An Uneven Split

"Split Decision" [Oct. 19], on surgery choices for early-stage breast cancer, contains inaccuracies that warrant correcting. It did not recognize several very prominent partners, such as the Agency for Healthcare Research and Quality (AHRQ), the Offices of Women's Health at the National Cancer Institute and the Department of Health and Human Services and the Office of Research on Women's Health at NIH. The FDA was also very involved in the review and editing of content related to reconstruction and breast implants.

The headline on page F5, "Brochure Aims to Sell More Women on Lumpectomy," touts a bias toward lumpectomy. In fact, however, the brochure was developed and tested to be an unbiased resource for women needing to make an informed decision that accounts for their own specific concerns.

Partners started with a document written at the 12th grade level that resulted from an AHRQ-sponsored scientific forum on the issue. Through the partnership, an easy-to-read brochure was developed and pilot-tested with women across the country to assure comprehension, neutrality, and usefulness in making such a critical treatment decision. This resource can be found on the Internet at http://cancer.gov/cancertopics/breast-cancer-surgery-choices and is also accessible to women who contact the Cancer Information Service at 1-800-4CANCER.

Rosaly Correa-De-Araujo,

Agency for Healthcare Research and Quality

Mary Grady,

Agency for Healthcare Research and Quality

Lenora Johnson,

National Cancer Institute

Wanda Jones,

Department of Health and Human Services

Anna Levy,

National Cancer Institute

Vivian Pinn,

National Institutes of Health

Diana Zuckerman,

National Research Center

for Women & Families

"For Some Lumpectomy Patients, a More Convenient Treatment" [Oct. 19], which accompanied "Split Decision," did not mention several important considerations. First, the Mammosite device was FDA approved only as a "boost" or extra, focused treatment. It was not approved for use as a first line radiation treatment for breast cancer. Second, and perhaps more importantly, there are no long-term data regarding efficacy. Only short-term toxicity data are available. Essentially, we don't know if it works as well as the standard external beam treatment, only that it won't substantially cause harm to the patient. Third, it is the most expensive radiation treatment available with the least clinical outcome data.

As breast cancer diagnosis and treatment sub-specialists, we strongly encourage eligible patients considering the Mammosite treatment option to participate in a controlled national clinical trial, opening in early 2005. This study is designed to evaluate the long-term outcome of patients treated with this and other partial breast treatments.

Irene Gage, MD

Colette Magnant, MD

Rebecca Zuurbier, MD

The Sibley Center for Breast Health

Washington

Coffee Addiction? Don't Swallow It

Americans are already subjected to enough conflicting health advice without hearing bogus claims that caffeine is an addictive drug ["Starbuckless Syndrome?" Oct. 12]. I experience baseball "withdrawal" symptoms every October, but Post-World-Series-Disorder shouldn't be a recognized medical condition.

Roland Griffiths, the researcher responsible for this assault on common sense, isn't exactly a reliable source. The director of the U.S. National Institute on Drug Abuse has already rebutted his claim that caffeine is a psychoactive drug. And Griffiths's earlier caffeine "addiction" study involved just seven human subjects -- including himself and a family member.

His latest research also ignores a well-regarded 1999 study that demonstrated that one to three cups of coffee per day has no effect on the region of the brain responsible for addiction.

If the definition of addiction continues to be stretched to its breaking point, it won't be long before our children need prescription drugs to break their peanut-butter-sandwich habits.

David Martosko

Director of Research

Center for Consumer Freedom

Washington

A Lesson Learned, but Too Late for Boinger

In "The Silence of the Bunnies" [Oct. 19], Dan Stark correctly noted that he "missed something" in Horton's and Boinger's lives and deaths.

Although he was tangentially aware that what Native Americans call animal medicine surrounded him, he failed to grasp what his 7-year-old daughter knew intuitively. Animals are teachers, value their lives, and are deserving of the same love and protection given to humans. Housing rabbits outdoors often ends in this type of tragedy no matter how "charming" the hutch.

As Stark pointed out, domestic rabbits "are ill-equipped to live in the wild," yet he failed to provide the kind of protection of his rabbits that the guardian contract between humans and their companion animals demands.

That Stark hadn't "particularly loved the bunnies" is obvious. Stating that he did not want "to draw a comparison between human and animal deaths," he did just that when considering his own mortality. The rabbits taught him to see, but the lesson came at the very high price of the rabbits' lives. Hopefully, their deaths have not been in vain and he will continue to keep his eyes open.

Lana Lehr

Managing Director

RabbitWise Inc.

Kensington

The Shin Bone's Connected to . . .

I was surprised to read "there is little you can do besides running and walking" to avoid shin splints. My trainer told me of an exercise that she has used for years. Sit in a chair with your feet flat on the ground. Lay a lightweight dumbbell across your foot, at the base of the toes. Keeping your heel on the floor, raise the front of your foot slowly (otherwise the weight will slip off). Start with light weights, and work your way up -- it doesn't take much weight to make this an effective exercise. You can definitely feel the muscle working during this exercise. You can do this while you're reading the paper in the morning, or at your desk at work.

Another thing Lynn told me: Stop doing those calf raises. You'll overwhelm your shins.

I have started to jog on the treadmill, and was concerned about shin splints, since I've had them in the past. But since beginning this exercise I've not had any problems.

Katie Shea

Gaithersburg