Talking About Incontinence

In "When You Gotta Go" [Sept. 14], Jennifer Huget bravely brings to light the hush-hush mentality many Americans associate with incontinence. As the executive director of a not-for-profit consumer advocacy organization dedicated to educating people with bladder control problems, I applaud her for sharing her personal story and encouraging readers with symptoms to seek medical attention.

To help men and women with involuntary leakage of urine understand the condition and initiate a dialogue about appropriate management options and treatments, we have developed a bladder health self-assessment tool. I encourage your readers to access this tool online by visiting www.nafc.org.

Nancy Muller

Executive Director,

National Association For Continence

Charleston, S.C.

Drugs or surgery are inappropriate first-line treatments for incontinence. The most effective, safest and cost-effective therapies for treating urinary incontinence are pelvic floor muscle exercises, biofeedback and/or behavioral therapies (also called bladder retraining).

Many randomized controlled trials have demonstrated the effectiveness of these therapies in diverse populations, including homebound elders, women who have just given birth and female soldiers with exercise-induced incontinence. These therapies work for both stress incontinence and urge incontinence and, in a direct comparison, biofeedback-assisted behavioral therapy was superior to the most popular drug treatment.

Additionally, the belief that estrogen helps incontinence, although popular among physicians, is a myth. Randomized controlled trials consistently show no benefit of estrogen over placebo.

Adriane Fugh-Berman, MD

Associate Professor,

Department of Physiology and Biophysics

School of Medicine

Georgetown University

Washington

Disorderly Conduct

I am very disappointed in the irresponsibility of "No, That's Sick" [Sept. 14], your article on pro-eating-disorder Web sites. Perhaps it was meant as a warning to parents or doctors about the existence of these sites. Instead, you advertised specific sites, with names, screen shots and quotes. I can guarantee that every Web site mentioned in the article is enjoying a surge in membership today.

Why not balance things out by mentioned recovery-oriented Web sites that include online support? The National Association of Anorexia Nervosa and Associated Disorders (ANAD) site has bulletin boards as well as weekly support groups nationwide. They can be contacted at www.anad.org or 847-831-3438. (ANAD also happens to be the organization that persuaded America Online to stop hosting pro-eating-disorder Web sites.)

Other online support groups include www.paysonroad.org and www.something-fishy.org. Something Fishy has members all over the world and very strict guidelines that prevent anyone from posting tips and weight-loss goals.

Millie Plotkin

Silver Spring

Malpractice Rates: Who's to Blame?

I was very disappointed in "Maryland: A Red State?" [The System, Sept. 7]. It was difficult to really find out what was happening.

Apparently Jeannette Akhter didn't quit primarily for insurance costs, so why was she a main focus of the article? She has apparently had two claims in the last 29 years if she gets the current third one dropped. That doesn't seem to be a surge of frivolous lawsuits, but it's difficult to say since you don't give us that information. What was the basis of the suits? How much was paid out, if any? How many babies does she deliver each year? If she is paying $75,000 to $85,000 per year for insurance with two claims in 29 years -- implied by your article since those are the only figures given -- I think it makes the case for those who say that it's primarily an insurance company problem and not primarily related to malpractice. For the Capital Women's Care group, how many physicians are involved? How many suits have they been involved in and what was paid out? With 7,000 deliveries, it would seem that they could self-insure if they have confidence in their people and they haven't had major payouts.

We need better and more complete information in order to make good decisions about what needs to happen. I don't think your article contributed to a better understanding of the problem.

Raymond E. Meyer

Falls Church

Bile Aside, Thanks for Noticing

Thank you for the positive reviews of "The Proper Care and Feeding of Husbands" and "Woman Power" in "All the Queen's Men" [Sept. 14]. I wonder, though, whether it would be possible for a feminist to review my work without the vitriolic, hate-filled, mean-spirited personal attack on me? It just might be an interesting assignment.

Laura Schlessinger

Sherman Oaks, Calif.