Let us follow this reason to it’s logical conclusion. Then nobody taking any benzo’s should be driving. People taking sedating H1 blockers (benedryl), should not be driving, people with diabetes on insulin should not be driving, people who have taken sleeping pills the night before should not be driving (just in case). People taking anitnausea meds should not bedriving. People taking ANY medications which include somnolence should not be driving. Should people be warned of medication side effects yes. Should a person with widly metatstatic cancer on 100 mg oxycontin BID be driving…probably not. But there is a huge difference between that patient and somebody taking an occ. percocet. To make an assinine blanket statement like “DO YOU MAKE SURE THAT PATIENTS YOU PRESCRIBE OPIOIDS DO NOT DRIVE? is idiocy at it’s worst. But this is america where there is no longer personal responsibility. When in doubt find an attorney.

I wrote you an explanation of what I believe are the standards for opioid prescribing, as related to some questions you asked about practice habits.

I am not going to start reviewing auto accident cases you forward to me or point out to me on websites.

If you read my answer you should clearly be aware that proper prescribing should not be a contraindication to driving.

If you don`t agree – that is your right.

I believe what you originally conveyed to me was hearsay. You told me that in your state some representative of a medical malpractice carrier told you that there were accidents and they were related to overprescribing opioids and now the auto insurers were mounting a lawsuit against the doctors. All that may be factual – but your impression – or anyone else’s as to your statements, or your medical malpractice friend’s impression, and all of those allegations apparently are not, as yet, proven.

Why don`t you wait til this case is over and, at that time, present a review of the findings.

Until that time comes, I don`t have any other opinion about these circumstances.I`m trying to be nice and helpful to you.

Next time you address any questions to me-put your name on the communication.Provide the name of this ‘ representative’ you speak of – otherwise I`m not interested in debating this with you.

You asked questions about what basis I used to prescribe. Without knowing who you are I answered your questions faithfully and truthfully-according to scientific opioid prescribing facts-which are proven. If you are trying to tell me that there are doctors who prescribed opioids and those opioids caused an accident- thats not my problem, and it never will be-trust me.

If I can help in some other way-I will.Best wishes in resolving this issue.

Dr. Mangino

None of my patients have ever filed a lawsuit against me.

Sorry to hear that some doctors in your state are being litigated against.

When patients take opioids, as directed, they should not be impaired by those dosages.

This means that the doctor is knowledgeable enough to prescribe these medicaions in the proper manner – and the patient adheres to taking the medication as prescribed.

There is no bona-fide medical reason why patients who take these medications should have any problems driving that would not have been caused by other factors, such as the concomitant use of other drugs or alcohol at the time of those accidents you refer to.

The information you provided to me is “Triple Hearsay.”

You were told that somebody said that somebody did something which involved yet even another person.

Maybe it would be good if you asked your family doctor if he prohibits patients taking insulin from driving – based on the rare and unlikely chance that too much insulin had sent these patients into a hypoglycemic spell-causing a car accident.

Thank you for your inquiry into my practice habits. Hopefully this reply will clarify the issues and dispell any concerns of yours that anyone might even try to mount a successful lawsuit against me.

William Mangino MD

Are you referring to the epidemiologic study by Dr. Sherine Gabriel of the Mayo Clinic in New England Journal of Medicine on whether breast implants increase the risk of certain diseases and symptoms .It was supported by Plastic Surgery Educational Foundation and by a grant from the National Institutes of Health. Where Dow-Corning comes into the picture? The link is here.

http://content.nejm.org/cgi/content/full/330/24/1697

Nonsense. That number is about 5 times Merck’s annual PROFIT, based on last quarter’s profit of $1.5 billion.

These cases will likely take a decade. Which means that based on this quarter’s earnings, Merck will make about $60 billion in that time. If they pay $10 billion out for Vioxx, then they will still have $50 billion in profit – that’s profit, not operating expense (including the expense of developing new drugs).

If you’re going to use scare tactics, at least use the known numbers correctly. That $50 billion estimate was pulled out of thin air, but even using that, Merck still made $10 billion in profit over that time. If you’re going to try and generate sympathy with made up numbers regardless of Merck’s liability, at least use numbers that don’t end up with Merck still making $10 billion.

As for Dow Corning, the only studies that have been done which claim the breast implant litigation was “junk science” were funded by Dow Corning.

“The pharmaceutical industry will be going to China next.”

OK, if you say so. I imagine they can’t wait to go somewhere where patent protection is virtually nil.