4. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Washington, DC: American Psychiatric Association; 1980. 5. Spitzer RL, Fleiss JL, Endicott J, et al. Mental status schedule: properties of
factor-analytically derived scales. Arch Gen Psychiatry. 1967;16:479.
Reply.\p=m-\Icould not agree more with Dr Frank's comments. Our analysis of "subclinical depression" was an effort to look beyond the DSM-III criteria. We used an early version of the Diagnostic Interview Schedule that did not include In
all the
symptoms of generalized anxiety disorder; thus, a full analysis of a mixed anxiety/depression category would have
been difficult.
Myrna Weissman, PhD Columbia University College of Physicians and Surgeons New
York, NY
Factors Influencing the Testing for Driving Under the Influence To the Editor.\p=m-\Therecent letter by Saylor et al1 about driving under the influence of drugs (DUID) prompts us to issue a word of caution. As the authors point out, 14% to 81% of impaired drivers with low or negligible blood ethanol levels test positive for other mind- or performance-altering drugs. The wide range observed may be due to several factors. Drug testing for DUID is not uniform. Because of limited resources, police-related toxicology laboratories frequently focus their efforts on the prosecution of offenders and not on complete toxicologic testing. For example, in states where ethanol intoxication is legally defined as a specific concentration of ethanol in blood, a higher concentration in a driver's blood may prompt no further toxicologic testing since the blood ethanol concentration alone is sufficient for prosecution. If a driver's blood ethanol concentration is low or negligible, tests for other intoxicating drugs may be conducted. The detection of drugs may therefore be directly related to the diligence of the search, which, in turn, may be constrained by laboratory resources. For epidemiologie purposes, DUID data may themselves be "impaired." Police may prefer to test persons who are overtly intoxicated, whereas legally intoxicated persons showing min¬ imal behavioral changes may escape testing. Regional variation in the types of drugs detected may be a function of the toxi¬ cologie methods as well as geographical drug-use patterns. Toxicologie reports may indicate that a specimen is "neg¬ ative for significant quantities" of a particular drug. Although some researchers may interpret such language to mean that the specimen is negative for the drug, the drug may be present, even in quantities that could alter performance. In addition, some laboratories use unconfirmed screening tests that may yield false-positive results. There is little doubt that drugs other than alcohol (whether prescription or illicit) play a significant role in impairing drivers. Our purpose in writing is to encourage those studying this topic to carefully evaluate their toxicologie data in order to avoid com¬ ing to erroneous or misleading conclusions. In the future, epi¬ demiologie studies could be facilitated by a more uniform ap¬ proach to DUID testing. Law enforcement and other agencies wishing to define the scope and nature of the DUID problem more clearly could improve the quality of data by adequately funding and supporting toxicology laboratories.
Randy Hanzlick, MD Emory University School of Medicine Atlanta, Ga R. Gibson Parrish, MD Centers for Disease Control
Atlanta, Ga 1. Saylor KE, DuPont RL, Brown H. The than alcohol. JAMA. 1992;267:652.
'Beverly Hills, 90210': The Lap Belts Don't Show on TV To the Editor.\p=m-\Safety-beltwearers who sustain motor vehicle accidents have an approximate two-thirds reduction in severity of injury, hospital admissions, and hospital charges.1 Unfortunately, young adults are among those least likely to wear safety belts.2 "Beverly Hills, 90210" is a popular television show among young adult viewers. The stars are 17-year-old fraternal twins (one boy, one girl) who are both licensed drivers. Although these two "role models" do a lot of driving, consistent with the show's Southern California milieu, neither actor ever buckles up. The producers of this show should insist that the actors wear safety belts during the show's filming. This seemingly innocuous procedure might encourage young adult viewers to wear their safety belts and might reduce the head and facial injury rate in this age group. Samuel Z. Goldhaber, MD Brigham and Women's Hospital Boston, Mass Michele A. Hamilton, MD UCLA School of Medicine Los Angeles, Calif 1. Orsay EM, Turnbull TL, Dunne M, Barrett JA, Langenberg P, Orsay CP. Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents. JAMA. 1988;260:3598-3603. 2. Goldbaum GM, Remington PL, Powell KE, Hogelin GC, Gentry EM. Failure to seat belts in the United States: the 1981-1983 Behavioral Risk Factor JAMA. 1986;255:2459-2462.
use
Surveys.
In Reply.\p=m-\Asthe executive producer of a television show that seven of 10 teenage girls who are television viewers tune to any Thursday night, no one is more aware of the impact that our series has on this impressionable segment of the viewing audience. That is why the National Association of Social Workers, the Center for Population Options, the National Conference of Christians and Jews, and the American Red Cross have recognized our series for tackling such subjects as teenage sexuality, substance abuse, and race relations in a mature and
responsible manner. And that is why in every scene in which anyone is shown driving a car, the characters are also wearing seat belts. Perhaps the reason that Drs Hamilton and Goldhaber thought otherwise is that our two prime show vehicles, a 1967 Mustang and a 1972 Porsche, are classic cars that are equipped only with lap belts that, unfortunately, are not visible on camera. As the son of a pediatrician who is also the former chief of staff of the Cedars-Sinai Medical Center in Los Angeles, I hope my response clears up the matter for these physicians and other health professionals who read your publication or have children who watch the series. Charles Rosin
"Beverly Hills, 90210" Los Angeles, Calif
Error in Figure. \p=m-\Inthe article entitled "The Concepts of Stress and Stress System Disorders: Overview of Physical and Behavioral Homeostasis," published in the March 4, 1992, issue of THE JOURNAL (1992;267:1244-1252), an error occurred in Fig 3, on page 1249. The ordinate and abscissa headings were transposed; the ordinate should be labeled "Stress System Activity," while the abscissa should be labeled "Stressor Potency."
high way: driving under influences other
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 06/01/2015
factor-analytically derived scales. Arch Gen Psychiatry. 1967;16:479.
