For Some, a Painful Reality

When I jump out of our local health club’s pool after swimming a mile, I never tire of seeing others try to stifle their gasps when they see scars crisscrossing my back (“Treating Back Pain,” April 26). After two major spine surgeries to mitigate scoliosis–which included the removal of five discs, fusion of vertebrae and implantation of enough metal screws, rods and hooks to set off an airport metal detector–my only successful method of reducing back pain is to move, and not to be afraid to do so. It is such a pleasure to see Claudia Kalb bring this truth to light. You can beat pain by letting your body do what it was designed to do. Treat it well and make it strong! Jennifer Hindel Crete, Ill.

Claudia Kalb should be applauded for her informative article about back pain. However, she overlooks an evolving trend in spine surgery, namely the emergence of less invasive options. Percutaneous procedures for disc disease have been used successfully for years. Incisions smaller than the size of a fingernail provide a port of entry. Through these tiny incisions and under very controlled X-ray guidance, surgical instruments are placed directly within the disc, which can then be decompressed through a variety of techniques. This often allows instant relief for suffering patients, shortens hospital stays and facilitates more rapid recoveries. The clinical advantages to this approach include smaller incisions that cause less damage to muscle and soft tissue. Passing directly into the disc avoids the bones that are typically removed during open surgery. There is even evidence that a type of percutaneous disc decompression not only reduces pain but promotes healing within the disc. Joshua A. Hirsch, M.D. Chief of Minimally Invasive Spine Surgery Massachusetts General Hospital Boston, Mass.

I see causes for back pain that go beyond the stress and turmoil of daily life. Let’s begin with shoes. It used to be that we wore shoes that supported the development and maintenance of our feet and legs. Now even young children are wearing flip-flops and platform shoes with no arch support. Beds also cause problems: now people sleep on blowup mattresses, water beds and platform beds. And let’s not forget the concrete floors and other hard surfaces against which we pound our bodies on a daily basis. We can blame back pain on stress and our busy lives, but we should also take responsibility for determining what we can do to promote good health, which includes our backs. Look around; it’s common sense. Ellen Sorrin New York, N.Y.

I don’t think your cover photo of the back of a beautiful, sexy woman really represents or captures the back problem in the United States. Why isn’t the “average Joe”–with an overworked, sweaty body, hairy back and love handles–on the cover? That would be a better representation of the American worker who experiences on-the-job, financial and family stress all bottled up in his back. Sal Lopes Acton, Mass.

While I appreciated your point that nonsurgical options should be thoroughly explored, I have to wonder why physical therapy, one of the most successful nonsurgical interventions, was given little attention. Research has proved that specific physical-therapy methods have helped 70 percent of patients get 80 percent better in six to eight visits. Subjective improvements with these methods last at least 12 months. Additional evidence for the efficacy of physical therapy can be seen in a 1998 New England Journal of Medicine article, where it was determined that physical therapy was able to achieve similar results in 50 percent fewer visits than were needed with chiropractic treatment. My intention in including this last reference is not to attack chiropractors, but simply to point out that you did a disservice to your readers by neglecting physical therapy, a potentially life-changing solution. Ryan Langejans, Physical Therapist Paw Paw, Mich.

The cover story seemed half-baked to me, so I’ll add my personal experience to round out your readers’ knowledge. I was a serious candidate for back surgery 10 years ago, when my most recent lower-back attack laid me up for nine days and left me in a bent position for six months thereafter. I was grateful to my doctor for not pushing surgery, but was surprised by his resistance to chiropractic measures and his preference for drug therapy. I tried chiropractic nonetheless, and have never looked back. My progress under a chiropractor’s care was immediate and long-lasting. I lead a perfectly normal life now, but for the occasional increase in pain, which is cured by one or two trips to my alternative-medicine man. Glen Boudreaux Houston, Texas

The academic pressure I had in school, and problems with my parents, caused excruciating back pain. Every move was painful. My mother sent me to a chiropractor, to therapists, even for biofeedback. Nothing seemed to help. After I finished school, moved out of the house and got married to a wonderful husband, the pain disappeared. Now, four children later, I’m still pain-free. Name Withheld Spring Valley, N.Y.

