I'm a pharmacy student in my 3rd year of the PharmD program, and today I presented a clinical seminar for school entitled, "Is Rosiglitazone (Avandia) Safe for Use in Cardiovascularly-Compromised Patients?" I think that the object of each physician should be to CLOSELY monitor patients who possess a necessity for a TZD, for potential adverse cardiac outcomes. Pharmacists are more readily accessible to the patient and are more able to identify and address important monitoring parameters, chiefly increased weight gain. The severity of this, in turn, can be relayed back to the PCP by the pharmacist, facilitating a feedback system that may help assign the patient the need for more frequent follow-up appointments with the PCP to assess the potential for adverse cardiac outcomes. PCPs should be aware that we as pharmacists are aware of the issues and parameters that should be magnified in practice, and that we're here to help and guide to the best treatment efficacy for the patient.

Alex, Athens, Georgia

If regulators only focused on whether there was a risk of heart attack, there would be no drugs to treat diabetes.

According to oficial US statistics (2005), 20.8 million people—7 percent of the population—have diabetes.

Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. According to death certificate reports, diabetes contributed to a total of 224,092 deaths.

Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.

To deprive patents access to Avandia and other similar drugs would be irresponsible.

Chris Johnson, London,

I am amazed that a drugs manufacturer can issue a drug with side effects which can cause heart failure/heart attacks. Avandia should be withdrawn from the market. Is this a case of Money rules, the patient comes second.

D Fowler, Chalfont St. Peter, Buckinghamshire U.K.