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Previous Volume 354:1322-1323 March 23, 2006 Number 12 Next

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To the Editor: With regard to the letter by Dr. April (Oct. 6 issue),¹ in reference to a Perspective article by Topol on the overuse of nesiritide for congestive heart failure (July 14 issue)²: Dr. April claims that the current president of the American College of Rheumatology (ACR), along with an unnamed past president, encouraged the use of intravenous office infusion of infliximab (Remicade) over other treatments, such as self-injected medications, "as a way to offset poor reimbursement for patient care." We are writing to respond to Dr. April's unfounded statements.

The issue of access to medications for the treatment of rheumatoid arthritis and other autoimmune diseases came into focus with the development of new biologic treatments that are administered only by self-injection or as intravenous infusions. At the time that these treatments were introduced, Medicare did not cover self-injected medications, which forced many patients to choose infusions administered in hospitals or in physicians' offices. Since 2002, the ACR has advocated that patients should have access to all approved therapies for rheumatic disease and that decisions about which treatment is most appropriate should be made by patients and their physicians. The ACR has also clearly stated that rheumatologists should be compensated for the work that they do and not for the drugs that they choose. We believe that the only factor that should influence a physician's decision regarding which medication to prescribe is the best interest of the patient.

The ACR leadership, including the current president (Dr. Tindall), fought for the inclusion of self-injectable medications in the 2003 Medicare Replacement Drug Demonstration Project and worked hard to encourage rheumatologists to help their patients participate in this project. As of October 7, 2005, 40,239 patients were enrolled, with coverage for self-injected medications, including 14,337 patients with rheumatoid arthritis. Neither the ACR nor its president has ever encouraged physicians to favor office infusions over other treatments for rheumatic diseases.

Elizabeth A. Tindall, M.D.
Oregon Health and Science University
Portland, OR 97224

David A. Fox, M.D.
University of Michigan Medical Center
Ann Arbor, MI 48109

Dr. Tindall reports having served as an investigator for Amgen, Bristol-Myers Squibb, Genentech, and Abbott. Dr. Fox reports having received a research grant from Genentech, and his institution has received educational grants from Abbott, Amgen, Centocor, and Wyeth.

References

1. April PA. Nesiritide -- not verified. N Engl J Med 2005;353:1525-1527. [Free Full Text]
2. Topol EJ. Nesiritide -- not verified. N Engl J Med 2005;353:113-116. [Free Full Text]

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Related Letters:

Nesiritide — Not Verified
Sackner-Bernstein J., Aaronson K. D., Schreiner G., April P. A., Topol E. J.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1525-1527, Oct 6, 2005. Correspondence

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