As a physician who believes in randomized clinical trials, I was spared repeat surgery for a recurrent herniated disc by Dr. John Sarno, who was mentioned in your article. Over the past nine years I have dealt with numerous aches and pains by using his approach. For critics to refer to this approach as a placebo is both inaccurate and inappropriate. Studies have demonstrated that the placebo effect is real and is mediated by endorphins. Sarno’s approach has minimal cost, has virtually no side effects and has been efficacious in numerous patients. In view of this, perhaps it should be required by insurance companies before patients undergo surgery. Susan E. Light, M.D. Menlo Park, Calif.

Your article on back pain was remarkably balanced. Yet it clearly showed why the U.S. health-care system is in such precarious shape. The staggering cost of back surgeries–a high percentage of which are either nonessential or marginally effective compared with acupuncture and/or massage–is only one example of the misuse of technology by a publicity-mesmerized public. Rustum Roy, Chair Campaign for Better Health Pennsylvania State University University Park, Pa.

Unfortunately, not all of Dr. John Sarno’s patients will agree with the assessment that he is “some kind of lumbar messiah.” When I consulted Sarno some years ago about the excruciating pain in my back and legs, the diagnosis was stress-caused pain, and he prescribed his usual treatment: attendance at his New York City lectures and sessions with an appointed physical therapist. The degree of my pain was such that I had to be transported back and forth to the lectures and sessions lying on a pile of blankets in the back of a van; at the lectures I lay on a table in agony. When no relief came, he pronounced me “self-destructive” and sent me to a psychiatrist, who wanted me to talk about my mother. During the course of it all, I lost 40 pounds and seemed near death. Eventually I broke away and consulted a traditional physician, who quickly discovered that the ravaged nerves in my back and legs had come not from “repressed rage” or too-early toilet training but from the toxic bite of a deer tick. Moral: a one-size diagnosis does not fit all and can have devastating results. Wallace J. Cooper Briarcliff Manor, N.Y.

I believe that many readers benefited from your cover story. You provide vivid pictures of the angst that back-pain sufferers endure, and list many treatment options. However, one choice you omitted was osteopathic manipulative treatment. All doctors of osteopathic medicine (D.O.s) are trained in OMT, a hands-on treatment. D.O.s use their hands to examine patients’ backs and other parts of their body, such as joints, tendons, ligaments and muscles, for pain and restriction during motion that could signal an injury or impaired function. People of all ages have found relief from pain and dysfunction, as well as improved mobility, through OMT. In fact, a study published in the Nov. 4, 1999, issue of The New England Journal of Medicine noted that OMT was just as effective in treating low-back pain as conventional options, with lower costs and fewer side effects. D.O.s are fully licensed physicians who can prescribe medication. We practice a preventive approach to health care and focus on treating people, not just symptoms. Darryl A. Beehler, D.O. President, American Osteopathic Association Chicago, Ill.

As licensed massage therapists and educators, we would like to advise you on an alternative approach to working with back pain other than the need to “distract patients from the pain of fingers pushing into their muscles.” Massage therapists trained in reputable schools have the skills to gently apply the tools and techniques to induce relaxation at various depths of muscle tissue to address a spasm. Communication is essential in order for the massage therapist to work within one’s pain tolerance to help one feel better. We use the “whole body” approach so that one can become more aware of how to move and use muscles. Our goal, as you state in the sidebar “Staying Healthy,” is to “prevent the torment of back pain from ever happening.” Demara Stamler, Executive Director Cathy Ayers McInturff, Director of Education Potomac Massage Training Institute Washington, D.C.

Giving So Generously of Oneself

Bob Burke and his volunteers are to be highly commended for their efforts to assist the less fortunate in coping with our complex tax regulations, and working with them to obtain the refunds for which they qualify (“Helping the Needy Crack the Tax Code,” My Turn, April 26). AARP has had a similar Tax Aide program since 1968, and in our community we reach large numbers of folks who have no idea they might be eligible for federal- or state-tax refunds. Furthermore, in our state, refunds are available on real-estate taxes for primary residences of elderly, low-income and/or disabled individuals. In some cases, part of an elderly person’s rent may be reimbursed. Our main problem appears to be reaching the target groups, for often they do not subscribe to newspapers and must rely on word of mouth to find out about the AARP Tax Aide program. Our local service is sufficiently extensive that we will make house calls to those who are homebound and need tax assistance. Charles Dare Rolla, Mo.

