Tuesday, June 10, 2008; HE02

Freaking Out About Dancing

Every week, a new article ["Two Types of Dirty Dancing," June 3] appears with a new negative sexual trend: teenage girls giving oral sex to be popular or because they don't want to be seen naked; marriage counselors increasingly report that they hear women regret having a threesome; sex tapes seemingly everywhere; high school and college girls making out with each other for money or free beer from leering guys; and women attending shows to learn new "tips" from porn stars.

I don't think this is the equality that the feminist movement was fighting to get.

When it's just accepted that men and women all should love strip clubs and porn, there may be a problem. Is this due to America's conflicted views on sex? Europe isn't this screwed up, is it?

Rob Stein

Springfield

When I was a GWU student in the early 1940s, excessive drinking was rare [" 'Scary' Drinking Behavior Rises at GWU," June 3]. At that time, an exacting curriculum, particularly in the sciences, did not permit binge drinking, nor did living at home (most students were local) encourage such behavior. Today there may be more knowledge to absorb than when I attended school, but there seems to be less desire from students to do so. Instead, for many, college is for partying and socializing.

Nelson Marans

Silver Spring

One year ago this month, I experienced a torn retina, which is a tear in the retina without a retinal detachment ["Now You See, Now You Don't," June 3]. While I was walking home from work, I saw a flash of light in my right eye, followed by a storm of floaters.

I read years ago that such symptoms require immediate care, so I went to an eye doctor within a couple of hours. The doctor referred me to a retina specialist, who treated my tear with a laser first thing the next morning. My vision is completely normal now.

My strong advice to anyone who experiences a sudden rash of floaters is to get to an ophthalmologist right away.

Sally G. Jackson

Martinsburg, W.Va.

In "The High Price of a Medical Miracle" [May 27], the writer, Darshak Sanghavi, is worried that by identifying high-cost regions and hospitals, the Dartmouth study will trigger cost-cutting measures that will result in patients with rare, expensive but potentially curable conditions not getting the health care they need.

I edited the 2008 Dartmouth Atlas, and the research focused only on Medicare recipients with incurable, chronic illness. In these cases, the physician is often fairly certain that the patient won't live much longer, but there is a medical gray zone where the doctor must decide how intensively to treat -- could extra ICU time or additional consults with specialists buy a few more months of a comfortable life?

Dartmouth researchers and others have generally found chronically ill patients in high-cost regions of the United States don't live any longer (and probably live more uncomfortably) than their counterparts in the low-cost regions.

The U.S. health-care system will never go bankrupt providing valuable lifesaving treatments to appropriate patients with curable conditions. Far from suggesting that the nation save money by denying such patients needed care, the Dartmouth research says we can cut spending and simultaneously improve the poor quality of our health care -- without rationing.

Shannon Brownlee

Schwartz Senior Fellow

New America Foundation

Annapolis

Darshak Sanghavi responds:

Ms. Brownlee suggests we can save money and improve health care by, for example, reducing ICU time or additional consults for patients in the "medical gray zone." But the problem in the "gray zone" is that no one knows what might work. As in my patient's case, it's not always easy telling which treatments are "valuable," which patients are "appropriate" and what conditions are "curable."

Selectively denying access to treatments deemed reasonable by a doctor is, after all, rationing. It may be inevitable, but let's not pretend there's no downside.