The Controversy Continues

I found "Insuring Controversy" [Sept. 21] well-balanced and provocative. As a practicing surgeon, I would like to comment on some of the views espoused by those interviewed.

What was Art Caplan thinking when he said that it was "unethical to charge somebody for something that has nothing to do with services"? Medical litigation insurance has nothing to do with services? Hospitals will not allow you to practice medicine within their walls without it. It has everything to do with services, and every business in America has to have insurance to protect itself. The only difference is that they may (and do) pass the cost of rising insurance rates on the consumer.

Then there is Arthur Levin. He pulls the "rich guys" card to get sympathy from those who might earn less. "Here we have a privileged group of professionals making more money than most Americans ever dream of. . . ." Physicians are highly educated, highly trained and basically give up their lives in their twenties to pursue postgraduate medical training. We work extremely hard (nights, weekends, emergencies) and are expected to make life-and-death decisions in the heat of the moment. Can you give me one good reason why I shouldn't make more money than the average American?

We need to reframe the entire discourse here. Up until now, this has been known as the malpractice crisis. If it's a malpractice crisis, then it must be about bad medicine, right? Wrong. It's about litigation. There is no question that those who are injured by egregious errors must be given their day in court. However, the vast majority of suits against physicians are about unintended results, not bad medicine. I shall henceforth call it the medical litigation crisis.

Mark E. Artusio, MD

Frederick

I was shocked by the story. I have been a registered nurse for 34 years and a health care advocate/activist for as many. There are many bad doctors who should not be practicing, but the medical profession will not police its own. Doctors turn a blind eye to the errors and malpractice of their peers. The vast majority of cases are settled out of court with the stipulation that the patients and their families never discuss them. Therefore, the general public never learns about these bad docs.

I just relocated from a small town where a doctor who had at least three previous malpractice suits filed against him has never had to face his day in court. The most recent case involved a death and falsification of hospital records by the doctor and the hospital administrator. Because this case was settled out of court, no one in the small town really knows what happened. The hospital was considered a hot potato by the malpractice insurers; their premium went up and their coverage was bounced around by various companies.

Doctors are quick to blame the trial lawyers for skyrocketing health care costs while they rarely accept any responsibility for our health care meltdown.

Susan J. McKenney

Arlington

You glossed over the insurance companies' responsibility in the rise of malpractice insurance. I think that it would be interesting if someone pursued the opinions stated by those lawmakers and lawyer groups who oppose the caps on insurance payoffs because they say the premium increases are necessary because of the economy and losses by insurance companies. I think that it is time to stop insurance companies from controlling the medical health of this country.

Sheila H. Smith

Riverdale Park

Alcohol Advice Is Hard to Swallow

Sally Squires suggests alcoholic beverages as a source of magnesium in "Overfed, Undernourished" [Lean Plate Club, Sept. 21]. However, the physicians at Sloan-Kettering warn that alcohol use depletes vitamins and nutrients, and the presence of alcohol has been reported to hasten the breakdown of antioxidants in the blood, speeding their elimination from the body.

Also consider:

* Alcohol stimulates both urinary calcium and magnesium secretion.

* If you regularly consume alcohol, you may be at increased risk for magnesium deficiency.

* Alcohol is the most notorious cause of magnesium wasting, and the deficiency of magnesium is common, especially in the elderly.

* Magnesium deficiency has been associated with cardiomyopathy due to alcohol use, and low levels of magnesium can increase the susceptibility to many health problems, including irregular heartbeat.

What is needed is disclosure of all the studies, not only about prescription drugs but also the drug "alcohol," and not just selective reporting of "possible" positive effects.

June Russell

Charlottesville

No Geezers Here

Thank you for "Same Old Politics" [My Time, Sept. 21]. I am sick and tired of people waiting for us to die. I have the same brains now that I had when I was 20, but I'm a lot smarter now!

Pat Finnegan

Arlington

Great column! I'm 70 years old, work four days a week at an intellectually stimulating job, run, lift weights, bike, hike, dance, read, write, have romantic interests and look forward to new experiences and adventures for many years to come.

Yeah, I take three pills a day. Yeah, I had a heart attack and bypass surgery. But I am not defined by my pill intake! I am not a stereotype! I am not a geezer!

Ron Nessen

Washington

A Jester and Much More

"Mr. Don't-Fix-It" [Sept. 21] made me think I must be one of the lucky ones.

When I was diagnosed with stage 3 breast cancer two years ago, my husband of almost 40 years became my closest confidant, supporter, advocate and in-house jester. Having heard horror stories about the behavior of some men when faced with similar situations, I can only be eternally thankful that he is the kind of person who will go through the fire with me, always.

If there is anything good about cancer, it's discovering the true meaning of the phrase "in sickness and in health." And in this family, at least, there is nothing more important than maintaining one's sense of humor.

Judith Bradley

Bethesda