I took a deep breath and composed myself before entering the hospital room. I was a third-year medical student and preparing myself to deliver bad news. I was well aware that I had never done this before. He had a resident, an attending physician, and a lung specialist all caring for him, but I was the one who saw him three or four times a day. I was the one who spent the most time with him, and I felt that I should deliver the news.

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The following letter was written in response to the article by Dr. Thomas Marzili, entitled “What’s Going to Happen to Brave Surgeons and Patients?”

Dear Dr. Marzili, I just read your essay in the April Pharmacy and Therapeutics. I enjoyed the article. As a surgeon who is often asked to take on such difficult cases, I can tell you the decision-making process is never easy.

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The key unanswered question about the proposed rule by the Food and Drug Administration (FDA), which would require bar codes to be placed on drugs that are sold to hospitals, has nothing to do with the pharmaceutical industry. To paraphrase Bill Clinton: “It’s the hospitals, stupid!” Pharmaceutical manufacturers can add bar codes to their products to a fare-thee-well, but if the hospitals do not purchase the expensive scanners needed to read those bar codes, the whole effort to reduce medication errors will be for naught.

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Realizing that health care prokviders must gather information, analyze it, and share the results with others in order to learn from medical errors, the House of Representatives passed the Patient Safety and Quality Improvement Act (H.R.663). The Act encourages providers to conduct research and gather data about the causes of medical mishaps and then share their findings with other providers in order to learn ways to remedy systems and practices.

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By now, most P&T readers are familiar with the clinical efficacy of the low-molecular-weight (LMW) heparins. Indeed, these new compounds are being prescribed in many settings—from acute coronary syndrome to the prevention and therapy of deep venous thrombosis (DVT). LMW heparins are being given in the outpatient setting through supervised programs coupled with intensive patient education. I think it is fair to say that the LMW heparins have created a true “paradigm shift” for the therapy of DVT. There is also mounting evidence of their cost-effectiveness, and most P&T committees have readily put these compounds on the formulary.

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Several obstacles to vaccination have been identified, not the least of which is the uncertainty surrounding the potential threat of a deliberate release of the smallpox virus. The risk of such an exposure is presumed to be low, but the population at risk cannot be estimated should an exposure occur. As a result, the ACIP and HICPAC, acting on the directive from the President, have devised recommendations for each acute-care hospital to identify groups of health care workers who could be vaccinated so that they would be able to respond to an exposure. These recommendations must be put into the context of the likelihood of exposure for each acute-care setting and the resources available, either within that center or as a coordinated effort among centers where no single institution might have all essential personnel.

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On December 13, 2002, President Bush announced the National Smallpox Immunization Plan (NSIP) to immunize health care workers who might have to respond to patients affected by an outbreak of smallpox. This plan is designed to help local and state authorities in planning and preparedness by providing vaccine to approximately 500,000 individuals. This program is voluntary and is structured to provide a cadre of first responders in the event of the return of smallpox as a health threat. Not since the end of the compulsory smallpox vaccination campaign in 1972 has the general public been offered this vaccine. As of May 9, 2003, a total of 36,217 civilian health care workers had been vacci-nated.

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