Clinic Article Failed to Pass the Test

At a time when 45 million of our citizens are uninsured and many more are under-insured, The Post decides to run "A Physical Escape" [Oct. 5], about how the very wealthy find new ways to spend their money. The independently appointed United States Preventive Services Task Force has reviewed many of the tests Nicklin is so proud to have received at the Greenbrier Clinic. The task force graded them a D, meaning that the harm outweighs the benefit for asymptomatic individuals.

When I took the Hippocratic oath I don't remember the part about doing as many tests as possible for cash on healthy individuals at resorts, so as to find benign conditions that generate more tests, anxiety and costs, all the while knowing that the tests may do more harm than good. At a time when many of us suffer from real diseases, when drug prices continue to escalate and our inner cities have third world health statistics, I would presume The Post also has some oath to provide better researched, balanced and critical reporting.

Dan Merenstein, MD

Washington

Secrecy Helps Fuel Malpractice Crisis

In his response [Interactions, Sept. 28] to "Insuring Controversy," Dr. Mark Artusio writes that the current malpractice premiums crisis is not about bad medicine. "It's about litigation," Artusio states. It's actually about information. Specifically, the lack of information about physicians' work history that is available to the public.

Artusio, like most physicians speaking out on this subject, neglects to mention the role that physicians themselves, through the American Medical Association (AMA), have played in raising malpractice insurance premiums.

The Department of Health and Human Services maintains a National Practitioners Data Bank (NPDB) that includes malpractice claims payments and out-of-court settlements made on behalf of individual doctors. The NPDB allows hospitals and medical boards (but, tellingly, not doctors) access to that information. Congress, however, under pressure from the AMA, forbids public access to those records. Under such a shroud of secrecy, state medical boards have been woefully lax in disciplining errant doctors. Some states, Maryland included, allow limited access to information on doctors' backgrounds.

Even attorneys cannot access the NPDB, unless -- and here is the kicker -- the attorney is requesting access as part of a malpractice lawsuit. So by their secrecy, doctors invite malpractice actions as a patient's only recourse for getting needed information.

Any reforms addressing the medical malpractice issue must include public access to the NPDB. Only a small percentage of physicians accounts for the majority of medical errors and malpractice actions. So secrecy is unnecessary. And unfortunate, because that secrecy has engendered enough distrust to drive a wedge between patients and their doctors. It is into that gap in the doctor-patient relationship that HMOs, insurance companies, third-party administrators -- and attorneys -- have inserted themselves, to the detriment of both patients and doctors.

Mike McLaughlin

Laurel

Junk Food and the Ads That Promote It

It was telling to read in "Overfed, Undernourished" [Lean Plate Club, Sept. 21] that the chairwoman of the Dietary Guidelines Scientific Advisory Committee, Janet King, was "surprised" that Americans could be so overfed and still be short on key nutrients. She further expounded about being appalled that in the land of plenty so many people make the wrong food choices.

Clearly she hasn't watched too much TV of late, read a paper, driven around town listening to the radio while noting the advertising billboards. If she got out into the real world that we live in, she might be equally surprised to see how heavily we are bombarded by every make, shape and form of processed food!

For King to be surprised about the lack of healthy diet in America speaks volumes on her ignorance of the relentless messages we receive in the media. If junk food had similar advertising bans as we have imposed on hard liquor and tobacco, well, maybe that'd be a start!

John P. Gaffigan

Fairfax Station

Smart Companies Seek Out Older Workers

I would add a dimension to "Breaking Through the Silver Ceiling" [My Time, Sept. 28]. Senior Employment Resources (SER) is a nonprofit organization in Northern Virginia that counsels clients over 50 years old who are seeking full- or part-time employment.

In the 21 years of our experience, overwhelmingly, small businesses have responded to our solicitations for job opportunities for seniors. Small business people in all areas of endeavor recognize the reliability, savvy, experience and judgment that are common in older workers.

"Necessity is the mother of invention" is a saying endemic to large corporations. Most large organizations were affected by the need for Y2K program patches at the end of the last decade, and they looked to the programmers with the necessary experience, namely those retirees who had written the programs decades before. Currently, health service organizations are leading the way in dealing with the nurse shortage by trying to extend the careers of retiring nurses, if only for part-time work. Hopefully, large corporations will look more commonly to the older and retired sector for their non-emergency needs.

M. Susan Allan

Executive Director

Senior Employment Resources

Annandale

Painless Protection for the Heart

After reading "Cut Off at the Bypass" [Sept. 28] comparing heart bypass surgery vs. angioplasty, and my own experience, I am convinced that stress tests and angiograms should be a routine preventive procedure.

Although an EKG has been part of every annual physical, it wasn't until I changed internists -- at age 85 -- that my first-ever stress test led to an angiogram and subsequent angioplasty with stents. Although I never had a symptom of heart disease or unhealthy cholesterol levels -- eat sensibly and exercise -- two arteries were 90 percent blocked.

My cardiologist explained that 30 percent of these procedures are on patients who never had a symptom. Although getting something stuck in your groin and snaked up to your heart sounds scary, cardiac catheterizaton is painless, with practically no discomfort. I heartily recommend it.

Irving Andrusia

North Bethesda