Bob Burke’s My Turn essay captured perfectly the positive experience that has kept us Volunteer Income Tax Assistance volunteers going back to the basement of a public library in Boston for the past four tax seasons. However, the article doesn’t describe how the taxes of the working poor can be surprisingly complicated–and expensive, at least from the taxpayer’s perspective. Every year we have to break the horrifying news of a $2,000-plus tax bill to several people who make less–usually far less–than VITA’s $30,000 gross-income eligibility limit. Often these people–bicycle couriers, aerobics instructors, taxi drivers–have been treated as independent contractors by companies that probably should have treated them as employees and paid FICA, workers’ compensation and unemployment-insurance premiums, with-held taxes and issued W-2s. For these people, the bill is shockingly large. Many work multiple low-paying jobs. Some have limited education, limited English or a disability. None has any idea where all the money is to come from. Holly B. Anderson Scott D. Anderson Natick, Mass.

So Bob Burke would love to see free tax preparation for the needy take off in other communities. In January I had the pleasure of joining the thousands of free tax preparers nationwide through AARP. Before this winter, the only tax forms I had filled out were my own. AARP gave me the training to help others and can train you, too. Contact AARP and offer your services. Chances are there is a system in your area that would welcome your willingness to help. AARP provides volunteers with training, supervision and the very satisfying opportunity to help your community. Jodie Flickinger Columbia, S.C.

We don’t read enough about opportunities for reaching out to help others, although I’m sure they are out there in every city. For example, in St. Louis we have a program called Little Wishes (littlewishes.net), which grants the wishes of foster children. All these children want is the “typical childhood experiences.” However, like other states, Missouri has a budget crunch. Paying for a foster child’s dancing lessons, art classes or basketball clinic is just not going to happen. Little Wishes picks up what the state can’t. Just another example of small gestures that have yielded huge results for the recipients. Jodi Redler Chesterfield, Mo.

Guided by a Deep Faith

You repeat the refrain that president Bush is unreflective and shallow because he leads from “faith and vision.” But what could be more reflective and deep than distinguishing right from wrong, or good from evil? What nobler vision exists than one premised upon such deliberations? Darryl W. Jackson Washington, D.C.

As with any other elected official, I strongly affirm that President Bush’s performance as our commander in chief should be evaluated and scrutinized (“The Gospel According to George,” April 26). The conflict in Iraq is of grave concern, especially with many Americans dying, and the president should be held accountable for our involvement. But why must his religious beliefs be ridiculed? Why run a “Gospel According to George” headline? Why was his speechmaking referred to as “preaching,” his resolve as “faith” and his supporters as “the faithful”? While you may be using clever imagery, ultimately it shows contempt for the president’s beliefs. Dean Sisk Murfreesboro, Tenn.

The comparison of President Bush to Martin Luther was unfortunate and unfair. Luther stood alone against the political and ecclesiastical authorities of his day and was willing to die rather than recant his beliefs. Bush is the authority, backed by the military might of the most powerful nation on earth, and the ones dying are American soldiers and innocent Iraqi civilians. George W. Bush is no Martin Luther. Frieda Nowland Lacrosse, Wis.

The U.N.’s Role in Iraq

As Fareed Zakaria states in his April 26 article, “The President Must Command,” it may just be a false blessing that the United Nations is becoming more involved in postwar Iraq. But I cannot agree with the assertion that sending more American troops to Iraq is the key to success. America is fighting a conflict without defined fronts or even secure supply lines, so the Army may need to rethink how it trains its men and women, who seem vulnerable to attack no matter where they are in the country. The Marines are trained to be riflemen first, regardless of their other duties. Sending 50,000 to 60,000 troops to Iraq without proper combat training in the uncertain months ahead can only increase our casualty numbers. I hope that in the near future the Army will take hints from the Marines’ unparalleled success in combat so our forces can quell the insurgency and minimize American casualties while doing so. Peter Benbow Davidson, N.C.

Fareed Zakaria quotes military strategist Karl von Clausewitz as saying, “War is the extension of politics by other means.” In fact, Clausewitz also said, “War is the extension of diplomacy by other means.” And our government’s ignorance of that distinction explains why we are in this Iraq mess: nobody followed Clausewitz’s wisdom. We spurned diplomacy, offended solid European allies and almost wrecked the highest international institution of diplomacy, the United Nations. All we did was perform “shock and awe.” Let’s try diplomacy. Gerhard C. Hamm Honolulu, Hawaii

Why Not Divide Iraq in Three?

