Modern laboratory technology has spawned a plethora of techniques for measuring and monitoring drug concentrations and body constituents; but the availability and frequent over-use of these determinations, some of which are exotic and require specialized personnel and expensive apparatus have further escalated the already high cost of medical care in several ways. The specter of medical malpractice suits has compelled the physician to practice defensive medicine including ordering unnecessary monitoring procedures, particularly for drug levels. Further impetus has been superadded by the courts and state legislatures; for example, phenylketonuria (PKU) determinations are mandatory in almost all states. Court rulings have held that "common knowledge" not expert testimony, may be all that is necessary to hold the doctor culpable for not ordering a test; nor is expert testimony necessarily required if the Physicians Desk Reference (PDR) or drug company insert recommends that certain tests or monitoring procedures be performed and the doctor fails to comply. (PSRO) programs will force further conformity, leave less to the discretion of the physician and place the government in an ever more regulatory role. Professional societies should take cognizance of the impropriety and danger of the government dictating diagnosis and treatment and should launch a vigorous program to scrutinize pending regulatory legislation and to make official and informed representations to appropriate legislators.

Adult↗

PubMedDate not supplied

Neurological complications of drug abuse.

Widespread drug abuse, a comparatively recent medicosocial phenomenon, presents protean clinical patterns and challenging diagnostic problems daily that mimic classical medical syndromes. However, few reports have delineated predominantly neurologic syndromes associated with drug abuse. Five patients were observed illustrating the critical importance of considering drug abuse in the differential diagnosis of neurologic disease, particularly in the young population. It has been found that attention directed to four sources of information will substantiate the diagnosis of drug abuse in the large majority, thus expenditing the prompt initiation of appropriately directed treatment. In addition careful history and neurologic examination, a routine screeen of blood and urine should be run for barbiturates, bromides, alcohol and salicylates. An electroencephalogram is highly recommended as an initial study. It is informative, non-traumatic and inexpensive. Low voltage fast activity is consistent with drug effect and usually rules out other metabolic causes of coma. Other diagnostic principles are enumerated and illustrative cases are cited.

Adolescent↗