Letters to the Editor
LETTERS to the EDITOR
Responses to the John Edwards editorial
The editorial written by Charles J. Lockwood that appeared in the August 2004 issue, "John Edwards: The wrong prescription for ob/gyns!!!" was inappropriate for Contemporary OB/GYN. I do not feel that a scientific journal should take a political position in regard to a presidential election. Dr. Lockwood is overstepping his bounds as scientific editor. When I read the article, I was more impressed with the favorable positions in regard to the medical field that John Edwards had taken than the negative one discussed by Dr. Lockwood, that of being a trial lawyer. Dr. Lockwood is certainly entitled to his view, but he chose the wrong vehicle to display it.
Donald B. Katz, MD
Louisville, Ky.
Dr. Lockwood's reply: I appreciate Dr. Katz's heartfelt comments. However, I do not recall taking a vow of political celibacy when I became a physician. Where politics affects ob/gyns, I will continue to call them as I see them. Conservatives were as angry at my July editorial on Plan B as liberals were for August's editorial on Senator Edwards. The truth is neither party's positions are entirely supportive of women's reproductive health or the physicians who look after it.
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I was surprised to read the editorial by Dr. Lockwood in the August 2004 issue of Contemporary OB/GYN. His contention that John Edwards is the "wrong prescription for ob/gyns" was interesting but extremely one-sided and exceptionally shortsighted. The malpractice crisis deeply impacts us all but I find it interesting that people are able to react to one issue without seeing the effect on the whole. By critiquing only one prescription it appears that the alternative prescription is a preferable answer. The rationale is akin to saying that you should vote for a leader because he made the trains run on time or built the autobahns. There are other issues involved that have a greater impact on practicing ob/gyns. As a provider of women's health services, I find the potential side effects of the alternative prescription just as distasteful. What about the prescription for women's reproductive choices, evidence-based prevention of teen pregnancy and stem cell research? As a practicing ob/gyn I would sooner live with the cost and problems of the present tort system than risk losing my daughters' options and choices in the future. Keep political prescriptions out of your journal unless you are willing to give an informed consent about all potential side effects of alternative medicines.
Gary R. Cohen, MD
Mission Hills, Kans.
Dr. Lockwood's reply: Thanks for your passionate and heartfelt response. However, as I have said before, I will speak out against any threat to my profession and to women's health whether it comes from the right or the left. I love being an obstetrician and I will not apologize for feeling as passionately about my job as you do about the Kerry-Edwards ticket. As to your implication that I am not evenhanded: I believe my July editorial thoroughly discussed the "side effects" for the alternative medication (i.e., the current Administration)and I certainly received my share of criticism from Pro-Lifers over that editorial. What I don't appreciate, but do find somewhat ironic, is that I have now been linked with Nazis by both conservatives (see "Letters to the Editor," August 2004) and now liberals. It is clearly a sign of just how shrill and polarized our politics have become. Gone are the days when President Reagan could have cocktails with Speaker of the House O'Neil. Finally, Dr. Cohen, I would also point out that at the rate we are going there will be no medical students entering ob/gyn and the rest of us will not be able to afford or even obtain malpractice insuranceso there may not be any providers able to address your "daughters' options and choices in the future."
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Dr. Lockwood's remarks about John Edwards as the wrong prescription for obs is right on the money. I will vote for the Bush team (while holding my nose) as this is a far lesser evil than a team that includes John Edwards.
Marvin S. Amstey, MD
Rochester, N.Y.
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Enjoyed and wholeheartedly agree with your editorial. I would add that Americans have the unique opportunity to vote for a man who has the ability to talk directly from the fetus in utero during labor to the jury (according to a recent New York Times article). Also, Edwards' partner in law stated that if you showed him a hospital with a low C/S rate, he'd show you children in wheelchairs!!!
Jon R. Snyder, MD
New York, N.Y.
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Nice editorial on the Edwards issue but if 70% of liability decisions favor the physician, then a whole lot of suits are being filed because of physician testimony. We have seen the enemy. IT IS US!!!
J. Rajan, MD
Lansing, Mich.
Editor's note: See the "Clinician to Clinician" article by Dr. Arnold Cohen (September 2004) about what ACOG is doing to discipline "experts" who provide inaccurate or patently erroneous opinions.
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In response to Mr. Edwards' reply to the New York Times reporter stating, "that perhaps the nation's C/S rate was too low," I must agree with him. I think entirely too many medical decisions are being made by physicians these days that should be made by lawyers. In fact, if we really want to decrease medical malpractice suits, women should just bring their lawyers to the hospital with them and if there are any major medical decisions to be made, their lawyer could make it right then before any treatment is started.
George Stefenelli, DO
LaGrange, Ga.
