THE TRAJECTORY OF A PAINKILLER

To the Editor:

Re "Sales of Painkiller Grew Rapidly, but Success Brought a High Cost"
(front page, March 5), about Purdue Pharma's efforts to promote OxyContin
for the treatment of moderate to severe pain:

As a pain physician in private practice before joining Purdue Pharma, I was
visited by Purdue sales representatives, all of whom conducted themselves
in a professional manner and promoted OxyContin according to its approved
labeling. As an academician, I can say no other company has done more to
increase the understanding of pain.

Through discussions with medical examiners in several states, we have
confirmed that the vast majority of deaths attributed to OxyContin abuse
were in fact due to abuse of multiple drugs, often including alcohol.

The media frenzy about OxyContin abuse is interfering with good pain
management. In fighting drug abuse, we must not limit patients' access to
strong analgesics to manage pain and preserve quality of life.

J. DAVID HADDOX, M.D. Senior Medical Dir., Health Policy, Purdue Pharma
Norwalk, Conn., March 6, 2001

To the Editor:

Re "Sales of Painkiller Grew Rapidly, but Success Brought a High Cost"
(front page, March 5):

Undertreatment of pain affects many more people than the much smaller
numbers engaged in diversion for abuse purposes.

Underrecognition and undertreatment of pain is a major public health
problem. People with pain are at high risk for depression, dependency,
inability to work, other illnesses and even death. The excess focus on
risks distracts from the primary importance of the effective treatment of pain.

DIANE E. MEIER, M.D. New York, March 5, 2001

The writer is co-director of the Center to Advance Palliative Care, Mount
Sinai School of Medicine.

To the Editor:

Re "Sales of Painkiller Grew Rapidly, but Success Brought a High Cost"
(front page, March 5):

Of course pharmaceutical companies market their products by direct contact
with doctors. It works!

The real problem lies with the doctors who abrogate their responsibility
for continuing medical education. Many do not consult the great abundance
of objective information available to them. They prefer the easier, less
perfect path: take the samples, listen to the pitch, prescribe the drug.

ALFRED G. GILMAN, M.D. Dallas, March 5, 2001

The writer, a Nobel laureate, is chairman of the department of
pharmacology, University of Texas Southwestern Medical Center.

To the Editor:

Re "Sales of Painkiller Grew Rapidly, but Success Brought a High Cost"
(front page, March 5): The "high cost" that is the real theme of your
article is that doctors, medical schools and other medical institutions
still believe that they can accept "free" lunches and the like and not be
influenced by the drug companies' marketing agendas.

Perhaps it is time for influential medical institutions to take a stand and
stop accepting free lunches, free educational support and all the other
goodies that are accepted as "free." Or is that too much to ask of people
who have promoted the ubiquitous and harmful sale of $1 billion of a drug
that, while quite useful, represents a minor advance in the important field
of pain treatment?

BERTRAND M. BELL, M.D. Bronx, March 5, 2001

The writer is a professor of medicine, Albert Einstein College of Medicine.

To the Editor:

Re "Sales of Painkiller Grew Rapidly, but Success Brought a High Cost"
(front page, March 5): On several occasions, our efforts to educate
consumers and health care professionals about undertreatment of pain and
end-of-life care have been supported with small grants from Purdue Pharma.
Not once have any conditions been attached.

Based on the work that we do nationally, we are aware that Purdue has
provided similar support to many organizations across the country with the
common goal of improving care of the dying.

MYRA J. CHRISTOPHER Pres., Midwest Bioethics Center Kansas City, Mo., March
5, 2001