Letters to the Editor

The worried well
BY DR. ROBERT BURTON
(09/27/99)

Monday's article is yet another example of the paternalistic doctor-knows-best attitude still prevalent in our medical community. It is this very type of commentary that has led to the reluctance of patients to question physicians, led to delayed diagnoses, to ignorance of alternative treatments and to unnecessary surgery.

He states, "When I was in medical school, we were taught that the majority of medical office visits were for reassurance of the 'worried well.'" When was he in medical school, the 1950s? A time when women were considered hysterical and silly, mental illnesses disgraceful, the physician a godlike being and the medical community not held liable for negligence and outright misdemeanor?

The wealth of information available to patients has finally put the power in their hands -- the power to question, the power to seek alternative forms of treatment and the power to understand diagnoses and probable outcomes. I suggest it is this power that makes physicians uncomfortable, not the hypochondria of a single acquaintance who is surely the exception rather than the rule.

Given the current 10-minute appointment allotted by HMOs and for-profit medical corporations, if patients do not take the initiative to research illnesses and treatments, the choices left open to them will be limited and the chance of misdiagnosis increase. New treatment options are becoming available at an amazing rate, yet are often not on an insurer's "approved" list and therefore not discussed and/or offered to the patient.

Most of us know people who took a complaint to a doctor only to be told "it's all in your head," later to find out that the problem indeed existed. Had the patients pushed their cases, sought out more empathic physicians or done their own research months of discomfort, and in some cases even death, could have been avoided.

My own experience bears this out. Several years ago I began having symptoms of extreme fatigue and weight gain. I was sleeping 12-20 hours a day and had gained 40 pounds in three months. The first doctor I saw was able enough and ran a few tests, but wouldn't return my phone calls and was only available for appointments with three or four weeks' notice. As you can imagine, my career was in jeopardy; I couldn't wait that long. The second physician I went to (a young male) spent five minutes with me and proceeded to lecture me about eating habits! Finally, a third physician took a good look at my record and proposed that a medication I was currently taking might be the culprit, even though I'd been taking it for over a year. My symptoms were rare, but not unheard of, side effects for this particular medication. We reduced my dosage to see if that would help and -- hallelujah! -- problem solved. Had I not been persistent, the result might have been much different.

I now research every medication I'm given in the Physician's Desk Reference and am an active participant in my own medical care. If a doctor will not spend the time to get to know me and to discuss treatments and medications with me, I will go elsewhere. I deserve respect and to be treated as an intelligent adult, not an ignorant child. After all, I have the power over decisions affecting my body.

-- S. Swayze
Albuquerque, N.M.

"Total Memory Workout"
BY STEVE BURGESS
(09/16/99)

As a nurse who works daily with patients suffering from ALS, I was appalled to read the first paragraph of Steve Burgess' review of 'Total Memory Workout'. His offhand comment about a fatal disease demonstrated a complete lack of compassion and class. Granted, ALS does not affect as many people as Alzheimer's disease, but it should notbe relegated to the "I'll think about it if it affects me" category. ALS remains an always fatal disease, and increasing awareness is the only hope we have of getting the funding for much-needed research into it. With his comments, Mr. Burgess dismissed with a casual wave of his literary hand all of the hardship endured by people suffering with this disease, as well as all of the hard work by those who are doing everything in their power to increase awareness of ALS.

Fear of memory loss is rampant among baby boomers. Yet if you were to ask those same people if they feared equally losing all motor control, their ability to eat and speak, and eventually the ability to breathe, I suspect that you would find the same level of fear. ALS strikes every bit as randomly as Alzheimer's disease. Shame on you for displaying such ignorance in a column dedicated to health information.

