Pros and Cons of Bunion Surgery

Relief of pain is certainly a clear benefit of having bunions fixed {Cover, Aug. 7}. However, there are even more serious reasons for correcting bunions. When a bunion becomes progressively worse, the abnormal forces will eventually deform the entire foot, ie., hammertoes, neuromas or corns. More sobering, if the deformities progress and you develop diabetes or circulatory problems as you grow older, you may be predisposed to ulcerations, infections and even loss of limb. The benefits of having surgery to correct such foot conditions far outweigh the short-term expense and inconvenience of the surgery. Mark D. Sussman DPM The Wheaton Foot Center Wheaton "What risks?" asks the podiatrist in your article on bunions. Infections, osteomyelitis, mental anguish and the loss of ability to pursue physical activities. I was lured by a TV medical spot reporting on "walk in, walk out" surgery performed by a local podiatrist. Plagued with nausea all week, the sixth postoperative day I had pain, fever and uncontrollable shaking. Twelve weeks after the operation, I was admitted to the hospital with osteomyelitis, a bone infection. Six weeks of strong intravenous antibiotics resulted in serious side effects. Mary Garbacz Oakton

Other Answers to Rationing Care

As a paramedic and medical student, I am offended by the illustration {Cover, July 31} on rationing medical care. That image of slit-eyed, faceless, dour care providers offering the frowning patient a band-aid is oversimplified and inflammatory. Rationing health care is not a compromise of compassion, as you have shown it, but rather a realistic way to allocate appropriate care to the most people with limited resources. It is sad that our "gimme" society of ultimate consumerism wrongly assumes that if a service exists, all have an automatic right to it at any cost. Taking fiscal responsibility for our health care will undoubtedly involve tough choices, but your cold portrayal of health care workers offering nothing before a "wallet biopsy" is false and insulting. Andrew Kramer Silver Spring Medical technology -- "more and mightier machinery," as the writer put it -- does not run up our health care bill. Injudicious use of technology can and does. Appropriately used, technology can save money as well as lives. By blaming "machinery," you lend credence to the dangerously simplistic notion that all we have to do to control health care costs is to freeze technological advance. The harder but wiser course is for society to grapple with the ethical and financial issues surrounding the use of technology. The trend toward living wills, outcomes measurement and hospital ethics committees is encouraging evidence that this is beginning to happen. Ted R. Mannen Senior Vice President Policy and Communications Health Industry Manufacturers Association

Oops -- Mammograms in the Wrong Place

Your warning about shortcomings of mammograms, particularly their failure to catch cancer of the endometrium, was timely. The headline, however, also might have pointed out that mammograms are not very good at detecting brain tumors. Jay Cutler Bethesda

Editor's Note: Many readers wrote to advise us of the error in the headline {Letters, Aug. 7}.

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