NurseWeek
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December
4, 2000
Mercury
menace
This
was a great article ("Unraveling
Autism," Nov. 20). You do a wonderful job of tackling
a difficult subject.
I
am the parent of a child wrongly diagnosed as PDD-OS.
We
had a full toxicology run done on her and she came out to
have an incredible amount of mercury in her system (19.3
parts of mercury per million).
We
are in chelation and ABA therapy, and our daughter is well
on the road to recovery.
Ronald
G. Miller Jr.
Elizabethtown, Ky.
Regarding
"Unraveling
Autism": great article. More, more, more about
this, please. Is there any reason mercury has to be in any
injectable? Aren’t there alternatives?
Tobi
Hale, MSW
Estes Park, Colo.
More
than a free lunch
A
writer recently urged a boycott of pharmaceutical companies’
free samples, incentive gifts, etc. ("Stop
the hypocrisy," Readers Respond, Nov. 20). I would
like to offer a different side of the story.
Pharmaceutical
reps do much more than give us pens, cookies and lunches.
I am the charge nurse in pediatrics at a private, nonprofit
clinic with a poor, largely uninsured minority population.
Many of our children are not MediCal eligible and are covered
by the Child Health and Disability Prevention program only
for well-child and immunization visits.
Purchasing
a thermometer, acetaminophen and a nasal bulb aspirator
is a financial burden for these families, who also need
to pay cash for the doctor’s visit. Even those who do have
publicly funded insurance often find that the medication
the doctor wants to prescribe (a nonsedating antihistamine,
for example) is not covered, and only a less effective or
higher side-effect medication (sedating antihistamine) is
covered.
Frequently,
we must document a treatment failure with two lower-priced
medications, then do a lot of paperwork in order to get
pre-authorization for the treatment of choice. Sometimes
these rules seem terribly arbitrary; e.g. MediCal will cover
Augmentin for acute otitis media but not for periorbital
cellulites, which is actually a more serious diagnosis.
Augmentin costs over $100 for a toddler-size prescription.
Most
over-the-counter medications for fever and pain relief,
nasal congestion, etc., also are not covered, but symptom
relief is an important part of pediatric patient care. An
uncomfortable, congested child will not eat or sleep well,
possibly becoming dehydrated and even sicker. The free samples
we receive often mean the difference between a patient getting
the medication she needs, or going without. At the very
least we can provide a trial of a few days’ worth of medication
to see if it will be effective before writing a full prescription.
I
have never seen one of our providers persuaded to prescribe
a particular medication by receiving a cute stuffed animal
or coloring books. Our providers take great care to review
clinical data and studies regarding particular medications,
and I do not believe their independent judgment is compromised
by receiving "freebies." Nor am I concerned that
it is unfair to the patient to promote one brand over a
generic equivalent. In fact, when I tried to explain to
a patient that she could purchase a generic acetaminophen
in lieu of the name brand, our medical director indicated
she wants the patients to stick with only the name brand
because then we know exactly what the child has taken.
Many
of our parents are illiterate, many more have only elementary
school educations, and few can read an English-language
medication container to see if a generic is the same as
a more expensive name brand. Indeed, I recently saw an infant
who had been double-dosed with both Tempra and Tylenol because
the parent didn’t know they are both acetaminophen.
The
pens, Post-its, Band-Aids, tissues, exam table paper rolls,
etc., that we receive also help our clinic budget just a
little, at a time when the clinic is in dire financial straits.
The reps also have been very responsive in providing patient
education materials in the language of our patients. Finally,
I have seen the pharmaceutical reps go to great lengths
to advocate for better coverage by MediCal and other insurers.
Certainly, they have a profit motive, but the bottom line
is better patient care.
Sue
Weaver, JD, MSN, RN
San Francisco
Nursing
pioneers
After
reading "On
Their Own" about nurse-managed clinics (Nov. 20),
it seems that Joy Smith Catterson, RN, and I are really
unique in that our Independent Nursing Practice, the first
corporation of its kind, is an entity that is rare.
Together
we, and later I alone, created a successful entrepreneurial
business that was extremely profitable, and in fact has
now allowed me the freedom to produce and host TV shows.
We were truly freestanding and never based our services
on any income from grants or any government subsidies at
all. Our own investment of $500 apiece later turned into
a financially viable and very profitable business employing
hundreds of nurses with diverse services in home care, private
duty, first-aid on movie sets, etc.
Our
adventure is chronicled in Nurses: On Our Own, which
includes an update and another chapter on the how-to business
of nursing without any attachments to government or universities
as a basis for income. This business grossed many dollars
and the stories are intimate, intense and bittersweet with
great rewards.
Thank
you for giving us the chance to inform other nurses of their
own ability to forge ahead and venture into the world of
business and medicine. The book is available through bookstores
and at www.iuniverse.com.
Karen
White Gibson, RN
Romeoville, Ill.
