Letters

Its not that I have a thing against baldness, but more that this seems like a trend on your cover, and not necessarily an attractive one given the extreme right-wing predisposition to skinheads, the noted drug addiction of Dr. Freud, and Mr. Welsh's novels, which explore drug culture.

Regarding Mr. Kramer's Internet-based AIDS activism project, potential participants beware. Public discussion of one's personal medical history for use in selecting medication regimes is at best of questionable value and at worst dangerous, and may lead to insurance discrimination or harmful treatments. While gathering information on an electronic database may provide some useful anecdotal evidence, in no way will it replace a properly executed clinical trial. AIDS activists are right to involve themselves in the medical process, but unmonitored dissemination of Internet hearsay is no substitute for a controlled, scientific study when it comes to making informed medical decisions.

Kevin O'driscoll, Ph.D.
Columbia University

Mark Schoofs replies: Driscoll sounds valid caveats about the HIV treatment database project, all of which were covered in my story. Nobody thinks the project will replace controlled trials, but with proper design and enough patient participation, many scientists believe the database could yield important information. To quote veteran AIDS researcher Anthony Fauci, "It's worth a try."


Quantum Leap

I enjoyed Mark Schoofs's "Freud in the Age of Prozac." Like the wave/particle duality in quantum mechanics, where light can be considered both a wave and a particle, there are seemingly contradictory and complementary points of view on the mechanism of consciousness.

The brain is certainly full of myriad chemicals, but so are ordinary cells. Yet we have never created a cell from scratch--restarting the flame of life that was sparked over one billion years ago. It is our arrogance that believes we can so easily understand, philosophically or scientifically, the mysteries of our existence.

We abuse the medical miracles that give us deeper insights into--and some relief from--psychological problems with our "pill" mentality. We risk upsetting the delicate chemical balance of the brain irreversibly. Neither psychotherapy nor drug remedies can solve all of our psychological problems; they can only offer the potential to help people cope with their problems.

Michael Pravica
Yonkers


Mythtaken

In Tom Carson's review of my documentary The Farmer's Wife ["Soap of the Earth," September 22], he writes of me: "...he's out to swell their story to the stature of myth--a glowing echt-Americana epic, with editing that lingers importantly over every gorgeous sunset that Darrel drives his tractor through and lardings of fake Copland soaring away on the soundtrack. While the director may believe that he's honoring the Buschkoetters, these embellishments falsify their experience as much as sticking them in The Real World's swank digs would."

And speaking of digs, for the record, the "lardings of fake Copland" Carson writes about are on the promos, commercials, and wrap-arounds for The Farmer's Wife, all of which were done for Frontline--it's not music from The Farmer's Wife .

The Farmer's Wife has about six hours of original music, written and performed by the legendary guitar hero Reeves Gabrels, who was recently asked to render his "lardings" on the Rolling Stones single, "Out of Control."

David Sutherland
Boston, Massachusetts


Handle With Care

Sharon Lerner's HMO Watch column, documenting the inequities in managed care, is long overdue. As a former utilization-management nurse, I believe that national health insurance is the only fair solution to America's health care dilemma. Unfortunately, Lerner doesn't seem to have done her homework.

In the article Damaged Care" [October 13], which accompanied her first column, Lerner wrote that the "infamous gatekeepers" are not physicians. This is false. Managed-care gatekeepers are the subscribers' primary-care physicians. Lerner was referring to utilization-management nurses who process authorization requests from primary-care physicians for follow-up and specialist care, and who evaluate requests by applying criteria developed by participating physicians.

In Lerner's HMO Watch column headlined "Numbers Game" [October 20], she focused on a couple's attempt to get Oxford Health Plans to pay for home health care, which was not covered in their plan. Finding fault with Oxford for not covering the couple's request for in-home care is like someone who bought a car without air-conditioning for a midsummer drive through Death Valley blaming Ford for heat stroke.

Health care is too important to leave to the vagaries of the marketplace, but badly needed critiques of the status quo fail when driven by ignorance. Neither utilization- management personnel nor their employers are the problem as much as the public's fear of change.

Andrew Katz
Brooklyn

Sharon Lerner replies: In legal language, gatekeeper usually does mean the primary-care physician. However, in common parlance the term is widely used to refer to any managed-care employee who makes decisions about patient care. As for the comparison with heat stroke, the couple's dispute with Oxford is about the terms of their policy. Oxford told the Voice that their policy didn't include at-home care. However, in the past, the company has acknowledged that their coverage included at-home nursing care--then questioned the medical necessity of that care. Even so, you raise a good point: choice of policy is crucial. Unfortunately for the couple discussed in the column, that choice was made by an employer.

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