Prescription Drug Extortion

Your article on the cost of AZT {Cover Story, Sept. 15}, which I consider extortion, reminded me of how I felt recently when I went to purchase Ceclor, a commonly prescribed pediatric antibiotic. The cost was $45.

I paid it, of course, but I wondered what I would have done had it been a cold winter day and I'd had three kids at home, not too much food in the refrigerator and had to choose between buying the medicine and paying my heating bill. Would I have told the clerk I'd be back in a few minutes and gone home empty-handed? A lot of parents must, because the pharmacist didn't add the water to the medicine until after she told me the price and I had assured her I was going to pay for it. Would I have walked out on the street and begged for enough money to pay for it, or grabbed someone else's purse?

I am offended by the price I am forced to pay for this medication. But if i couldn't pay for it, I'd feel hurt and humiliated and furious.

How can a country as rich as ours ask parents to choose between heating the house their kids live in or risking a busted eardrum? Medicaid does not eliminate the problem. Many poor families are not covered -- especially if the parents work, especially if both parents live with the children.

I believe this kind of social policy costs us all dearly. It breeds alienation, desperation, anger and fear among those in need and the rest of us who share their cities and schools.

Let the government tax the profits of the drug companies enough to pay for the drugs for all who need them. Surely they can afford it. In August, they spent over $3 million fighting drug coverage for Medicare beneficiaries. Better yet, let the whole industry be a public utility, since it serves such a vital public need.

Barbara Berney

Washington

Therapy and Trust (Cont'd)

"Can Your Therapist Be Trusted" {Medical Ethics, Oct. 13} gives short shrift to the viewpoint that secrets should be kept and confidentiality respected absolutely, even by marital and family therapists. Why conduct individual sessions with spouses if the privacy privilege cannot be upheld?

Yes, it is difficult to compartmentalize information, to be a couples or family therapist while helping individuals to assert, protect and enjoy their rights. But this is a challenge worth meeting. I understand that some family therapists prefer to avoid the problem by refusing to meet with individuals or subgroups. But I do not understand the willingness of some to meet with individuals, to invite sharing what is most difficult, and then to insist that the matter be disclosed to the spouse. Of course, improved communication is a prominent goal of therapy, but ventilation or unburdening of secrets is not always therapeutic. Unfortunately, some therapists believe that all secrets are pathological, a view that leads at times to the purging of one soul at the expense of another.

Spouses can be seen individually by a therapist who also sees them as a couple. The ground rules must be clear. I think confidences should be kept. The therapist can support disclosures, but the responsibility must never be taken away from the client. If the therapist feels something is going on that is incompatible with couples therapy -- an ongoing affair, or dishonesty about finances or drug habits, for example -- then the marital sessions can be suspended until the individual problem is resolved. This is not a simple matter, but doctor-patient privilege is such an important element in helping that I hate to see it abrogated, whether by carelessness or misguided therapeutic zeal.

E. James Lieberman, MD

Washington

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