What’s New in the World of Medicine

' Fertility & Diet ': Readers of our 'Health for Life' package and cover story on how diet and exercise can help overcome infertility praised self-empowerment, calling medication a last resort. One said, "When we look to medical science to solve such problems as infertility, we avoid making real changes in our lives. Women have a twofold reward: better health and greater chance of natural conception." A doctor concurred. "[For instance,] osteoporosis is almost never found in those who maintain programs of resistance and exercise. Drugs aren't the primary answer."

On 'Is Photography Dead?': "Today's manipulation of images differs from earlier efforts in the tools used and the ease of working, but not conceptually. Saying the medium has 'lost its soul' is a recurring reaction in art. Change is healthy, even if you don't like it."
John Mills, Nashville, Ind.

Conceiving a Better Diet
I Read "Fats, Carbs and the Science of Conception" (Health For Life, Dec. 10) with great delight. You were wise to point out how diet affects ovulation and that male infertility will probably not benefit from dietary improvements. We in the fertility community have been telling patients to limit simple carbs for years. Our motto in Atlanta is "If it's white, it must take flight. If it's brown, it can go down." Unfortunately, the socialization of bad eating habits and the availability of fries and soda conspire to defeat our patients in their fertility quest—as many reject our suggestions as too disruptive to their day-to-day routines. Until we find a way to make fast food desirable and healthful, we are going to see continued growth in our waistlines and waiting lines to see fertility specialists.
Daniel Shapiro, M.D., Medical Director
Reproductive Biology Associates
Atlanta, Ga.

I read your cover story on fertility the week of my second miscarriage after my fourth attempt at in vitro fertilization. For the authors to imply that a woman can overcome a complicated disorder merely by changing her diet is misleading. There have been many diet books targeting infertile couples, and in desperation we try them. When the diet fails, we move on to the next overhyped book. Women with a serious ovulatory problem need a good reproductive endocrinologist, not just a different diet. I know my journey through infertility includes a doctor who can help me. No amount of iron, plant proteins and ice cream will change that.
Kimberly A. Dyer
Lewiston, Maine

Our health-care system cannot improve unless we change the focus (in both direction and funding) toward preventive care by fixing the way general practitioners are reimbursed ("Cures for an Ailing System"). It's easier to be compensated for an amputation and the purchase of a prosthesis than it is for disease prevention and management with a primary-care provider. With payment for primary-care services stagnant or even reduced since 2000, it is no wonder that medical students, who often have large educational debts, are migrating toward higher-paying subspecialties. This trend is being fueled by the Centers for Medicare & Medicaid Services' reliance on a resource-based relative scale determined by federal law. For 2008, this formula will reduce payment to primary-care providers by about 10 percent (unless Congress acts). Commercial insurance companies usually follow the government's lead.
Maurice W. Stutzman, M.D.
Millersburg, Ohio

"Bones of Invention" failed to mention that hundreds of physicians no longer offer bone-density testing and that dozens of imaging centers have closed in 2007, with many more set to close in 2008. This is due to drastic reductions in reimbursement by Medicare and other insurance because of the Deficit Reduction Act, which became effective last January. Just as the epidemic of osteoporosis is being fully recognized, and new drugs and treatment options are available, patient access to these important and valuable treatments is being compromised. I own a company that provides mobile bone-density testing to more than 10,000 rural and underserved patients in the Northeast. If the Medicare Fracture Prevention and Osteoporosis Testing Act of 2007—which would freeze reimbursement at 2006 levels—is not passed, I will be joining the ranks of those centers forced to close, resulting in the loss of jobs and leaving 10,000 people without access to this valuable test. If they aren't diagnosed, many won't be treated with the exciting new drugs your article talked about.
Dan Burneika
Harvard, Mass.