State official thanked for enforcing prescription rule

Marylanders with chronic diseases or conditions requiring continuing prescription medication owe State Insurance Commissioner Steven B. Larson a hearty "thank you."

His action ("HMO fined for policy on 90-day prescriptions," Dec. 2) should serve notice to the various plans that "bad medicine" will not be tolerated. I say "bad medicine" because, as a family physician, I see how patient compliance is decreased as medications become more difficult to obtain. Not infrequently, I see patients who have been out of their medication because the arbitrary and capricious 30-day supply rules of numerous insurance plans are such an annoyance for busy, active people. Others reduce their dosage on occasion, to make the medication "last" until they can get to the HMO-approved pharmacy, which may or may not be all the way across town.

I've had patients ask me to "prescribe the medication more frequently per day," not to take more pills, but to get a reasonable supply at one time. Surely we can practice better medicine than by falsifying prescriptions so that our patients can get adequate therapy.

Marylanders with chronic disease need to know that, according to The Sun article, "the state's requirement [is] for providing a 90-day supply of drugs when prescribed by a physician."

Thank you again, Commissioner Larson!

William D. Hakkarinen

Cockeysville

The writer is treasurer of the Maryland Academy of Family Physicians.

The links are obvious between poverty, learning

Mike Bowler's article about the experimental Direct Instruction programs used by several city schools ("Another view of reading tests at two schools," Nov. 29) left me confused.

On the one hand, one of the strongest arguments made by advocates for Direct Instruction programs is that they are virtually impervious to the debilitating effects of poverty. Yet the bulk of Bowler's article was spent comparing the poverty rates at various schools that use DI (and one school that does not).

Now if poverty has little relevance to DI, why spend so much space discussing the program's effectiveness in terms of poverty? The reason seems clear: Poverty does matter, just as do all the cultural variables that impact students' lives.

This point was underscored by a Sun editorial ("High school report"), which appeared the same day. Citing several possible reasons for the stagnant graduation rates in U.S. high schools, the editorial noted as "obvious" the amount of time American students spend distracted by TV, malls, video arcades, cars and part-time jobs, that is, by all the attractions of popular culture. Indeed, their poverty may intensify their preoccupations, with evidence suggesting they spend even more time than others in pursuit of escapism. Poverty will do that to a person.

In short, there is no such thing as a "poverty-proof" curriculum, any more than a "culture-proof" curriculum. Direct Instruction, whatever its merits, should not be promoted as if there were.

Howard Bluth

Baltimore

School-voucher opponents not anti-poor children

Continuing his relentless attack on liberals, George F. Will in his Nov. 29 Opinion*Commentary column, "School choice gets needed boost from Supreme Court," extolled the merits of school-choice programs and accused those who do not agree with him as being in a "protracted war against poor children." This harsh and insulting rejection of individuals and groups who do not see vouchers as the solution to the troubles of the public schools is a low blow that doesn't recognize the breadth and depth of the opposition to vouchers.

For example, in May of this year, the Jewish Council for Public Affairs (JCPA) published its yearlong study that concluded it should reaffirm its opposition to publicly financed vouchers for private school education. One of the major reasons for this position was that voucher programs would undermine public education. The organized Jewish community has long been a strong advocate for quality public schools.

This study was not undertaken lightly. It was directed by a committee of lay and professional leaders representing JCPA national and local members, agencies and a wide range of local communities from coast to coast that conducted their own grass-roots examination of this complex issue.

The proponents of this study and its results are surely not part of a "war against poor children."

William H. Engelman

Baltimore

Victims of Hurricane Mitch need cancellation of debts

As the victims of Hurricane Mitch continue to bury their dead, tend to their sick and rebuild their lives, many countries and international lending institutions have promised debt relief. But unless that relief is total cancellation of current debts, Nicaragua, Honduras, El Salvador and Guatemala will only find themselves in a deeper hole.

Even before the storm hit, these countries were paying more to service their external debts than they were spending on health and education. Under the unbearable yoke of debt, there is little hope that the people of Central America will improve their lives. In this hour of tremendous need, all nations, the International Monetary Fund and the World Bank should cancel the debts of these four countries. With so much to be thankful for, this is no time to play Scrooge.

Stephen Valk

Atlanta, Ga.

AARP supports study to identify high-risk drivers

Timothy Wheeler's Nov. 11 article, "MVA to test older driver" states that "there is no ready way to identify which older drivers pose risks". Despite that, accidents involving older drivers frequently lead to emotional and fear-based responses such as proposals for renewal testing based solely on age. That is why the AARP is participating in the Maryland Research and Development Consortium, which is supporting the recently inaugurated pilot test of the driver screening assessment. The goal of the pilot test is to identify ways that will more fairly and accurately identify high-risk older individuals.

AARP supports thoughtful approaches to keeping unsafe drivers all ages off the road, just as we support helping those who need to improve their skills, change their habits or find good alternatives to driving.

It will be several years before the state has enough information from the study to assess the benefits of this type of screening. In the meantime, there are actions that older drivers can take to improve their skills and prevent traffic accidents. AARP's 55 ALIVE/Mature Driving program teaches older drivers useful strategies for dealing with changes in vision, hearing and reaction time. Nationally, more than 6 million older drivers have taken this driver refresher class since we introduced it in 1979. In Maryland, people can call 1-888-227-7669 to locate a convenient class.

Margaret A. Dixon

Clinton

The writer is immediate past president of AARP.

All aboard for visitors to the B&O; Museum

Anyone who has not seen the "Miniature Marvels" on display at the B&O; Railroad Museum is missing an exhibit that is little short of fabulous. This extensive collection features many rare and historic models and toy trains made by many of the finest artists and craftsmen in America.

And of course, there is the largest, oldest and most comprehensive collection of steam engines and rolling stock in North America. Also don't forget the model garden and rare clock collection and the most powerful steam engine ever built in the rear yard. There is free secure parking and an affordable entrance fee.

Anthony W. Buechner

Baltimore

The irony of spending on a road to Gibson Island

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Hooray! Route 100 now connects Route 29 and Gibson Island.

Taxpayer money buys the signs and maintains the roads that lead to Gibson Island. Isn't it ironic that one can get in his or her car and drive to the causeway that connects the island with the peninsula? Alas, they won't let you in!

Robert E. Johnson

Glen Burnie

Pub Date: 12/06/98