December 2006 Letters to the Editor
All the Livelong Day
I spent two hours with Paul Scott when he interviewed me for “Town vs. Train” (November 2006). I have four points to add to the article.
Citizens Against Rochester’s Bypass is a grass-roots organization of rural and city residents, environmentalists, and even Mayo employees. We formed to protect the environment of land, homes, and farms in Olmsted County.
Our group prevailed at the STB (Surface Transportation Board) and the Eighth Circuit Court in St. Paul on the environmental merits of the case. The decisions reaffirmed our position: no 34.1-mile bypass through wetlands, calcareous fens, sinkholes, etc.—no 30-to-40-foot cuts and fills tearing up sensitive terrain.
Our position is “No Bypass and Negotiate on the Current Line.” As I told Tim Walz when he spoke in favor of the “ultimate bypass” through Austin, negotiation for a balanced decision requires two willing groups. Paul Scott clearly said Rochester “told the train boss to find another way.” There is no negotiation in that stand.
Without negotiation, citizens of Minnesota will find state Representative Tina Liebling working to get transportation dollars for Rochester’s train problem. Her comments came at a press conference in Rochester. Those transportation dollars for Rochester would come at the expense of state roads, bridges, and other rail communities with much greater rail traffic, such as Moorhead, Mankato, and Winona.
Citizens Against Rochester’s Bypass
Is Dr. Bowron really comparing a woman to his credit card (“Gardasil Duty,” October 2006)? What sublime arrogance.
Dr. Craig Bowron’s October Hippocratise column discussed the pros and cons of a new vaccine that can prevent some types of cervical cancer. He quoted the National Cancer Institute as stating, “The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual,” adding his own characteristically pithy comment: “And the surest way to avoid credit-card debt is not to own one. Or to have just one and use it wisely.”
My November column (“Why Do You Think They Call It Dope?”) trumpeted the cost savings and efficacy of generic medications, but my colleagues who treat patients with seizures say I might have blown that horn too loudly.
The task of controlling a patient’s seizures while minimizing drug side effects can sometimes be quite tricky, as anti-epileptic medications are part of a small number of drugs that display a “narrow therapeutic window.” If levels of the drug in the blood rise above that narrow therapeutic window, toxicity occurs; levels below that range can cause seizures to return.
On rare occasions, this sometimes-delicate balance is upended when patients renew their anti-epileptic medications and a generic equivalent is substituted for their brand-name drug. A few days after the switch, a seizure can occur or side effects may develop.
According to scientists at the Food and Drug Administration (FDA), this shouldn’t be the case. After all, the FDA goes to great lengths to certify that a generic drug, in comparison to a branded drug, provides the same drug levels at the same dose, proving the two drugs to be “bioequivalent.”
But physicians like Dr. Joanne Rogin, chair of the professional advisory board of the Epilepsy Foundation of Minnesota, swear it isn’t so. “Although generic medications are an appropriate cost-effective alternative that we endorse for some anti-epileptic drugs, in a number of cases they have caused difficulties,” says Dr. Rogin. “That’s why physicians like myself and the Epilepsy Foundation have serious concerns about mandatory substitution of generic anticonvulsants without the prior approval of us or our patients.”
So, if you a have a seizure disorder, pay close attention to what medication you’re getting, and before changing over to a generic anticonvulsant, or even when switching from one generic to another, be sure to check with your doctor.
Meanwhile, if you have a sore knee, stick with generic ibuprofen or acetaminophen.
CRAIG BOWRON, MD
Thank you for recognizing John Bresland’s short story, “The Cooler,” with a Tamarack Award (November 2006). It is a primer in the power of the telling detail, and the rewards found in taking the time to choose a word so exquisitely right that it makes all other valid choices seem terribly wrong.
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