Dr. Schernhammer Replies

To the Editor: My associates and I appreciate the additional background information conveyed by Dr. Gold and colleagues. Although presenting data on physician suicide rates by medical specialty was beyond the scope of our analysis, we undoubtedly welcome their invitation for more research.

Generally, men tend to successfully commit suicide more often than women, whereas suicide attempts among women are higher than those of men. It is possible, however, that women physicians more successfully commit suicide than do women outside of the medical profession. Among U.S. medical students, the observed suicide rate of female students equaled that of the male students (although they were still three to four times higher than those of their age mates), indicating a relative scarcity of attempted suicides in that profession (1).

That access to drugs can support higher suicide rates has long been shown: for example, in Australia, an increase in suicides by women coincided with the implementation of a law that facilitated access to barbiturates (2). Therefore, it appears likely that higher suicide rates among physicians, who tend to prefer methods that are typical for their profession (3), may be coupled with both their easier access to drugs, as well as their better know-how concerning the successful use of such methods. The interesting proposal by Dr. Gold et al. of unintended secondhand environmental exposure to drugs as a risk factor for drug addiction and possibly suicide among anesthesiologists adds another layer of complexity and warrants further investigation.