Forgiveness essential to healing profession
Regarding "New laws let doctors say 'I'm sorry' " (Article, Aug. 21) and "Broadening the role of forgiveness in medicine" (Article, Aug. 21):
Your articles on forgiveness in medicine will find a responsive chord in many readers. As sentient and compassionate beings, physicians have longed for permission to express sympathy for and to patients who experience suboptimal outcomes regardless of any contribution the health care system might have made to that outcome. Yet we have too often been prohibited by fear that our empathy will contribute to a case against ourselves or our colleagues.
There is another piece to the litigation aspect of this story. I teach physicians who have experienced malpractice litigation that, in addition to forgiving ourselves for any part our own behavior may have played in the initiation of a lawsuit, it is also ultimately necessary to forgive the patient-plaintiff. This is prerequisite to the healing that must occur within us if we are to continue to provide care and compassion after being wounded by the prevailing tort system in this country. Forgiving these "others" is even more difficult than forgiving ourselves, but it is essential in order to experience and practice in our own lives the art of healing we profess.
--Louise B. Andrew, MD Millersville, Md.
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The gut has a "powerful role in influencing systemic health"
Regarding "Autism could have bacterial connection" (Article, Aug. 14):
This article raises an intriguing connection between gut microbial balance and cognitive and behavioral function in a subset of children with autism. Certainly this link represents a significant, promising avenue for further research and raises the potential for related clinical interventions.
Readers should be aware, though, that the relationship between gastrointestinal function and autism, as well as other cognitive/learning disorders, has been implicated in several previous studies, and that these physiological connections are not simply the random "hunch" of a concerned housewife-mother, as the AMNews article implies (although the mother's persistence in pursuing this possible etiology in relation to her son's condition should be applauded).
Digestive abnormalities have been reported in many children with autism, with GI symptoms often corresponding to autistic symptom severity. One study found 43% of autistic children exhibited impaired intestinal permeability (compared with none in the healthy control group). Increased intestinal permeability has been linked to increased translocation of bacteria and harmful bacterial products through the gut barrier's paracellular tight junctions, causing increased passage of potential neurotoxins into the systemic circulation.
The gut's powerful role in influencing systemic health, including psychological and physiological function, has far-ranging repercussions in the etiology of a wide array of diverse conditions. Testing for these digestive and bacterial imbalances and understanding these relationships promises to yield exciting new clinical interventions that may enable us to better prevent and treat these disabling conditions.
--Myron B. Lezak, MD Asheville, N.C.
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Don't trust HMO group's offer
Regarding "HMO coalition claims proposal will lessen doctors' red tape" (Article, Aug. 7):
The HMO coalition's promise to improve relations with patients and physicians is analogous to the fox letting the chickens out of the coop for a bit of fresh air and exercise.
--David Lubin, MD Tampa, Fla.
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Don't ignore a request for hormone therapy simply because it is the patient who requests it
Regarding "Testosterone therapy hype may be creating false hopes" (Article, Aug. 7):
While one does not wish to practice at the sole direction of patient demands, it would seem silly to shun a therapy that may indeed be of value simply because a patient requests it.
For years we have practiced hormone replacement therapy for the naturally declining hormonal levels of female menopause. Why would treating the sagging hormone levels of our male population be viewed so differently?
The fact that low testosterone is a natural occurrence of aging is not a reason to ignore it, or any other ravages of aging. Testosterone replacement, just as estrogen replacement, has risks and benefits. It is the physician's responsibility to provide information and quality monitoring.
--Richard Silverman, MD Houston
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