Diagnosis Remains an Art

"Matters of Life and Death" [Cover Story, November 16] portrayed better than any television series many unspoken but nearly universal truths about the practice of medicine in today's world. Despite the comforting illusion that advanced technology has elevated medical diagnosis to an exact science, the fact remains that it is still an art, and an extremely capricious one at that. Unfortunately, in an era where "physician productivity" is rewarded while physician "receptivity" is punished, the gentle arts of watching and listening for tiny clues and hints (hallmarks of the great diagnosticians in medicine's history) are among the earliest casualties.

The same time pressures that lead patients to seek immediate access to care for minor complaints, and tempt caregivers to acquiesce to demands for a "quick fix" such as antibiotics when none are indicated, compound the inadequacy and inappropriateness of care that resulted in the near-death of the anaphylactic patient whose case was discussed in the story.

It is not surprising that the author now writes about those experiences: Perhaps sharing these frustrations is therapeutic for him. It certainly is validating for his colleagues.

Louise B. Andrew, MD

Millersville

Low-Carb Diets: Magic or Myth?

"Eat Fat, Get Thin?" [Cover Story, November 23] gives one example of an unfortunate side effect of a low-carbohydrate diet. A woman developed a serious bowel problem from a diet nearly devoid of fiber. But not all low-carb diets allow so little carbohydrate as the Atkins diet.

I have been on the Protein Power diet for six weeks. Phase I of the "intervention" part of this diet allows 30 grams of carbohydrates per day. I "spent" my 30 grams each day on a large salad, a portion of fruit and whole grain crackers. This is probably more fiber per day than was contained in my former diet, which was crammed with refined carbohydrates. I have since moved on to Phase II and am now eating 40 to 50 grams of carbohydrates per day.

Too many dieters fail to read the book. They never know or heed the cautions given by the authors. I do drink eight glasses of water each day. I do take a potassium supplement. I do keep a food log and measure food portions. And the diet has worked for me.

I have lost 25 pounds in six weeks. My fasting blood cholesterol has dropped from over 220 to 185. I don't need snacks, and I don't go into a feeding frenzy when I get home from work.

No diet is "one-size-fits-all" magic. It is unfortunate that your article may discourage this group from trying the low-carb approach.

My doctor is helping me keep watch for possible problems. Meanwhile, she has congratulated me on this success after my years of failure at weight loss and cholesterol level control.

S.E. Hopkins

Davidsonville

* If Dr. Atkins has truly discovered a diet that leads to permanent weight loss while promoting health, he would have won the Nobel Prize by now for solving the extremely complex medical problem of obesity.

Americans who believe in the Atkins diet should ask themselves this: How come every professional health or nutrition-related agency--including the American Heart Association, American Cancer Society, American Diabetes Association and the National Institutes of Health--recommends a low-fat, high-carbohydrate diet rich in fruits, vegetables and whole grains? What possible incentive could these agencies have in promoting a diet that, according to Atkins, is harmful because it causes obesity?

The truth is that hundreds of studies exist showing that a carbohydrate-rich "pyramid-type" diet that is rich in fiber and antioxidants has numerous health benefits and can lead to weight loss if one eats moderate portions. In contrast, the high-protein diet gurus have never published a single study or produced any credible evidence (testimonials don't count) showing that their diets are safe and effective.

People following the Atkins Diet will be shortchanging themselves of many key nutrients found in carbohydrate-rich foods, and therefore will be at increased risk of heart disease, cancer and other diet-related chronic diseases.

Mark A. Kantor, PhD

Associate Professor and Extension Specialist

University of Maryland

Department of Nutrition and Food Science

College Park

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