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Letters to the Editor 

How Hsaio

Oh frabjous day, callooh, callay. After months and years of bad news from every corner, on almost every subject, at last I have found an article that shows solutions to a big problem — how to fix the health care mess in our state [“For Health Care Reform, Dr. Hsiao Is the Man With the Plan,” January 19]. Like a good solution to a lot of other problems: When it appears, it can be reasonable, logical and doable. Thank you to Kevin J. Kelley — and more so to Dr. William Hsiao.

Mary Lighthall

Charlotte

Bravo, Ballet Story

I was both pleased and heartened to read Megan James’ article, “Raising the Barre” [January 19] about the attributes and benefits of the study of ballet.

Ballet is 500 years old, and if the value of anything is how long it hangs around, then this thing is priceless. Yet, as Jonathan Franzen offers in his timely novel, Freedom: “all the real things, the authentic things, the honest things are dying off … intellectually and culturally.” I worry when I attend performances of the New York City Ballet at Saratoga each summer, and note the dwindling and aging of the audience witnessing a brilliant company of Balanchine dancers articulating this most extraordinary art form.

Still, in spite of all the misconceptions and, yes, ignorance about ballet, Jennifer Homan’s recent history of it, Apollo’s Angels, has been on the New York Times best-seller list for months now; the widespread interest in and fascination with the current film Black Swan has garnered Screen Actors Guild and Golden Globe nominations for Best Picture; and now Megan’s article in Seven Days is giving notice to local practitioners. Bravo!

Well, how about giving ballet another 500 years, at least? Personally, ballet has given little ole me so much that I owe my very life to it.

Patty Smith

Whiting

That’s Not Italian

The cover of Seven Days, depicting Dick Mazza as a godfather, is not amusing. Would you have depicted Gov. Shumlin as a loan shark? Or Madeleine Kunin as a whore?

Italian Americans — and persons of Italian origin everywhere — have been victimized by the Mafia for too long to have its vicious, archaic culture now used to identify and stigmatize us. You’re making fun of the victims.

Italians have their own very serious political issues right now. Berlusconi, also of course, but an electorate who allegedly supports him and supports a strongly anti-immigrant agenda. Vermont’s institutions, among which I proudly count Seven Days, should be fierce guardians of diversity and tolerance and embrace — not ridicule — the vast humanistic legacy of Italian civilization of which the Mafia — and fascism — are destructive aberrations.

Louis Mannie Lionni

Burlington

Pick Your Bottle Battles

What about the bottle pickers? Ken Picard’s discussion of proposed bottle-bill revisions leaves them completely out of the picture [“Is Vermont’s Bottle Bill Ready for Recycling?” January 26]. However, we do hear a lot in the article from the lobbyists for the beverage association. Frankly, I don’t care much about the profits of the wholesale beverage industry, but I do care about the small army of pickers who work hard every day to keep the streets free of redeemable glass and aluminum. Why is our bottle bill not celebrated as a rare triumph of the free market? And where is the basic contradiction between holding the manufacturers responsible for excess packaging (bravo!) and holding on to an expanded deposit bottle bill that has worked well?

Andrew Simon

Burlington

Guns and Kids Don’t Mix

Thanks for an excellent article exposing, yet again, the incredible intimidation that the pro-gun lobby in our state has continued to exert upon our legislators and politicians, even at the expense of child safety [“Aiming Low,” January 26].

I was particularly disappointed at the quote from Sen. Anthony Pollina, for whom I have voted in the past. His suggestion that the law regarding safe storage of firearms now proposed in the legislature (H.83) is a “knee-jerk reaction to recent events” is preposterous and insulting to all of us who have been working for years in diligent and careful ways that respect excellent research showing such laws save lives and prevent suicide. Shame on him for a knee-jerk statement!

The simple truth is that suicide is the second-leading cause of death for Vermont teens 15-19 years of age, and most youth suicide in this state is carried out with guns. True, as Mr. Cutler points out, guns are widely accessible to youth in our state. But we don’t have to accept the fatalistic statement that “sometimes things [will] happen” as a result.

There is widespread agreement among groups across the spectrum, from the NRA to the American Academy of Pediatrics, that guns should be locked up and stored without ammunition when kept in homes with children. Certainly this should be a common-sense issue for owners in homes where anyone is felt to be at significant risk of self-harm.

This child-safety law would not in any way restrict the rights of anyone to keep or bear arms; it simply codifies that owners have a responsibility to store them in a way that minimizes the risk of serious injury or death. There are no provisions to enter homes or check for safe storage — these laws only apply in the event that injury has resulted from reckless storage.

I hope that legislators will have the courage to look seriously at this bill and will see that it can help to protect our young people without infringing on anyone’s rights.

Eliot Nelson, MD

Burlington

Dr. Nelson is a professor of pediatrics at the University of Vermont College of Medicine.

Proposed Gun Law Is Unenforceable

My sincere sympathies to the families of the youngsters who took their own lives [“Aiming Low,” January 26]. It is already illegal for anyone under 16 to possess a firearm without parental consent. It’s already illegal to provide anyone under 16 with a firearm without parental consent. And it’s already illegal for anyone to possess a firearm in a school building or on a bus. (13 VSA sections 4008, 4007 and 4004, respectively).

A new law requiring that each owner lock up his or her firearms is virtually unenforceable and won’t prevent any future tragedies.

