Correspondence
that was noted in the patients who were taking these drugs before the drugs can be included on a list of those that definitively cause megaloblastic anemia. We agree that zidovudine could cause a megaloblastic anemia since it is a thymidine analogue, but we did not include all such drugs on the list. Charles S. Hesdorffer, M.D. Veterans Affairs Medical Center Washington, DC charles.hesdorffer@va.gov
Dan L. Longo, M.D. Since publication of their article, the authors report no further potential conflict of interest.
1. Fuld H, Moorhouse EH. Observations on megaloblastic anaemias after primidone. Br Med J 1956;1:1021-3. 2. Palacios-Martinez D, Garcia-Alvarez JC, Montero-Santamaria N, Villar-Ruiz OP, Ruiz-Garcia A, Diaz-Alonso RA. Macrocytic anemia and thrombocytopenia induced by orlistat. Int J Endocrinol Metab 2013;11(4):e6721. 3. Robson HN, Lawrence JR. Megaloblastic anaemia induced by phenylbutazone. Br Med J 1959;2:475-7. 4. Mason JBI, Zimmerman J, Otradovec CL, Selhub J, Rosenberg IH. Chronic diuretic therapy with moderate doses of triamterene is not associated with folate deficiency. J Lab Clin Med 1991;117:365-9. 5. Allan RW. Myelodysplastic syndrome associated with chronic valproic acid therapy: a case report and review of the literature. Hematology 2007;12:493-6. DOI: 10.1056/NEJMc1515180
Cost of Smoking among Homeless Adults To the Editor: Three quarters of homeless adults smoke cigarettes.1 The substantial health consequences of tobacco use among homeless people have been documented,2 but less is known about the financial effects of tobacco use in this population. From April through July 2014, we used time– location sampling3 to survey homeless adult
cigarette smokers at five high-volume clinics operated by the Boston Health Care for the Homeless Program in an emergency shelter, a daytime drop-in center, and an academic medical center. Among 357 eligible persons, 306 (86%) participated. We asked participants how much money they had spent on tobacco in the previous week, examined overall expenditures
Table 1. Tobacco Expenditures, Income, and Subsistence Difficulties among Homeless Smokers.* Characteristic
Nicotine Dependence† All (N = 306)
Low (N = 109)
Medium (N = 86)
High (N = 96)
P Value‡
that was noted in the patients who were taking these drugs before the drugs can be included on a list of those that definitively cause megaloblastic anemia. We agree that zidovudine could cause a megaloblastic anemia since it is a thymidine analogue, but we did not include all such drugs on the list. Charles S. Hesdorffer, M.D. Veterans Affairs Medical Center Washington, DC charles.hesdorffer@va.gov
Dan L. Longo, M.D. Since publication of their article, the authors report no further potential conflict of interest.
1. Fuld H, Moorhouse EH. Observations on megaloblastic anaemias after primidone. Br Med J 1956;1:1021-3. 2. Palacios-Martinez D, Garcia-Alvarez JC, Montero-Santamaria N, Villar-Ruiz OP, Ruiz-Garcia A, Diaz-Alonso RA. Macrocytic anemia and thrombocytopenia induced by orlistat. Int J Endocrinol Metab 2013;11(4):e6721. 3. Robson HN, Lawrence JR. Megaloblastic anaemia induced by phenylbutazone. Br Med J 1959;2:475-7. 4. Mason JBI, Zimmerman J, Otradovec CL, Selhub J, Rosenberg IH. Chronic diuretic therapy with moderate doses of triamterene is not associated with folate deficiency. J Lab Clin Med 1991;117:365-9. 5. Allan RW. Myelodysplastic syndrome associated with chronic valproic acid therapy: a case report and review of the literature. Hematology 2007;12:493-6. DOI: 10.1056/NEJMc1515180
Cost of Smoking among Homeless Adults To the Editor: Three quarters of homeless adults smoke cigarettes.1 The substantial health consequences of tobacco use among homeless people have been documented,2 but less is known about the financial effects of tobacco use in this population. From April through July 2014, we used time– location sampling3 to survey homeless adult
cigarette smokers at five high-volume clinics operated by the Boston Health Care for the Homeless Program in an emergency shelter, a daytime drop-in center, and an academic medical center. Among 357 eligible persons, 306 (86%) participated. We asked participants how much money they had spent on tobacco in the previous week, examined overall expenditures
Table 1. Tobacco Expenditures, Income, and Subsistence Difficulties among Homeless Smokers.* Characteristic
Nicotine Dependence† All (N = 306)
Low (N = 109)
Medium (N = 86)
High (N = 96)
P Value‡
