More about deep vein thrombosis
The article on deep vein thrombosis [“Long, strange trip,” Jan. 17] was very informative, but it omitted other information that readers might want to have. DVTs and pulmonary embolisms can also signal the presence of undiagnosed cancer. As the author notes, he will have to wait until he finishes a prescribed period of anticoagulation therapy before he can be tested for the genetic disorders that may account for his clotting. In the meantime, I hope his doctors are ruling out various forms of cancer that could have triggered his clotting episodes.
Jane Durch, Arlington
Seven years ago, at age 13, our daughter developed two blood clots behind her left knee soon after our return from a trip to Europe. She had spent the entire flight curled up reading Harry Potter and probably did not get up and move around at all. As they don’t expect to see blood clots in someone so young, it took two trips to the emergency room and a visit from a physician friend to finally get her diagnosed correctly, but thankfully in time to avoid further damage to her veins and/or movement of the clots.
As they told us later, tough as those first months are, this can be a blessing for the entire family. We were all tested and found out about the genetic links to this predisposition, and we now are careful to avoid the triggers that you mentioned in the article. Thanks to the Human Genome Project, the tests are available to screen the public, but it seems as though the tests are not done until after someone in the family has had a clot.
Mary Ellen Rogers, Alexandria
Drugs and money
Thanks for the brand-vs.-generic-drug comparison [“Pricey drugs may not be better” Jan. 17]. Another important one is Lipitor, a wealth-enhancement medication for Pfizer. Its patent years are over, so a big effort is underway to persuade patients and doctors to stick with it, instead of switching to its chemically equivalent generic.
A related issue, little known even to physicians, is that the FDA does not compare newly patented drugs with older similar ones. All that the new drug needs to get on the market is to perform better than placebo. This arrangement has more to do with politics and economics than with science, health and consumer protection. Most of the new, expensive drugs in my specialty, psychiatry, are no better at relieving depression and/or anxiety than older generics. And until a drug has been in use for several years, its long-term side-effect record has not been determined.
E. James Lieberman, MD, Potomac
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