Why is it considered important to maintain a united Iraq (“A Deadly Face-Off,” April 26)? There are three distinct ethnic groups in Iraq: the Kurds, the Shiites and the Sunnis. Clearly, the Kurds and the Sunnis do not want to be dominated by the majority Shiites. An underlining cause of the insurgency on the part of the Sunni population is clearly to ward off that possibility. In the longer term, an attempt to maintain a united Iraq will inevitably lead to civil war. A united Iraq was the product of colonial rule and was held together only by a brutal dictatorship. Why not allow self-determination for each of the ethnic groups? Given the escalating violence, what interest is being served by keeping Iraq intact? Trevor Schindeler Ontario, Canada

Bob Woodward’s New Book

One line in the April 26 article " ‘I Haven’t Suffered Doubt’ " stopped me in my tracks: “[Bob] Woodward apparently had access to all the main players and interviewed Bush for more than three hours.” If there is time to be interviewed for articles and books, why is there scant time for the 9/11 commission, whose stated goal is to identify intelligence failures and recommend reforms? And out of curiosity, may I ask if Cheney was present during Woodward’s interviews? David J. Melvin Chester, N.J.

Bob Woodward’s new Bush-bashing book, “Plan of Attack,” should be subtitled “How to Get John Kerry Elected President.” In this latest, not very subtle attempt to put a Democrat in the White House, Woodward is quoted as saying: “Powell thought that Cheney had the fever… the cool operator from the first Gulf War just would not let go. Cheney now had an unhealthy fixation.” Given the plethora of books attempting to undermine the war in Iraq, it would appear that the Democrats are the ones single-mindedly obsessed with taking Bush out. Sadly, they’re not as passionate about having removed a tyrant who was an avowed enemy of the United States as they are about removing a president who is fiercely defending it. Bob Weir Flower Mound, Texas

It is a good thing that Colin Powell did not resign in spite of reported reservations about the course of action of his government. His is just about the only voice of reason within the chorus that directs the policies of this presidency. In staying, he may have damaged his image and his future career, but he has certainly helped the country in doing so. For this he deserves my respect, if not my admiration. Ursula K. Urrutia San Jose, Calif.

The Post-Roe Generation

You report that 55 percent of college freshmen support abortion, down from 64 percent 10 years ago (“Generation Ambivalent,” April 26). The article treats this like a problem. In our society, shouldn’t abortion not be the first line of easy problem-solving? Let’s hope that by choosing not to abort, people are making responsible choices about whether to have sex, and that when they choose to do so, they are taking responsibility for such actions, either by raising the child or by taking advantage of adoption options. NARAL and Planned Parenthood are playing on an unfounded concern. Abortion will never go away. Scott Flaherty Wilson, N.C.

The title of the article “Generation Ambivalent” and most of your reporting suggest that opposition to abortion is not so much a principle as a state of indifference. However, hasn’t it been the pro-abortion lobby that has for years benefited from indifference by those who say they “personally” oppose abortion but don’t feel they have any right to express their opinion in regard to others? Peter A. Jirasek Hickory Hills, Ill.

At Those Prices

I usually enjoy reading Tip Sheet, but the April 26 “Summer Guide” on seasonal splurges was embarrassing. It included many clothing items that the average person would consider outrageously over-priced. A pink purse for $725? A straw hat for $168? A pair of swim trunks for $135? A plastic bracelet for $100? It says that spending money on exorbitantly priced things is more “fun” than sharing it with those who are in dire need. Save those “tips” for a time when poverty and hunger aren’t a daily concern for millions of people worldwide. Bob Burke’s My Turn, a story about volunteers who help poor people get their tax refunds, was quite a poignant antidote. Laurel Lippert Truckee, Calif.

Corrections

Our April 26 story about back pain stated that Dr. Dan Cherkin of the Group Health Cooperative’s Center for Health Studies is conducting the first large trial of chiropractic treatment for back pain. In fact, his trial focuses on acupuncture. Cherkin has reviewed previous studies of spinal manipulation, which have found modest clinical benefits equivalent to those of conventional treatments.