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(Circulation. 2001;103:e128.)
© 2001 American Heart Association, Inc.

Correspondence

Cigarette Smoking: How Much Worse Can It Get?

David S. David, MD, FACP

2222 Santa Monica Boulevard, Suite 302, Santa Monica, CA 90404

To the Editor:

I was delighted to read Dr Califf’s recent editorial.¹ What made it so special wasn’t just the scientific part of the editorial, but Dr Califf’s discussion of the equally important (if not most important) ingredient that transforms an ordinary, or even an extraordinary, individual with an MD degree into a physician, and this is the humanity and ethics of medicine.

Dr Califf is absolutely correct when he points out the inhumane attitude of some MDs toward the ordinary human frailties of many of our patients. This is a new phenomenon, where doctors blame the patients for their ills and seriously consider not treating them. The patients who suffer the most from this attitude are the socioeconomically deprived members of our society (the elderly, minorities, and the poor).² Having a patient choose between spending limited funds at a fast food place for high-calorie sustaining meals for themselves or their children or paying for expensive medication is a no-contest choice.^{3 4} For someone to call such patients noncompliant and berate them is an inhumane act. Such an act is grossly immoral and cruel by any healthcare provider, especially one with an MD degree.

References

1. Califf RM. Cigarette smoking: how much worse can it get? Circulation. 2000;102:1340–1341.[Free Full Text]
   
2. Rathore SS, Berger AK, Weinfurt KP, et al. Race, sex, poverty and the medical treatment of acute myocardial infarction in the elderly. Circulation. 2000;102:642–648.[Abstract/Free Full Text]
   
3. Kasiske BL, Cohen D, Lucey MR, et al. Payment of immunosuppression after organ transplantation. JAMA. 2000;283.2445–2450.
   
4. Baker DW, Shapiro MF, Schur CL. Health insurance and access to care for symptomatic conditions. Arch Intern Med. 2000;160:1269–1274.[Abstract/Free Full Text]
   

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