It is unreasonable to believe that one could be for the right to life when there are no preparations being made to take care of babies in trouble and sustain life after birth. All of us are too comfortable about infants dying after birth. We are not as impassioned about babies dying from malnutrition, socioeconomic devastation, or psychological genocide. There is a high infant mortality rate in the blackC community. The level overall is 2 to 3 times that of the white community. That is abominable, yet we are dreadfully comfortable with those numbers. Our primary impassioned viewpoint is vigorously against abortion. Some arrogant conservative politicians feel that it is acceptable to have unwanted babies as they watch the ultimate demise of new life through one of the above mechanisms. The lesson plan is clear. Blacks must address their own internal problems as other ethnics do. Focus in on the issues, determine the best solutions, and move unscaffed with vigor and determination to resolve the problems. There continues to be a rather grievous misunderstanding as to who is responsible for whom. My brothers and sisters are still laboring under the misconception that "somebody will take care of us," "somebody will look after my babies," "somebody will take care of my own personal health." I appeal to the black community, do not be misled. Why would you believe that some other ethnic group is ordained to look after your welfare? It is ludicrous to expect others to care for you more than you care for yourself. Helping oneself is godly. Doing for self and regulating ones own life is not improper, sinful, or misguided. Fear of being called a bigot, an 118
isolationist, a nonconformist, and a hate-monger is unrealistic and continues to be used by those who wish to oppress freedom. As an obstetrician-gynecologist, my personal position on abortion is perhaps not relevant. People frequently approach me for abortion services without success. Suffice it to say that I am for the rights of women to make choices just as men do. I appreciate life as granted to us by God. And, I respect all mankind with a special love for the blacks, Afro-Americans, Africans in America, and Negroes, in that order! Odie Payne, III, MD South Shore Hospital Chicago, Illinois
National Health Insurance Program To the Editor: Our existing health care system in the United States is failing and demands reviews, reevaluations, and revisions. The current health program is exceedingly expensive, wasteful, inadequate, and discriminatory. Every American citizen does not have equal access to quality medical and surgical care. We have a two-tier health care system, which implies that those who can afford it may acquire good and adequate health care, but that those persons who are poor and many others of specific ethnic backgrounds, colors, national origins, or circumstances may not receive adequate medical care. Diagnostic related groups, second surgical opinions, outpatient or ambulatory surgery, preadmittance testings and authorizations, strict hospital utilization procedures, the sequences and consequences of the medical malpractice dilemma, and depreciation of physicians and pa-
tients by the US health system have not substantially improved our health care system in its prime objectives to extend, improve, and maintain high quality preventive, diagnostic, and therapeutic methods for all American citizens. Medical issues and problems in our society are: 1. High infant mortality statistics, especially for blacks and other poor minorities. 2. Millions of uninsured Americans without health care cost protection. 3. Inadequate health care for the poor. 4. Necessity of copayments by American consumers to insurance companies. 5. Diminishing average life span for blacks and other minority citizens in comparison with white Americans during the last 2 years. 6. Inadequate health care for blacks and other minorities. 7. Increasingly higher costs of health care. 8. High costs for governmental bureaucracy and insurance companies. 9. Shortages and unavailability of medical personnel, including nurses, physicians, etc. 10. Too many empty hospital beds (overoccupancy of space). It is my opinion that a United States national health insurance plan could be more relevant, more economical, more efficient, and more comprehensive for every America citizen than the current two-tier system. In one survey, over 50% of consumers, as reported by Woolhandler and Himmeistein, favored a national health insurance program in order to obtain comprehensive health care costs and free continued on page 177
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
LETTERS TO THE EDITOR The following have been reported in about 0.5 to 2 percent of patients but did not appear at increased frequency compared to placebo or other treatments used in controlled trials: gastric irritation, abdominal pain, nausea, vomiting, diarrhea, anorexia, constipation, aphthous ulcers, peptic ulcer, dizziness, headache, malaise, fatigue, insomnia, dry mouth, dyspnea, cough, alopecia, paresthesias. Other clinical adverse effects reported since the drug was marketed are listed below by body system. In this setting, an incidence or causal relationship cannot be accurately determined. General: Asthenia, gynecomastia. Cardiovascular: Cardiac arrest, cerebrovascular accident/insufficiency, rhythm disturbances, orthostatic hypotension, syncope. Dermatologic: Bullous pemphigus,erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis.