The FDA and Plan B
I read with a great deal of amusement the debate between Dr. Moore and Dr. Lockwood regarding the "FDA and Plan B" [Contemporary OB/GYN, August 2004]. While one says: the glass is half empty, the other one avers that it is half full. I am telling both that they are using the "wrong glass."
Dr. Moore is right in saying that very conveniently the onset of pregnancy has been changed from the moment of fertilization to the moment of implantation in order to label EC and intrauterine devices as contraceptives instead of abortifacients. But he is wrong to consider that a newly created human being is formed at the moment of fertilization bestowing the micro embryo with all the rights of a "child" or for that matter a newborn human.
Dr. Moore is right in labeling EC as an abortifacient in accordance with the definition that abortion is the interruption of a fertilized egg no matter if this is at the stage of zygote, embryo, or fetus. He is wrong, however, in denying his religious bias and at the same time pandering to commiseration and sympathy with words like "sanctity of life" and even worse making a foolish paradigmatic comparison between the atrocities of Nazi Germany and the inalienable right of our women to make a conscientious decision not to carry an "anencephalic" or totally deformed fetus to term.
Dr. Lockwood is right in asserting that "A zygote has the potential to become a person, but is not a person." The same way that I cannot collect Social Security at 60 years old, albeit I will be 65.8 years in the future, or a grape juice shall become a fine wine along the way, but it is not yet. He nevertheless fails miserably in avoiding the word "abortion" for the interruption of an 8- to 10-day fertilized egg or zygote just prior to complete implantation.
Both of them are wrong in trying to pinpoint when a new life actually starts. Life has no beginning nor has any end. Life is just a particular arrangement of basic components, among them oxygen, nitrogen, carbon and hydrogen, which under wondrous circumstances combine together to form amino acids, nucleotides, DNA, protoplasm, cells, tissue, and life itself. We enact laws in order to protect some types and stages of those arrangements especially "human life" and we do so taking into consideration priorities and the defense of the so-called "human rights," and there is nothing more basic than the free right to choose what is more convenient, comfortable, and less painful to ourselves, to our lives, and to our future.
Perhaps Dr. Moore will behave like Homer Wells in the movie "The Cider House Rules" when he is touched by a personal instance in which he has to make a decision based on his priorities, and whatever he chooses shall be perfectly okay and acceptable, but he has no right to impose that decision on his neighbor, who has the inalienable right to do the same choosing, albeit implementing a different route.
Perhaps Dr. Lockwood shall realize and accept that the insertion of an IUD and providing emergency contraception are indeed aimed at the interruption of a fertilized egg, and no matter how he juggles the definitions, "a rose by any other name is still a rose," and if the heat is too much for him he should immediately abandon the kitchen.
Julio C. Novoa, MD
Perry Hall, Md.
Dr. Lockwood's reply: Thanks for your thought-provoking critique. The primary point of our editorial and subsequent letter was not to try to define when life starts, or whether Plan B acts as an abortifacient, but rather to affirm that whether Plan B acts as a contragestive or a contraceptive should be irrelevant to the FDA's assessment of its suitability for OTC use since: (1) the drug is safe and effective by FDA criteria; and (2) unfettered access to early abortion is protected by the US Constitution as interpreted by the US Supreme Court in its Roe v Wade decision and subsequently affirmed, with modifications in its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v Casey. This was also my primary point at the FDA hearing when I argued that Plan B labeling should be employed to explain its potential mechanisms of action in lay language such that consumers could make a fully informed choice, in the context of their individual religious and moral views, as to whether or not they were comfortable using the agent.
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I must take exception to your recent editorial regarding emergency contraception. Your statement that "Anyone who thinks that maintaining the prescription status of Plan B will somehow stem the tide of teenage sex or increase chastity is hopelessly naive" is, I'm afraid, hopelessly naive. Although you criticize Dr. Weldon's statement as being "bereft of data," it is nonetheless full of common sense. To think that the absence of contraception does not reduce acts of sexual intercourse is simply absurd. Over-the-counter EC would eliminate this concern for otherwise unprepared females who are most likely to be teens. The burden of proof lies with Barr Laboratories to ensure that such over-the-counter status does not increase sexual activity and STDs among this most vulnerable female population.
Jeffrey A. Keenan, MD
Knoxville, Tenn.
Needless Pap smears
The phrase "needless Pap smears" in the article by BE Sirovich (which was summarized in the August issue of the electronic newsletter, Contemporary OB/GYN Newsline), deserves comment. Having practiced gynecology for 25 years and performing these "needless Pap smears," I was able to identify two women with early vaginal cancer, and an additional few with premalignant conditions which could be easily treated at this early stage. In addition, it is incalculable how many women would not have come in for their annual exam if not for the routine of the annual Pap smear. With no risk and minimal cost, this is not a procedure we should abandon casually.
Edward Zelnick, MD
Hollywood, Fla.
Letters to the Editor. Contemporary Ob/Gyn Oct. 1, 2004;49:30-33.