Laws merely provide a framework for prosecution after the event.

The most appropriate shrine to the memories of these youngsters is to improve the mental-health and suicide prevention programs in our schools.

Paul Gross

Jericho

Media Propagates Violence

Judith Levine’s “Poli Psy” column “All Against All” [January 19], offers a valuable perspective on the ideological and cultural roots of American violence, with one significant distortion.

In a grossly self-serving manner, she denies the culpability of the media in feeding, propagating or encouraging social violence. Given that we are no longer a local, oral culture, in which information is passed primarily by word of mouth, none of the right-wing messages she declaims would have been heard without some form of print or airwave or digital media to disseminate them.

This makes not only the authors of antisocial words liable for the real-world effects of language, but perhaps even more so the media which allow those words a wide audience without, at least, a concurrent editorial rebuke.

After-the-fact armchair pontifications offer little more than a sop to blood already on the ground.

Robert Riversong

Warren

Fletcher Allen Responds

The article “Fletcher Allen Tops the Charts in Death by Dialysis” [January 19] was a misinterpretation of complex data, and in one instance a wrong characterization of a heart surgery statistic.

The headline implies that mortality data indicate the deaths of patients treated at Fletcher Allen’s dialysis units were related to inferior dialysis care, with resulting high mortality. The article gave the public the wrong impression, and did a disservice to our dialysis caregivers and the patients they treat.

There are two issues that need to be addressed in considering dialysis care. One is the use of the appropriate method for comparing outcomes among outpatient dialysis facilities (the Centers for Medicaid and Medicare Services, CMS, does not collect inpatient dialysis data). The second relates to the structure of Fletcher Allen’s dialysis service.

First, the percentage of deaths cannot be meaningfully compared as was done here. This is because the patient characteristics at one unit may be very different from those at another unit. If one unit has sicker patients, it may have a higher death rate. To compare outcomes, a correction must be made for health differences (known as risks) among patients. The risk-adjusted death rate describing dialysis facility outcomes is the measure that CMS uses to compare dialysis facilities, not the crude percentage rates that appeared in the article.

The other problem with comparing outcomes is unit size. It is easier for a small dialysis unit to have either all very sick patients or all very healthy patients, making for large differences between death rates at small facilities that happen just by chance. Statistical methods also adjust for this possibility and are used to help fairly compare outcomes.

Deaths may be outside of the control of the unit. For example, over the four years in question there were five deaths at Fletcher Allen’s Central Vermont Dialysis Unit. Three of the deaths were patients who made the decision to stop treatment; one died from heart disease, and one from infection. The raw 40 percent death rate at that unit cited in the article is not really different from the 20 percent national average when CMS analyzes the data incorporating the appropriate adjustments.

Second, when CMS compares outcomes, there is the underlying assumption that chance will be a major factor in the percentage of sick patients at a facility. The outpatient dialysis service at the Medical Center Campus dialysis unit is unusual in that this chance is skewed.

When outpatients become too sick to be treated at a satellite unit, the hospital outpatient unit, which has more resources because it also treats very sick inpatients, accepts that patient. There is no provision for analyzing outcomes at a facility that deliberately accepts outpatients whose dialysis care is challenging.

There’s another problem with the article in paragraph nine, which states: “Brumsted’s claim is supported by another study: Last year’s report by the Northern New England Cardiovascular Disease Study Group revealed 6.3 percent of FAHC’s cardiac patients die of postoperative renal failure; the regional average is 3.8 percent.”

This is false. The statistic refers to the percentage of patients who experienced postoperative renal failure or renal insufficiency among the most recent 500 cases as of the end of June 2010, where the surgery was only for coronary bypass grafts. It is not a measure of mortality. It is not a measure of those who required dialysis — many don’t. It is not a measure of all cardiac patients, but a subset of certain heart surgery patients.

Regarding concerns stated in the article about staff and staff levels: The commitment by Fresenius Medical Care to hire existing clinical staff and maintain the current staffing levels is stated in the signed letter of intent, as is the commitment to our maintaining medical direction at those units. The same commitments will be included in the completed contract.

Fletcher Allen chose Fresenius, in part, because the organization is comfortable with Fresenius’ commitment to maintaining the quality of care Fletcher Allen provides for its patients.

Misleading stories such as this unnecessarily upset patients and their families, and impugn health care providers without reason.

John Brumsted, MD

Burlington

Brumsted is chief medical officer at Fletcher Allen Health Care.

Editor’s response: Last week’s Seven Days acknowledged the error related to the New England cardiac bypass surgery. As to the other points raised by Dr. Brumsted, Seven Days stands by its reporting. The data cited in the article have already been adjusted for comorbidities, as well as other patient characteristics, to allow site-by-site comparison.

CORRECTIONS:

In last week’s “Fair Game,” Shay Totten incorrectly reported that longtime Barre-Montpelier Times Argus editor Andrew Nemethy, who was laid off January 13, has declined a job at the Vermont Press Bureau. In fact, there has only been a preliminary discussion about the post and no offer made or rejected.

In “Roll Out the Barrels” Corin Hirsch wrote that Sean Lawson stated that hops contain cannabinoids. In fact, Lawson pointed out that while hops are part of the cannabaceae family, they do not contain illegal THC, the active cannabinoid in cannabis.

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