Gastrointestinal: Pancreatitis, glossitis, dyspepsia. Hematologic: Anemia, including aplastic and hemolytic. Hepatobiliary: Jaundice, hepatitis, including rare cases of necrosis, cholestasis. Metabolic: Symptomatic hyponatremia. Musculoskeletal: Myalgia, myasthenia. Nervous/Psychiatric: Ataxia, confusion, depression, nervousness, somnolence. Respiratory: Bronchospasm, eosinophilic pneumonitis,
rhinitis. Special Senses: Blurred vision. Urogenital: Impotence. As with other ACE inhibitors, a syndrome has been reported which may include: fever, myalgia, arthralgia, interstitial nephritis, vasculitis, rash or other dermatologic manifestations, eosinophilia and an elevated ESR. Findings have usually resolved with discontinuation of treatment. Hydrochlorothiazide-Gastrointestinal System- anorexia, gastric irritation, nausea, vomiting, cramping, diarrhea, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis, and sialadenitis. Central Nervous System-dizziness, vertigo, paresthesias, headache, and xanthopsia. Hematologic-leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, and hemolytic anemia. Cardiovascularorthostatic hypotension. Hypersensitivity-purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis; cutaneous vasculitis), fever, respiratory distress including pneumonitis, and anaphylactic reactions. Other-hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, and transient blurred vision. Whenever adverse reactions are moderate or severe, reduce or withdraw therapy. Altered Laboratory Findings: Serum Electrolytes: Hyperkalemia: small increases in serum potassium, especially in patients with renal impairment (see PRECAUTIONS:Captopril). Hyponatremia: particularly in patients receiving a low sodium diet or concomitant diuretics. BUN/Serum Creatinine: Transient elevations of BUN or serum creatinine especially in volume or salt depleted patients or those with renovascular hypertension may occur. Rapid reduction of longstanding or markedly elevated blood pressure can result in decreases in the glomerular filtration rate and, in turn, lead to increases in BUN or serum creatinine. Hematologic: A positive ANA has been reported. Liver Function Tests: Elevations of liver transaminases, alkaline phosphatase, and serum bilirubin have occurred. OVERDOSAGE: Captopril-Primary concern is correction of hypotension. Volume expansion with an I.V. infusion of normal saline is the treatment of choice for restoration of blood pressure. Captopril may be removed from the general circulation by hemodialysis. Hydrochlorothiazide-In addition to diuresis, overdosage of thiazides may produce varying degrees of lethargy which may progress to coma within a few hours, with minimal respiratory and cardiovascular depression and without evidence of serum electrolyte changes or dehydration. The mechanism of thiazide-induced CNS dapression is unknown. Gastrointestinal irritation and hypermotility may occur. Transitory increase in BUN has been reported, and serum electrolyte changes may occur, especially in patients with impaired renal function. In addition to gastric lavage and supportive therapy for stupor or coma, symptomatic treatment of gastrointestinal effects may be needed. Degree of removal by hemodialysis has not been clearly established. Measures to maintain hydration, electrolyte balance, respiration, and cardiovascular and renal function should be instituted. DOSAGE AND ADMINISTRATION: DOSAGE MUST BE INDIVIDUALIZED (SEE INDICATIONS AND USAGE). CAPOZIDE (Captopril-Hydrochlorothiazide Tablets) should be taken one hour before meals. CAPOZIDE may be dosed bid ot tid. Because captopril and hydrochlorothiazide are excreted primarily by the kidneys, dosage adjustments are recommended for patients with impaired renal function. Consult package insert before prescribing CAPOZIDE (Captopril-Hydrochlorothiazide Tablets). Available in tablets of 25mg captopril combined with 15mg hydrochlorothiazide, 25 mg captopril combined with 25 mg hydrochlorothiazide, 50 mg captopril combined with 15 mg hydrochlorothiazide, and 50mg captopril combined with 25 mg hydrochlorothiazide in bottles of 100. (J4-005L)
©1991 E.R. Squibb & Sons, Inc., Princeton, NJ 530-502 Issued: January 1991
continued from page 118
choices of physicians, dentists, and hospitals. Too much of our health care dollar is being diverted to insurance companies, and this is obviously a waste of billions of health care dollars. I encourage consideration of revision of the current US health care program to a health system which
guarantees every American high quality health care at reasonable costs and efficiency. Earl Belle Smith, MD Department of Surgery St Francis Medical Center Pittsburgh, Pennsylvania
TO SAY THANKgiftsYOU. day for care To those of you who give your time or your for the young, health care for the elderly, mental health programs for all Americans, we say thank you. \\ are your neighbors, your friends, members of the community who benefit from your generosity. Thank you for giving. Thank you for caring. Thank you for becoming united. UnihedWay
THANKS TO YOU IT WORKS FOR ALL OF US.
