Letters.

First, Do an Exam

I have great respect for Dr. David A. Grimes, but I am somewhat concerned about his recent guest editorial "No Strings Attached?" (Oct. 15, 2002, p. 6).

Although it may appear to him that women are required to get Pap smears before prescriptions will be renewed, what is really required is a good faith examination. Imagine all the lawsuits that will follow for bad outcomes if medications are prescribed without an exam. If a patient declines a Pap smear, I simply note in the chart that she declined and that I informed her of the possibility that she could get cancer of the cervix that would go undetected.

But we must evaluate any patient before any medicine is given. We must review historical data and do an exam. I don't really think anyone believes that Pap results have anything to do with contraceptive safety.

As to the fact that Dr. Grimes personally performed "hundreds and hundreds" of terminations on women "trapped into a pregnancy because we health care providers held them hostage," I doubt that they were all due to not having birth control pills. I don't doubt that these pregnancies occurred, but to say that we caused them is too much.

Doesn't anyone have responsibility for her or his own actions?

Has anyone not heard of condoms or contraceptive creams, jellies, film, and suppositories? Isn't it patronizing to believe that a woman doesn't have the intelligence to use an alternative if birth control pills are not available? I know the pill is the most reliable of the methods mentioned, but we didn't cause the unintended pregnancy.