BAREFOOT & PREGNANT
Regarding Ayelish McGarvey’s July 18/25 “Plan B for Plan B“: There is precedent for the FDA switching a prescription drug to an over-the-counter one but with age, and even location, restrictions. In the mid-1990s, it approved Nicorette and NicoDerm smoking-cessation products for use without a prescription only for smokers over 18. (Presumably, if you were 18 or under you still needed a doctor’s prescription.) In addition, the FDA said the products could be sold only in retail locations where there was a pharmacist–therefore not in convenience stores, the number-one outlet for cigarettes. Certainly reinforces the political aspect of a “scientific” decision.
Skidaway Island, Ga.
Congratulations on facilitating the resignation of David Hager from the advisory panel of the FDA. This evangelical physician has done harm to the cause of women’s health, as pointed out in your May 30 and July 18/25 issues. The American College of Ob/Gyns and other groups tried, but you got it done!
STEVE GORDON, MD
THE PANDEMIC LOOMS
Stony Brook, NY
Mike Davis’s July 18/25 “Avian Flu: A State of Unreadiness” rightly focuses attention on the emerging danger of an avian flu pandemic. One challenge that he could have emphasized more, however, is the difficulty that scientists have in monitoring flu dynamics within Southeast Asia because of the manner in which samples are analyzed. The international research community has emphasized the processing and analysis of samples at labs in Europe, Japan and the United States, rather than within the countries most affected by avian flu. Little effort has been made to develop scientific capacity within these countries, with the result that analyses are delayed and questions can arise because of contamination and confusion during international shipping.
As Jeremy Farrar, director of the Wellcome Trust Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, says in a recent issue of the journal Nature, “The international community continues to suggest that countries ship samples out somewhere else, while doing absolutely nothing to invest in enhancing the scientific capacity of the Vietnamese to respond to the epidemics themselves.” Such investment is essential both for more accurate analyses and more rapid responses. The US and international health communities should press for more support to develop capacity in these countries. A key in addressing infectious disease threats is rapid response to the correct problem in the right location. Improved scientific and medical capacity within the countries most affected will help give us that key.