Reply.\p=m-\Icould not agree more with Dr Frank's comments. Our analysis of "subclinical depression" was an effort to look beyond the DSM-III criteria. We used an early version of the Diagnostic Interview Schedule that did not include In
all the
symptoms of generalized anxiety disorder; thus, a full analysis of a mixed anxiety/depression category would have
been difficult.
Myrna Weissman, PhD Columbia University College of Physicians and Surgeons New
York, NY
Factors Influencing the Testing for Driving Under the Influence To the Editor.\p=m-\Therecent letter by Saylor et al1 about driving under the influence of drugs (DUID) prompts us to issue a word of caution. As the authors point out, 14% to 81% of impaired drivers with low or negligible blood ethanol levels test positive for other mind- or performance-altering drugs. The wide range observed may be due to several factors. Drug testing for DUID is not uniform. Because of limited resources, police-related toxicology laboratories frequently focus their efforts on the prosecution of offenders and not on complete toxicologic testing. For example, in states where ethanol intoxication is legally defined as a specific concentration of ethanol in blood, a higher concentration in a driver's blood may prompt no further toxicologic testing since the blood ethanol concentration alone is sufficient for prosecution. If a driver's blood ethanol concentration is low or negligible, tests for other intoxicating drugs may be conducted. The detection of drugs may therefore be directly related to the diligence of the search, which, in turn, may be constrained by laboratory resources. For epidemiologie purposes, DUID data may themselves be "impaired." Police may prefer to test persons who are overtly intoxicated, whereas legally intoxicated persons showing min¬ imal behavioral changes may escape testing. Regional variation in the types of drugs detected may be a function of the toxi¬ cologie methods as well as geographical drug-use patterns. Toxicologie reports may indicate that a specimen is "neg¬ ative for significant quantities" of a particular drug. Although some researchers may interpret such language to mean that the specimen is negative for the drug, the drug may be present, even in quantities that could alter performance. In addition, some laboratories use unconfirmed screening tests that may yield false-positive results. There is little doubt that drugs other than alcohol (whether prescription or illicit) play a significant role in impairing drivers. Our purpose in writing is to encourage those studying this topic to carefully evaluate their toxicologie data in order to avoid com¬ ing to erroneous or misleading conclusions. In the future, epi¬ demiologie studies could be facilitated by a more uniform ap¬ proach to DUID testing. Law enforcement and other agencies wishing to define the scope and nature of the DUID problem more clearly could improve the quality of data by adequately funding and supporting toxicology laboratories.
Randy Hanzlick, MD Emory University School of Medicine Atlanta, Ga R. Gibson Parrish, MD Centers for Disease Control
Atlanta, Ga 1. Saylor KE, DuPont RL, Brown H. The than alcohol. JAMA. 1992;267:652.
'Beverly Hills, 90210': The Lap Belts Don't Show on TV To the Editor.\p=m-\Safety-beltwearers who sustain motor vehicle accidents have an approximate two-thirds reduction in severity of injury, hospital admissions, and hospital charges.1 Unfortunately, young adults are among those least likely to wear safety belts.2 "Beverly Hills, 90210" is a popular television show among young adult viewers. The stars are 17-year-old fraternal twins (one boy, one girl) who are both licensed drivers. Although these two "role models" do a lot of driving, consistent with the show's Southern California milieu, neither actor ever buckles up. The producers of this show should insist that the actors wear safety belts during the show's filming. This seemingly innocuous procedure might encourage young adult viewers to wear their safety belts and might reduce the head and facial injury rate in this age group. Samuel Z. Goldhaber, MD Brigham and Women's Hospital Boston, Mass Michele A. Hamilton, MD UCLA School of Medicine Los Angeles, Calif 1. Orsay EM, Turnbull TL, Dunne M, Barrett JA, Langenberg P, Orsay CP. Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents. JAMA. 1988;260:3598-3603. 2. Goldbaum GM, Remington PL, Powell KE, Hogelin GC, Gentry EM. Failure to seat belts in the United States: the 1981-1983 Behavioral Risk Factor JAMA. 1986;255:2459-2462.
use
Surveys.
In Reply.\p=m-\Asthe executive producer of a television show that seven of 10 teenage girls who are television viewers tune to any Thursday night, no one is more aware of the impact that our series has on this impressionable segment of the viewing audience. That is why the National Association of Social Workers, the Center for Population Options, the National Conference of Christians and Jews, and the American Red Cross have recognized our series for tackling such subjects as teenage sexuality, substance abuse, and race relations in a mature and
responsible manner. And that is why in every scene in which anyone is shown driving a car, the characters are also wearing seat belts. Perhaps the reason that Drs Hamilton and Goldhaber thought otherwise is that our two prime show vehicles, a 1967 Mustang and a 1972 Porsche, are classic cars that are equipped only with lap belts that, unfortunately, are not visible on camera. As the son of a pediatrician who is also the former chief of staff of the Cedars-Sinai Medical Center in Los Angeles, I hope my response clears up the matter for these physicians and other health professionals who read your publication or have children who watch the series. Charles Rosin
"Beverly Hills, 90210" Los Angeles, Calif
Error in Figure. \p=m-\Inthe article entitled "The Concepts of Stress and Stress System Disorders: Overview of Physical and Behavioral Homeostasis," published in the March 4, 1992, issue of THE JOURNAL (1992;267:1244-1252), an error occurred in Fig 3, on page 1249. The ordinate and abscissa headings were transposed; the ordinate should be labeled "Stress System Activity," while the abscissa should be labeled "Stressor Potency."
high way: driving under influences other
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 06/01/2015
