Living Wills

The Health section's treatment of the right-to-die issue {Focus, July 3} contained a discussion of Maryland law that needs clarification. The sentence, "Maryland has a specific document that may be used to grant a medical power of attorney" is a bit misleading, for it suggests that a particular form is legally required. Unlike a living will, there is no prescribed form for a durable power of attorney for health care in Maryland.

However, the Maryland attorney general's office is making available a suggested form, developed by the Health Law Section of the Maryland Bar Association, which most people can fill out without the need to see a lawyer. To obtain this form, Maryland residents may write: Attorney General's Office, Opinions Section, 200 St. Paul Place, Baltimore, Md. 21202. Jack Schwartz Chief Counsel Opinions and Advice Office of the Attorney General Baltimore

Animals and Alzheimer's

As a physician and researcher, I am saddened and deeply concerned by Neal Barnard's attempt to confuse the public about animal research in the unsolved mystery of Alzheimer's disease {Letters, July 3}. Barnard, like many other single-minded animal activists, wants to deny all of us the potential medical benefits of compassionate animal research because of his moral objections to the use of animals for human needs. The fact is that we do not know what causes Alzheimer's disease, and we are not even close to a cure. It just does not make good sense to cut off valuable lines of investigation even before we have narrowed the list of suspects.

Computer models and cell-culture technology are often suggested as alternatives to animal research, but computers cannot take doses of new medicines, and isolated cells in culture cannot participate in memory experiments the way that animals can. Barnard cites the recent discovery of abnormal plaques in the brains of Alzheimer's patients. He should realize that to go from this important discovery to potentially beneficial medicines for Alzheimer's victims, animal research will be absolutely necessary.

We must not let a vocal minority fool us into thinking that animal research is not very important in the fight to cure Alzheimer's disease. Rather than eliminating animal research, we need to better integrate the existing basic science techniques in both animal and human studies. Trey Sunderland, MD Chief, Unit on Alzheimer's Disease National Institute of Mental Health

Treating Mental Disorders

Abbey Strauss states that primary care physicians should not treat psychiatric problems {Forum, June 26}. Unfortunately, the reality is that there are not enough psychiatrists in the United States -- much less in the economically depressed area in which I practice -- to treat all of the psychiatric problems that I see in my practice. This nation has shown an unwillingness to commit resources to providing even the most basic health care, such as prenatal care, to its people, so I see no reason to think that resources will be forthcoming to increase the supply of psychiatrists in my area or anywhere else. Therefore, I will of necessity continue to diagnose and treat psychiatric problems in my practice to the best of my ability. When a problem comes along that does not respond to treatment or is beyond my expertise, I will do my best to refer that patient to the woefully overworked local mental health clinic, or the local psychiatrists, whose rates, while really very reasonable, are out of reach of most of my patients. Jeremy C. Klein, MD Salem, W.Va.

Violence Against Therapists

Congratulations to Sally Squires for a well-balanced and sensitive article on tragic assaults on mental health professionals by their patients {Psychology, July 3}.

As the article pointed out, the vast majority of mental patients are not violent. Violence is most likely to occur when patients do not have access to appropriate mental health services and treatment. Charles R. Harman Director of Public Relations National Alliance for the Mentally Ill

The "Unsurance" Dilemma

Your story on cases when health insurance won't pay {Cover, June 26} ended by citing appeals for a national government health insurance system. However, aside from high-risk pools, other possible remedies were not considered. And the negative aspects that have plagued socialized medicine systems, such as long delays for treatment and less use of modern technology, were not discussed.

One remedy would be to have a catastrophic medical plan for children starting at birth, with coverage guaranteed until age 21 regardless of any accidents or illness, with payments unaffected by costs of treatment. This could become part of standard insurance plans. Such coverage would prevent the tragic financial burden of childhood cancer described in the article. Fred E. Foldvary Alexandria

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