-© 1985 UNITED WAAY
THE ADVERTISING COUNCILrn
177
isolationist, a nonconformist, and a hate-monger is unrealistic and continues to be used by those who wish to oppress freedom. As an obstetrician-gynecologist, my personal position on abortion is perhaps not relevant. People frequently approach me for abortion services without success. Suffice it to say that I am for the rights of women to make choices just as men do. I appreciate life as granted to us by God. And, I respect all mankind with a special love for the blacks, Afro-Americans, Africans in America, and Negroes, in that order! Odie Payne, III, MD South Shore Hospital Chicago, Illinois
National Health Insurance Program To the Editor: Our existing health care system in the United States is failing and demands reviews, reevaluations, and revisions. The current health program is exceedingly expensive, wasteful, inadequate, and discriminatory. Every American citizen does not have equal access to quality medical and surgical care. We have a two-tier health care system, which implies that those who can afford it may acquire good and adequate health care, but that those persons who are poor and many others of specific ethnic backgrounds, colors, national origins, or circumstances may not receive adequate medical care. Diagnostic related groups, second surgical opinions, outpatient or ambulatory surgery, preadmittance testings and authorizations, strict hospital utilization procedures, the sequences and consequences of the medical malpractice dilemma, and depreciation of physicians and pa-
tients by the US health system have not substantially improved our health care system in its prime objectives to extend, improve, and maintain high quality preventive, diagnostic, and therapeutic methods for all American citizens. Medical issues and problems in our society are: 1. High infant mortality statistics, especially for blacks and other poor minorities. 2. Millions of uninsured Americans without health care cost protection. 3. Inadequate health care for the poor. 4. Necessity of copayments by American consumers to insurance companies. 5. Diminishing average life span for blacks and other minority citizens in comparison with white Americans during the last 2 years. 6. Inadequate health care for blacks and other minorities. 7. Increasingly higher costs of health care. 8. High costs for governmental bureaucracy and insurance companies. 9. Shortages and unavailability of medical personnel, including nurses, physicians, etc. 10. Too many empty hospital beds (overoccupancy of space). It is my opinion that a United States national health insurance plan could be more relevant, more economical, more efficient, and more comprehensive for every America citizen than the current two-tier system. In one survey, over 50% of consumers, as reported by Woolhandler and Himmeistein, favored a national health insurance program in order to obtain comprehensive health care costs and free continued on page 177
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
LETTERS TO THE EDITOR The following have been reported in about 0.5 to 2 percent of patients but did not appear at increased frequency compared to placebo or other treatments used in controlled trials: gastric irritation, abdominal pain, nausea, vomiting, diarrhea, anorexia, constipation, aphthous ulcers, peptic ulcer, dizziness, headache, malaise, fatigue, insomnia, dry mouth, dyspnea, cough, alopecia, paresthesias. Other clinical adverse effects reported since the drug was marketed are listed below by body system. In this setting, an incidence or causal relationship cannot be accurately determined. General: Asthenia, gynecomastia. Cardiovascular: Cardiac arrest, cerebrovascular accident/insufficiency, rhythm disturbances, orthostatic hypotension, syncope. Dermatologic: Bullous pemphigus,erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis.
