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To the Editor. —I agree with Dr Westermeyer 1 that Hughes et al 2 and Baldwin et al 3 "have provided a valuable service" through their research on substance use among medical students and residents, but I am very disturbed by the focus of his editorial. It appears that Westermeyer has joined other Americans in ascribing the cause of impaired physicians (and pilots, ship captains, etc) to their use of illicit or improperly obtained drugs. The results of the studies he reviewed suggest otherwise. In both studies, alcohol is the most frequently used substance, with over 80% of all respondents reporting alcohol use. The survey of residents included questions on daily use and found that, except for marijuana and amphetamine use, where only 0.3% and 0.1% of respondents reported daily use, none of the other categories of illicit or prescribed drugs included daily users. In contrast, 5.0% of alcohol users

One hundred fifty consecutive, first-visit, general medical patients were simply and inexpensively screened by questionnaire, personal inquiry, and physical examination for drug and alcohol abuse. Seventeen (11.3%) currently used psychoactive drugs, excluding alcohol, and ten (6.7%) used drugs or alcohol on a daily basis to the point that the patient considered it an abuse problem. The majority of the drug and alcohol users recognized their problem on a short questionnaire that was part of a medical intake form. Almost all of the recognized abusers of drugs or alcohol subsequently entered treatment of their problem. ( JAMA 242:533-535, 1979)

To the Editor.— Readers of your recent editorial on a possible alcohol benefit to geriatric patients (226:779, 1973) or of the recent abstract on a possible protective effect of alcohol on a myocardial infarction ( Circulation 48 [suppl 4]:94, 1973) may be interested in the following data from the Miami Sudden Cardiac Death Study. In a series of 118 consecutive casesof sudden cardiac death, retrospective interviews identified 40 patients as "substantial" or "heavy" alcohol users and 78 patients as drinking little or no alcoholic beverages regularly. In all 118, autopsies were performed under identical protocol by the Chief Medical Examiner for Dade County, Fla, or by deputies under his supervision. The two groups (users and nonusers) were then compared for the presence of chronic coronary artery stenosis (Table 1) and for the presence of acute heart vessel or muscle damage (Table 2). Although the numbers in each cell are not