Too quick to discard accepted treatments
In their column "Medical uncertainty" (Opinion
Commentary, Feb. 18), Erik Rifkin and Edward J. Bouwer seek to emphasize the "uncertainties" that persist in modern medicine. In doing so, they challenge some pieces of conventional medical wisdom, including those on the detrimental effects of chronically elevated blood cholesterol and blood glucose.
As support for their argument, the authors cite two recent studies - one in which the cholesterol-lowering drug Zetia did not significantly affect plaque build-up in the carotid arteries and a second in which very aggressive blood sugar control was associated with increased mortality rates.
While these studies are important and should provoke further investigation, we do not agree with the sweeping conclusions the authors draw.
For example, a strong association between elevated LDL cholesterol and coronary artery disease is supported by extensive laboratory data and multiple epidemiologic studies over more than three decades. In addition, numerous large, randomized trials over the past 25 years have clearly demonstrated that statin medications reduce LDL cholesterol and the future risk of heart attacks and strokes, particularly among those at high risk for cardiovascular disease.
Based on this vast body of evidence, statin use is widely recommended in clinical guidelines.
Similarly, the adverse effects of chronically elevated blood sugar levels, including greater likelihood of coronary artery disease, stroke, kidney failure, blindness, nerve damage and amputations, have been well-established through many epidemiologic studies.
From time to time, new trials offer results that conflict with the totality of present medical research.
This may be because of the way the study was performed, or because there is more to be learned on the subject; the best response to such conflicting data is further investigation.
To be sure, there are still uncertainties in modern medicine.
However, it would be irresponsible to ignore vast realms of evidence on the basis of one or two conflicting results.
Adam Tanious
Dr. Chiadi Ndumele Baltimore
Dr. Ndumele is a postdoctoral fellow at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.
Although Erik Rifkin and Edward J. Bouwer make some interesting points in "Medical uncertainty," they also draw conclusions that are not necessarily supported by existing scientific data.
For instance, while it's true that we don't know all the factors that cause cardiovascular disease, it is clear that using statin medicines to control cholesterol is helping patients.
Mr. Rifkin and Mr. Bouwer may say there is little if any correlation between elevated cholesterol and heart disease. But there are reputable scientific studies that show a cause-and-effect relationship.
What's more, the general agreement in the medical community that diabetics should lower their blood sugar to decrease the risk of dying from heart disease is based on studies conducted over years.
Just because a recent federal study casts doubt on the premise does not mean that the original belief is now wrong.
The fact is that developing an understanding of the proper way to treat different types of patients requires ongoing evaluations of the science that can last for years. And since contradictory conclusions are often found study by study, it is important for physicians to avoid hasty conclusions about how to treat their patients.
Alan Goldhammer
Washington
The writer is a deputy vice president for the Pharmaceutical Research and Manufacturers of America.
New computer tax a boon for Virginia
The Sun's article "New tax stirs up threats to move" (Feb. 22) should serve as a wake-up call to Maryland legislators. The new computer services tax hasn't even taken effect yet but some companies are already seriously thinking about leaving Maryland for the more favorable business climate of Virginia.
As a former director of Virginia's Economic Development Partnership, I know firsthand about the competition between the states to attract new jobs and investment by high-tech and biotech companies.
This new tax makes it that much easier for Northern Virginia to compete with Maryland for any business that relies heavily on computer services - including those in financial services, health care and government contracting.
Maryland businesses are just beginning to realize the trouble this tax will cause when it goes into effect this summer.
They're also troubled by how this tax was enacted - by a conference committee at the 11th hour as a stopgap measure to plug a budget hole.
But over here in Virginia, we're not troubled at all.
In fact, let me extend my thanks to Maryland for giving a new advantage to the Old Dominion.
Steve DelBianco
McLean, Va.
Silly bills a waste of time and money
As I read Thursday's Sun, I came upon an article that not only disturbed me but also angered me ("Some bills take the cake," Feb. 21).
How is it that our legislators have the time or energy to debate what our state dessert should be but don't have the time to figure out a way to fix our current fiscal problems other than imposing more taxes on the citizens of Maryland?
This is just another example of how our current administration and legislators are letting down the citizens.
Cale Christensen
Reisterstown
Please tell me the article "Some bills take the cake" was an early April Fool's joke.
Lawmakers actually debate such silly proposals in regular Assembly sessions, and our governor has to call a special session to raise our taxes?
This must be some kind of a bad joke.
Al Ritter
Cockeysville
Let an old fugitive finish life in peace
I have been reading with interest the articles about Willie Parker ("Past caught up to fugitive who lived in open," Feb. 24).
Having lived in Maryland for 72 years, I've seen the state do some ridiculous things, but this one takes the cake.
Wow, they caught this dangerous felon after only 43 years.
I wonder if he tried to hold the marshals at bay with his cane or tried to escape again on his speedy wheelchair.
Why don't we leave this man alone and let him die in peace?
Lawrence Conner
Middle River
No need to accept carnage at colleges
A sense of futility appears to have followed the recent string of campus shootings ("Land of the free, home of the gun," Feb. 17).
Many people resign themselves to thinking that such all-too-common events are simply part of living in America. They want to give up.
But the reality is that school shootings are rare compared with other problems. More than 1,100 suicides and 1,400 alcohol-related deaths occur on college campuses annually.
At the same time, campus mental health centers are understaffed and overflowing. Yet providing the services they offer to students in need often gets little attention compared with debates about guns, security and emergency communication.
The last thing we need to do is give up. What we need to be talking about is the appropriate role of institutions of higher learning in student health.
Instead of either doing nothing or denying admission to or expelling students with mental health issues, colleges should re-examine their policies to enable all young adults, even those with mental health problems, to fulfill their potential.
Amelia M. Arria
College Park
The writer is associate director of the Center for Substance Abuse Research at the University of Maryland, College Park.
Let consumers buy wine of their choice
I am a personal chef and a wine enthusiast who cannot buy certain vintages of wine in Maryland and cannot be a member of wine clubs that could send them to my home.
Maryland liquor distributors do not distribute many of the smaller-release wines from larger vineyards or any releases from some of the smaller, lesser-known vineyards.
If Thomas Minkin is having such a hard time with establishments selling to minors, maybe he is not the person to chair the Baltimore County Board of Liquor License Commissioners ("Time to loosen state's liquor laws?" letters, Feb. 22).
But let's let the law-abiding citizens of Maryland sit down to a dinner with a beautiful bottle of the wine of their choice.
Kevin Goglia
Pasadena
Just staying home can curb racing toll
The tragic drag-racing deaths in Prince George's County could have been easily avoided. The adults involved in this accident could have stopped playing in the street.
The sister of one of the crash victims said, "Somebody needs to stop this" ("Late-night speed offers thrills, danger," Feb. 18).
But there is a way that we can stop such tragedies: Stay home.
Sophia Montgomery
Perry Hall