flu medicine over the phone. As a
physician myself, I was disappointed that you sided with her and didn't
appreciate the doctor's rationale.
The word "flu" is vague, and people
apply it to many different symptoms. A patient might become seriously ill or die
from a disease mistaken for "the flu."
Refusing to prescribe for a
patient I have not personally examined is just common sense. It protects the
patient, and it protects me from the possibility of a malpractice suit. No
doctor wants to be questioned in court, "Did you personally examine this
patient?" and have to answer "No."
Any doctor who prescribes over the
telephone is not practicing good medicine.
A. In this era of
Internet access to Viagra and other
prescription drugs, we applaud your caution about not
prescribing for a patient you have never seen.
This reader had a
long-standing relationship with her doctor, however. She was understandably
dismayed when she couldn't get an appointment to see him soon enough for a flu
drug to do her any good. She was sick for weeks as a result of this delay.
Patients and physicians face a dilemma during a bad flu season.
Obviously, patients at high risk should be immunized yearly. But if hundreds of
people are stricken with respiratory illness at the same time during a flu
epidemic, a doctor might be hard-pressed to examine them all within 24 to 48
hours of their initial symptoms. Current flu medicines are not helpful if
started later than that.
Millions of people treat themselves for "flu"
with over-the-counter medicines that do not speed healing. Tens of thousands die
from influenza complications. Because there are effective prescription flu
medicines, it seems a shame for people to suffer.
Q. My boss was
arrested for driving while impaired. He insists he had only two glasses of wine
at a party. He says you wrote something a long time ago about Tagamet affecting
blood alcohol. Could Zantac do the same thing? He takes it for heartburn. He'd
appreciate any written material he could show the judge.
A. This issue
remains highly controversial. Several years ago researchers demonstrated that
acid suppressers such as Tagamet (cimetidine) and Zantac (ranitidine) raise
blood alcohol levels. The significance of this finding was challenged by the
drug companies.
A new study (American Journal of Gastroenterology, Vol.
95, Jan. 2000, Pages 208-213) has concluded that "Under conditions mimicking
social drinking, ranitidine increases blood alcohol to levels known to impair
psychomotor skills needed for driving."
Your boss and anyone else taking
Tagamet or Zantac should be extra careful about alcohol consumption. We are
sending you our Guide to Alcohol and Drug Interactions. Anyone who would like a
copy, please send $2 in check or money order with a long (No. 10) stamped,
self-addressed envelope to: Graedons' People's Pharmacy, No. K-221, Box 52027,
Durham, NC 27717-2027.
Q. My teenager has menstrual cramps that keep her
out of school. Her friends use Midol, but her doctor suggested Aleve. Which is
better?
A. Aleve (naproxen) blocks prostaglandins, hormonelike compounds
that cause uterine cramping. Her doctor's recommendation makes sense.
COLUMN: PEOPLE PHARMACY
LOAD-DATE: February 22, 2000 
