Second Opinions About Second Opinions

Paul Steinberg presents a very sensible, logical approach to life-and-death decisions in "Safety in Numbers" (Aug. 24), and I would hope my specialist would take the same approach if the occasion arises. But he also displays a professional naivete that can be aggravating for us commoners attempting to deal with the business end of the American health care industry. He partly understands this in pointing out that as a physician he has a "special capacity as an aggregator of diverse opinions" (in itself, classic in-group lingo).

What he seemingly fails to comprehend, however, is that it requires no more effort from him than picking up the phone to assimilate the opinions of "20 separate colleagues" and no expense at all. For those of us not allowed to consider physicians our "colleagues," no insurance plan is going to cover 19 second opinions, and even if it did, it would take months to get the appointments and undergo the examinations and tests.

Dr. Steinberg's approach is laudable. It would be even more laudable if it were practical for all of us.

Tim Carlton

Washington

Twelve years removed from a diagnosis of malignant melanoma and almost two years post-treatment (brachytherapy and direct beam radiation) for prostate cancer, I couldn't be more in agreement with Paul Steinberg that medical extremis is not a time to submerge one's ego, or to concede that some one individual knows better than you what's best for your body and soul.

At age 63, diagnosed with prostate cancer, my only medical knowledge of cancer treatment had come from coping with a malignant melanoma some 10 years before. That slim education, however, was more than enough to teach me that nothing was finite about cancer treatment, and that the solution(s) to my problem could come from just about any source.

I consulted every doctor possible, including national authorities on prostate surgery and radiation, and attended multiple meetings of prostate cancer support groups. I learned something from virtually every consult and encounter, but what most impressed me was the heartfelt encouragement and reaffirmation of my search I received from the cancer victims who were not experiencing success in their treatment. To a man, such individuals were unanimous in decrying their resort to the first doctor and treatment that came their way.

With multiple distinct and viable treatment options available, there can be no single answer to the various manifestations of prostate cancer, and no better opportunity for one to wield the powers of analysis and decision developed over a lifetime.

This is an article that should be read by every man diagnosed with prostate cancer.

All best wishes, Doc.

Doug Crowe

Occoquan

The article submits that the primary care physician should assume the role Steinberg played in seeking opinions on his own care, but how many primary care physicians are willing and able to do this kind of time-consuming research in the face of ever-decreasing compensation from Medicare and private insurers? Not many, I would submit!

Jay W. Kerpelman

Rockville

Dr. Steinberg was fortunate that he was able to access experts around the country simply by picking up the phone. For your average medical consumer, contacting a disease association or support group is how they learn about the disease and various treatment options, how they hear about doctors with a flair for a particular treatment and where they get clues about hot new ideas being researched. His suggestion to get many ideas from many sources is a perfect sales pitch for online support groups.

Sadly, if an average female medical consumer did this amount of research on her own disease, she would be at risk of being called overly concerned, hysterical or opinionated. If the medical problem she is researching is an illness in her child, she may be called overly involved, a hovering/helicopter mother, interfering or obnoxious.

Far too many mothers (no fathers) in our organization have even been accused of causing their child's illness simply because they are appropriately determined to be highly involved the medical decision-making. Several have had their children removed by social services and accused of Munchausen syndrome by proxy because a "high level of medical knowledge" and "seeking multiple opinions" are said to be prime signs of this bizarre form of medical child abuse.

The day medicine stops treating informed women as pushy will be the day we can finally bury Sigmund Freud and his theories that women make themselves and their children sick by worrying. Beth Anderson, director

Pediatric Adolescent Gastroesophageal

Reflux Association

Buckeystown

The High Price of Inactivity

"Fitness on the Job" [Aug. 17] stated that the case for employer involvement in health promotion isn't clear-cut in terms of the financial bottom line; however, Fifty-Plus Lifelong Fitness and Active Living Leadership see this differently. In fact, recently we revealed a new tool -- The Physical Inactivity Cost Calculator (at www.digitalwave.com/inactivity/coi.php) -- to help business and government leaders estimate the costs of a physically inactive employee base or community. Together, with more than 20 organizations, we developed this online calculator to answer the question we kept hearing: "Can you show me the cost benefits of supporting physical activity?"

Research studies show that a physically active lifestyle is key when it comes to disease prevention. So why is there a lack of data that proves employer fitness initiatives reduce health care costs? One reason is that our government doesn't place an emphasis on these studies.

Walter Bortz, MD

Palo Alto, Calif.

Dr. Bortz is the founder of Fifty-Plus Lifelong Fitness, past president of the American Geriatrics Society, co-chairman of the American Medical Association's Task Force on Aging, and Clinical Associate Professor of Medicine at Stanford University.

The Crime of Martha Stewart

You are expressing your own schadenfreude placing Martha Stewart in the middle of men such as Saddam, Kozlowski, Tyson, Limbaugh, Ebbers, etc.

Why do you so enjoy in raking her over the coals? I wish you could find another woman more criminally-worthy of comparison to these men. Martha Stewart's only crime is that she is a woman who has achieved being a successful businesswoman in the American macho world and is therefore perceived as a threat to their power.

Francine Duemmel

Warrenton