Your report "Diabetic pregnancy risk starts early" (SN: 12/5/98, p. 356) brings up a very important and underdiagnosed problem. Controlled apoptosis is critical to the normal development of the optic nerve. However, in optic nerve hypoplasia, there is a marked reduction in the complement of fibers.

We and others have demonstrated that babies are born with this following a pregnancy in which the mother either ingested certain pharmaceuticals (especially anticonvulsants) or was diabetic. It makes excellent sense that the high blood sugar in some diabetic women leads to high Bax production, which in turn overinduces apoptosis, leading to underdevelopment of the optic nerve and impaired vision. What is particularly frightening is that optic-nerve hypoplasia probably represents the tip of an iceberg of other congenital brain defects that are even more difficult to ascertain.

Alfredo Sadun
University of Southern California
Los Angeles, Calif.

Your article "White-coat hypertension" (SN: 12/12/98, p. 380) exhibits the time-honored medical practice of blaming the patient. One wonders about patients with chronic, difficult-to-diagnose diseases who have suffered abuse from doctors who attribute their symptoms to hypochondria; patients who have witnessed egregious misdiagnosis or malpractice and have lost their confidence in the profession; and patients who have had to accept treatment from uncommunicative, arrogant, or otherwise abusive physicians. In short, this condition calls for investigation into whether the person most in need of treatment is the doctor.

Thomas L. Wymer
Bowling Green, Ohio