Letters to the Editor.

Editor:

I am a private-practice physician in Internal Medicine in San Diego. Your editorial in the August 2001 issue of Ear, Nose & Throat Journal was right on target regarding the interference of government with individual medical practices. Your conclusion was that "the time might come when the doctor can no longer risk dealing with the government as a third-party payer." Dr. Pulec, the time has come! Not only is it time to get rid of the government as a third-party payer, it is time to get rid of all insurance companies as third-party payers.

This is the core problem with healthcare today. The third-party payer is dictating to physicians what they can and can't do, and who they can and can't treat. The time has come to put the healthcare dollar back into the pocket of the healthcare consumer, so that decisions are again made between the doctor and patient and no one else.

We need to promote and be sure that Congress passes proliferation of medical savings accounts (MSAs). The current system needs to be weaned away while MSAs are implemented. Only then will the greatness of our healthcare system return to the forefront, and only then will both doctors and patients be completely satisfied.

Locally, I am president of an organization of private-practice physicians that is a marketing and referral group for non-HMO-type practices. You can access our Web page at www.indoc.org/sandiego/. There are a few of these organizations throughout California, and ours is just getting under way. It is a way for individual patients to find caring, "unmanaged" physicians who will treat them, not their insurance.

Donald M. Brandon, MD

Diplomate, American Board of Internal Medicine 

San Diego, California 

Editor:

I read with interest the article in the June issue of Ear, Nose & Throat Journal on endoscopic surgical approaches in patients with allergic rhinosinusitis (Endoscopic physiologic approach to allergy-associated chronic rhinosinusitis: A preliminary study. Nayak DR, Balakrishnan R, Murty KD. ENT J 2001;80:390-403).

First, I want to thank Dr. Nayak and his colleagues for their conservative approach and recommendations to treat medically before employing surgery.

I note that the authors use the term turbinoplasty to refer to their turbinate resection method and that they cite the technique they published in 1998. The term turbinoplasty was first used in an article published in Laryngoscope in April 1982, to refer to a specific technique that I put forth. Much as many people refer to facial tissue as "Kleenex," the term is now being used more generically for interior turbinate resection of whatever type.

It is unfortunate that innovators are forgotten so quickly, but apparently time marches on. I thank Dr. Nayak and colleagues for their work.

Richard L. Mabry, MD

Professor of Otolaryngology University of Texas

Southwestern Medical Center

Dallas, Texas

Response:

We appreciate Dr. Mabry's technique of turbinoplasty used to reduce the size of the inferior turbinate for various pathologic conditions. Since the April 1982 issue of Laryngoscope was not available to us when we wrote our article, we could not quote your work. This omission was not intentional, and we regret it.

The term turbinoplasty as we used it applies to both inferior and middle turbinate trimming. A brief description of our term turbinoplasty:

(a) the inferolateral resection of inferior turbinate with preservation of the mucosa of the medial aspect of the inferior turbinate to facilitate the entry of inspired air more into the inferior meatus than into the middle meatus (this physiologically increases the inspiratory flow rate along the inferior meatus).

(b) the posterolateral trimming of the middle turbinate to facilitate the entry of allergen-free air during expiration into the middle meatus, while the sinuses are ventilated.

A similar technique was described in our earlier article, which we cited.

Dipak R. Nayak, MS, FICS 

Ramaswamy Balakrishnan, MS, DNB 

Kanapaka Deepak Murty, MS

Department of ENT-Head and Neck Surgery

Kasturba Medical College 

Kamataka, India