-- Peg Merriman, R.N., B.S.N.
Clinical Coordinator
Rush-Presbyterian-St. Luke's ALS Clinic
Chicago

Is cyberpunk still breathing?
BY ANDREW LEONARD
(09/14/98)

I'm just getting around to commenting on Andrew Leonard's review of my novel "Mir" (Simon & Schuster, 1998), along with his diatribe on Scott T. Grusky's novel "Silicon Sunset" in the same article. Leonard's piece was entitled "Is Cyberpunk Still Breathing?" ("Two new science-fiction novels take a stab at an increasingly moribund genre"), and it was filled with a lot of officious remarks about cyberpunk being dead. He noted that "Once every couple of years a promising newcomer like Ian McDonald makes noise with a book like 'Terminal Cafe,' or an old fogey like William Gibson returns to form with an offering like 'Idoru.' But as a genre, cyberpunk is washed up, as outmoded as a 1980s hard drive."

Like Grusky, who responded to Leonard's cant in a more timely fashion, I'm perplexed as to why Leonard lumps my work with the cyberpunk genre that obviously obsesses him.

None of my novels -- "Rim" (HarperCollins, '93), "Mir" or the recently published "Chi" (Simon & Schuster, July '99) -- have ever passed themselves off as being "cyberpunk." You won't find the word "cyberpunk" mentioned in any of the books' jacket copy or publicity materials, which authors don't write themselves anyway.

Cyberfuture, yes. Cyberpunk? No. That's Leonard's personal phobia. Grusky quite rightly objected to this factual error in his letter to Salon: "Some may say that the cyberspace vs. cyberpunk distinction is trivial, and I for one have nothing against cyberpunk. But given the fact that Andrew lambastes lazy writing so viciously in his review, I maintain he should not engage in it himself."

Leonard's response to this mild slap on the wrist was to abjectly backpedal himself with an apology: "I was wrong to say that the book 'self-consciously' describes itself as cyberpunk. I mixed my misunderstanding of what he said with my interpretation of the book's self-description in a sloppy manner, and I truly regret the error."

It's ironic that barely two months after Leonard decisively "buried" cyberpunk in his op-ed piece that he was prostrating himself at the feet of novelist Pat Cadigan ("The Return of the Queen of Cyberpunk," Salon, 11/18/98) with all kinds of slavish personal observations: "Pat Cadigan still swaggers -- just like you'd hope a cyberpunk legend would. She's the kind of person who looks like she's wearing a leather jacket even when she isn't -- who you don't want to rile, but would love to party with."

All this purple prose gushes into the heart of the kind of "People" magazine glitz that really seems to fascinate Leonard : "Over dinner at a sushi restaurant in Berkeley, [Cadigan] recounted the moment when 'The X-Files' Gillian Anderson, hosting a BBC TV show, introduced a new segment by looking dramatically at the camera and announcing, 'And now, the queen of science fiction, Pat Cadigan.'"

Hey, Leonard, party on, dude! You may not remember this, but we once sat opposite each other at dinner in a Chinese restaurant in San Francisco. This was back in your bot days. Are the bots still with you?

OK, Leonard wrote his review in September 1998 -- that's ancient history in the world of the Internet and cyberspace - but here is, for want of a better term, a "timely" observation about Leonard's self-righteous rant about science fiction writers who rifle dated items from their e-mail and incorporate them into their writing about the future.

For some reason, Leonard was really riled that I happened to mention the Web infomeister Craig Newmark in my novel 'Mir.' Strangely enough for a book review, he devoted an entire paragraph to pointing out how passi this reference was: "The fancy that 'Craig's list' (which is now, by the way, technically known as 'The List Foundation') is still going strong in the year 2036 is an astonishingly lazy inside joke. It's also a nice metaphor for how contemporary science-fiction cyberpunk authors can't escape the confines of their own e-mail in-box."

Check your own e-mail, Leonard. Get hip. The List Foundation is now called "Craig's List" again. Am I omniscient or what?

By the way, Leonard, you really were unkind to pick on poor Craig. In "Mir," which I wrote back in 1997, I mentioned Craig purely as a kudos to all the great work he's been doing. That wasn't being trendy on my part, it was simply acknowledging a selfless pioneer. The current issue of Time magazine ("Getrich.com," 9/22/99) bears that out with a terrific feature on this wonderful man. I predict that Craig Newmark will be around a lot longer than you will.

-- Alexander Besher
San Francisco

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