Breast Cancer and Politics

Thank you for Sandy Rovner's excellent piece, "Battling Over Breast Cancer Studies" {Healthtalk, Sept. 29}. As her article so clearly showed, behind-the-scenes politicking and infighting is as common in the medical establishment as it is in the government.

Critics of the Women's Health Trial, which examines the link between breast cancer and dietary fat, claim it would be difficult, if not impossible, to determine whether or not women participating in the study truly were cutting their dietary fat as a percentage of total calorie intake from the current 40 percent average to the recommended 20 percent. They say such a diet would be too difficult and complicated to maintain for any length of time. If the response our organization has received for our dietary fat/breast cancer brochures is any indication, however, women are extremely willing to learn to make these changes. So far, more than 2,000 Washington Post readers have requested copies from a recent mention of its availability.

While the National Cancer Institute "encourages" the public to consume less fat, it may cancel the Women's Health Trial.

In the last 10 years, despite enormous spending on treatment, there has been barely a 5 percent increase in the five-year survival rates of women diagnosed with breast cancer. (It still hovers at about 50 percent.) The NCI has pledged publicly to increase this rate to 75 percent by the year 2000. How the NCI plans to achieve this feat, with no treatments anywhere near ready to be launched -- and while canceling innovative studies such as the Women's Health Trial -- is an important question.

Victoria Leonard Executive Director, National Women's Health Network Washington

Confidentiality at Risk

Any therapist who says that "nothing leaves the therapy room" and participates in third-party reimbursement for his or her services is not telling the whole truth {Medical Ethics, Oct. 13}. When a psychotherapy client uses health insurance to pay for therapy, several events occur that the public should be aware of: The relationship between therapist and client is no longer private. The therapist ceases to be a sole agent of the client and becomes an agent of the health insurance company. The client is stigmatized by a diagnosis of questionable medical validity. The information provided to the health insurance company may be impossible for the client to trace.

What are we to make of the following statement by a chairman of committees on confidentiality of both the American Psychiatric Association and the American Psychoanalytic Association before a government commission on the protection of privacy: "It is common knowledge that promising young corporate executives dare not take advantage of insurance coverage for psychotherapy lest their employers stigmatize them for having a disorder of mental health and arrest their careers"?

While there are certainly many therapists who can be trusted, the consumer should realize that whenever a third party enters into the therapeutic relationship, confidentiality is at risk.

Jeffrey A. Schaler

Silver Spring

Facing Abortion

Thank you for printing "The Politics of Abortion," for as a high-school student your cover story {Sept. 8} has helped me understand current policies on abortion.

Politics should have nothing to do with abortion, but unfortunately it does. As the Alan Guttmacher Institute states, "Most women who decide to have an abortion do so after great pain, usually great thought, not happily, and in consultation with several people." I'm glad that someone realizes that it's not just a choice of wearing red or blue.

Cathy Zaranis

Bethesda

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