LETTERS

Cut costs? Not when women expect perfection

In the May issue, Dr. Bruce Ettinger recommends that we avoid rushing to bone-preserving or enhancing drugs for low-risk women (Update on Menopause: “Curb your enthusiasm—no need to rush bone drugs if risk is low”). He notes that there is an extremely high cost per fracture avoided when treating women in their 50s to prevent osteoporosis. He goes on to recommend that we “give healthy women in their 50s permission not to take drugs if their risk of fracture within the next 5 to 10 years is low.”

I believe the issue here is “beneficence” versus perfection. For example, in the field of obstetrics, we must achieve 100% success with every delivery or risk being sued. While Dr. Ettinger is giving permission to this particular subgroup of women to avoid medical therapy to reduce their fracture risk, I am interested in what their attorneys would have to say if a fracture occurred. Certainly, informed consent is critical here, as are risks and benefits. But we live in a society that expects 100% perfect outcomes all the time.