By Doctors have let us down
Dr. Epstein’s essay (Other Voices, June 26) deserves a response. The deplorable condition of health care and the predicament that doctors face are no doubt described accurately enough, but where are the solutions?
See, doctor, this is where you and your AMA colleagues have failed us. We always counted on you, and long ago, as a block, you should have been standing up to the HMO/insurance onslaught for us. Instead, a certain number (maybe a tiny minority) of your colleagues were getting into profitable sideline provider businesses and developing HMOs themselves, and maybe the AMA didn’t feel like rocking that boat. So now the HMO/insurance company monster is fully grown and, as you imply, outranks and envelops you and your colleagues.
We have always thought of doctors as heroes and always trusted you to keep us healthy. However, without solutions, your article translates into a general whine. I would rather have seen suggestions from you for health care coverage, prescription drug benefits or other such issues.
Even though Congress has made a mess of many things, they might do some good if only campaign finance reform could take the lobbyists’ power away. Perhaps then we could divorce health care insurance from employment and get a good single-payer program, maybe even some reasonable pharmaceutical prices.
Until then we have to muddle through, hoping that doctors continue practicing, like mine does, with dedication to patients and the high calling of the profession.
Marvin L. EmerlingLos Altos
Immigrants have never been welcomed
Bob Norton’s look at immigrant history (June 19) sounds like how it was taught at my high school - one-sided, surface-level facts without getting to the deeper truth. If we want to use history to frame this debate, we must look much more critically than Bob Norton does at immigration’s past.
Immigrants, including those “model” immigrants from Europe, have never been embraced with welcoming arms, and these challenges are most clear in their struggles for bilingual education. In 1837, the first bilingual public school in New York was established for German-speaking children. Italians also fought for their own schools but were denied in 1843.
The history of Italians in the United States is often compared with that of Latino immigrants today, due to the institutional racism they faced in schools. Italians were the lowest-performing students and many were labeled as retarded because of their trouble with English.
Germans were the most effective in getting their children to be taught in their language, but others were also successful. In Texas there were Czech language schools; in California there were Chinese as well as Indian, Mongolian and Japanese schools.
In San Francisco, public schools taught German, Italian and French immigrants in their own native tongues. Native language instruction was absent from 1920 until the mid-1960s only because of fierce anti-German and then anti-immigrant reaction after World War I and World War II. The racism against Europeans succeeded in banishing it from U.S. classrooms.
The objectives of those immigrants fighting for “special treatment” were the same as they are today: to preserve a fragment of ethnic identity in their children, to enable them to learn so that they could become contributing citizens.
This country was built by immigrants and continues to be maintained and moved forward because of the unending work of newly arrived communities. It’s time Norton and the rest of the country recognized immigrants for their efforts.
Elizabeth GonzalezEast San Jose
Clarifications on Syndrome X
I wish to thank Elizabeth Cloutman for covering my lecture on Syndrome X of insulin resistance, which was given on June 11 as one in a series of public lectures at the Palo Alto Medical Foundation. However, I do want to clarify a few statements.
The review states that some hormones affect only one organ, an example being thyroid hormone. In fact, thyroid hormone has effects throughout the body, whereas many of the hormones produced by the pituitary gland are seen chiefly or uniquely by one target tissue.
Regarding insulin, it is important to add that the driving force in this disorder is the resistance to insulin in fat, muscle and the liver. Thus, Syndrome X occurs because of both insulin resistance in some tissues and the compensatory increase in insulin production then seen to excess in others.
The review also says that individuals with Syndrome X develop high levels of LDL cholesterol. In fact, they develop unusually small, dense and dangerous LDL particles whose risk can be underestimated because LDL blood levels are often normal.
Another statement implies that a fasting blood test for an insulin level can diagnose Syndrome X if the level is high; unfortunately, this is often not the case. Levels can be normal in people with insulin resistance or mildly high without insulin resistance, from differences in the metabolism of insulin. The diagnosis of Syndrome X is made on the basis of a constellation of clinical and laboratory abnormalities.
Of greatest importance is the issue that patients with insulin resistance also use insulin-sensitizing drugs even if they have not yet developed Type 2 diabetes. The most important intervention is the safest and least expensive, and consists of a healthy diet, weight control and regular physical activity.
Randy Linde, M.D.
Palo Alto Medical Foundation