Gastrointestinal: Pancreatitis, glossitis, dyspepsia. Hematologic: Anemia, including aplastic and hemolytic. Hepatobiliary: Jaundice, hepatitis, including rare cases of necrosis, cholestasis. Metabolic: Symptomatic hyponatremia. Musculoskeletal: Myalgia, myasthenia. Nervous/Psychiatric: Ataxia, confusion, depression, nervousness, somnolence. Respiratory: Bronchospasm, eosinophilic pneumonitis,
rhinitis. Special Senses: Blurred vision. Urogenital: Impotence. As with other ACE inhibitors, a syndrome has been reported which may include: fever, myalgia, arthralgia, interstitial nephritis, vasculitis, rash or other dermatologic manifestations, eosinophilia and an elevated ESR. Findings have usually resolved with discontinuation of treatment. Hydrochlorothiazide-Gastrointestinal System- anorexia, gastric irritation, nausea, vomiting, cramping, diarrhea, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis, and sialadenitis. Central Nervous System-dizziness, vertigo, paresthesias, headache, and xanthopsia. Hematologic-leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, and hemolytic anemia. Cardiovascularorthostatic hypotension. Hypersensitivity-purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis; cutaneous vasculitis), fever, respiratory distress including pneumonitis, and anaphylactic reactions. Other-hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, and transient blurred vision. Whenever adverse reactions are moderate or severe, reduce or withdraw therapy. Altered Laboratory Findings: Serum Electrolytes: Hyperkalemia: small increases in serum potassium, especially in patients with renal impairment (see PRECAUTIONS:Captopril). Hyponatremia: particularly in patients receiving a low sodium diet or concomitant diuretics. BUN/Serum Creatinine: Transient elevations of BUN or serum creatinine especially in volume or salt depleted patients or those with renovascular hypertension may occur. Rapid reduction of longstanding or markedly elevated blood pressure can result in decreases in the glomerular filtration rate and, in turn, lead to increases in BUN or serum creatinine. Hematologic: A positive ANA has been reported. Liver Function Tests: Elevations of liver transaminases, alkaline phosphatase, and serum bilirubin have occurred. OVERDOSAGE: Captopril-Primary concern is correction of hypotension. Volume expansion with an I.V. infusion of normal saline is the treatment of choice for restoration of blood pressure. Captopril may be removed from the general circulation by hemodialysis. Hydrochlorothiazide-In addition to diuresis, overdosage of thiazides may produce varying degrees of lethargy which may progress to coma within a few hours, with minimal respiratory and cardiovascular depression and without evidence of serum electrolyte changes or dehydration. The mechanism of thiazide-induced CNS dapression is unknown. Gastrointestinal irritation and hypermotility may occur. Transitory increase in BUN has been reported, and serum electrolyte changes may occur, especially in patients with impaired renal function. In addition to gastric lavage and supportive therapy for stupor or coma, symptomatic treatment of gastrointestinal effects may be needed. Degree of removal by hemodialysis has not been clearly established. Measures to maintain hydration, electrolyte balance, respiration, and cardiovascular and renal function should be instituted. DOSAGE AND ADMINISTRATION: DOSAGE MUST BE INDIVIDUALIZED (SEE INDICATIONS AND USAGE). CAPOZIDE (Captopril-Hydrochlorothiazide Tablets) should be taken one hour before meals. CAPOZIDE may be dosed bid ot tid. Because captopril and hydrochlorothiazide are excreted primarily by the kidneys, dosage adjustments are recommended for patients with impaired renal function. Consult package insert before prescribing CAPOZIDE (Captopril-Hydrochlorothiazide Tablets). Available in tablets of 25mg captopril combined with 15mg hydrochlorothiazide, 25 mg captopril combined with 25 mg hydrochlorothiazide, 50 mg captopril combined with 15 mg hydrochlorothiazide, and 50mg captopril combined with 25 mg hydrochlorothiazide in bottles of 100. (J4-005L)
©1991 E.R. Squibb & Sons, Inc., Princeton, NJ 530-502 Issued: January 1991
continued from page 118
choices of physicians, dentists, and hospitals. Too much of our health care dollar is being diverted to insurance companies, and this is obviously a waste of billions of health care dollars. I encourage consideration of revision of the current US health care program to a health system which
guarantees every American high quality health care at reasonable costs and efficiency. Earl Belle Smith, MD Department of Surgery St Francis Medical Center Pittsburgh, Pennsylvania
TO SAY THANKgiftsYOU. day for care To those of you who give your time or your for the young, health care for the elderly, mental health programs for all Americans, we say thank you. \\ are your neighbors, your friends, members of the community who benefit from your generosity. Thank you for giving. Thank you for caring. Thank you for becoming united. UnihedWay
THANKS TO YOU IT WORKS FOR ALL OF US.
-© 1985 UNITED WAAY
THE ADVERTISING COUNCILrn
177
