I enjoyed reading "How to Recognize the Best Doctors" {The Patient's Advocate, Feb. 2} in reference to the book by Dr. Phil R. Manning and Lois DeBakey, "Preserving the Passion." There is no question that medical competence is paramount for a successful therapeutic result.

The moral qualities stressed in the article, and in the late Dr. J. Arnold Bargen's warm reception of his very sick patient at the Mayo Clinic, have an equal value in the patient-doctor equation. These qualities are the fruit of a combination of inborn traits, family environment and extramedical education. This last condition requires, especially, the exposure to humanities which, unfortunately, the demands of our profession make it difficult to attain.

However, every physician should make an effort to get involved in other interests: literature, arts, music or any other

intellectual or social activity. The perspective that this type of cultivation of the mind affords to the physician results in a better understanding of the patient as a human being. More than four decades ago, I learned from one of my teachers the following words that condense the primordial role of the moral values in the practice of medicine: "The quality of a doctor depends on the kind of man that is underneath, because at the moment of the supreme decision, the man will prevail." Obviously, Professor Escardo from Buenos Aires, Argentina, had also in mind the female physicians who were practicing the profession.

Hector Bensimon, MD


Treating Cancer, Dashing Hopes

Patients and physicians alike want the best in medical care, and any interruption in flow of genuine technologic advance to the patients' bedside is lamentable. However, your Feb. 9 article, "Some Die Needlessly of Cancer, Says Study," and perhaps also the General Accounting Office, in addressing this problem mix all kinds of vegetables into a succotash that unnecessarily heightens the anxieties and concerns of affected patients and families.

The hyped headlines of "Needlessly Dying" and "Second-Rate Care?" are neither constructive nor fair, and when it is reported that only 6 percent of patients with one of the most major cancer sites, colorectal, receive first-rate care, one becomes a bit more concerned with the carrier of news than the news itself.

In the mid-1970s it was fashionable to treat certain categories of colon cancer with adjuvant 5-Fluorouracil chemotheraphy after initial surgery, but results were never impressive and only the most meager statistical trends were observed. Finally, there was consensus that such therapy was not generally warranted. The GAO report is dated in 1985, and at that time the situation had not materially changed. However, since that time there have been at least two significant studies that purport to show benefit, each using at least one agent that is still investigational. To my knowledge, neither study has been published in a peer review journal or been confirmed or accepted in the world oncologic community. Colorectal cancer has been frustratingly resistant to major advance, and the implication that everybody (94 percent) with the disease is getting second-rate care is unfair.

I would take a priori issue with the contention that patients in therapeutic trials are guaranteed state-of-the-art therapy or better. If such were the case, there would be no point in therapeutic trials. Indeed, a trial, properly designed, asks the question, "Is treatment B better than treatment A?" The answer is not always yes, and the literature is both full of incremental and even breakthrough advances, as well as studies that have shown a new treatment to be inferior to an old one.

There are a few things more important than pushing ahead with trials of treatment on the cutting edge of many diseases with rapid deployment of proven advances for the benefit of all. To freeze one time frame in this complex and evolving continuum, juggle the numbers and derive sensational conclusions is not constructive.

Charles P. Duvall, MD


Anyone Can Say 'YAG'

Robin Marantz Henig's article, "Cautiously, Gynecologists Turn to the Laser" {Women's Health, Feb. 10}, did a fine job of portraying the expanding medical applications of lasers. Her technical description of how a Nd:YAG laser emits light, unfortunately, fell prey to the slang so commonly used in the field for referring to it.

In a Nd:YAG laser, the YAG component is an yttrium aluminum garnet crystal, which merely serves as the host for the lasing element. The YAG is not the lasing element from which the light is derived, as stated in the article. In this case, the neodymium serves as the lasing element and actually performs the stimulated emission that produces the amplified light output.

If one were to stick to convention, a "YAG" laser would more correctly be called a neodymium laser. But can you say neodymium three times fast?

Kevin J. Gillis

Abell, Md.

Ethics: An Important Debate

The Medical Society of the District of Columbia compliments and thanks you for the Jan. 26 issue devoted to bioethics. You are to be commended for bringing these very timely and difficult topics to the attention of our community. You are providing an education the public needs in order to be involved in many decisions to be made in the care of our patients.

John J. Lynch, MD

Chairman, Bioethics Committee

Medical Society of the District of Columbia

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