Fair and balanced
Jennifer Durgin's cover story on cancer screening, in the Summer issue of Dartmouth Medicine, was masterful. It is probably the most accurate and balanced article most any of us in the field have ever seen written on this complex topic. Her article has been the centerpiece of many a dinner discussion during the past few months, both at DHMC and around the country.

I'm sure it was not easy so fairly presenting such a balanced perspective. The fact that both sides probably felt Durgin went too far in presenting the other side's position probably means she got it just about right. It's sort of what [DMS outcomes research pioneer] Jack Wennberg and his colleagues at the Foundation for Shared Decision Making went through during the development of their shared decision-making tapes for patients in the 1990s.

Again, my congratulations on this really important article on such a complex issue.

Michael Zubkoff, Ph.D.
Hanover, N.H.

Zubkoff is the chair of DMS's Department of Community and Family Medicine, as well as a professor of economics and management at Dartmouth's Tuck School of Business and codirector of Dartmouth's M.D.-M.B.A. program. He was the subject of the "Faculty Focus" profile in our Spring 2005 issue.

Both sides now
Thank you for the cover article "Screening for Cancer: Are We Hunting Too Hard?" by Jennifer Durgin in the Summer 2005 Dartmouth Medicine.

Since its inception in 1992, the New Hampshire Breast Cancer Coalition has called for honesty and clarity about the bene- fits as well as the limitations of mammography screening for breast cancer.

Slogans like "Early detection is your best protection" oversimplify a complex disease and mislead many women into believing that if they have this test, they will not die of breast cancer.

Women need evidence-based information about breast cancer screening. Anyone

The feature about cancer screening on the Summer cover, at left, inspired a couple of letters, while our Spring cover, at right, elicited a date and ID query.

who is considering whether or not to have routine mammograms would be well advised to read this article. Furthermore, it should inspire all of us to move forward from the debate about screening to determining what causes breast cancer and how best to treat it.

Nancy A. Ryan
Lee, N.H.

Ryan is chair of the New Hampshire Breast Cancer Coalition, a grassroots advocacy organization.

I see you?
Here is yet another letter regarding the cover feature about ICUs in the Spring 2005 Dartmouth Medicine. I was absolutely convinced that the patient depicted in the painting on the cover was my father-in-law, Guy White. He was the victim of a hunting accident in which both eyes and the bridge of his nose were shot out. Another bullet entered his right upper arm, shattering the bone. In the painting, the patient's eyes and nose are bandaged and there is an IV line in his left arm.

However, a caption on page 45 says that the photo on which the painting was based was used in an exhibit in 1957. But the hunting accident occurred in November 1959. Is it possible the date of 1957 is incorrect?

Dr. Brewster Martin of Chelsea, Vt., administered first aid at the scene and Guy was transported to Mary Hitchcock, where I know he was a patient in the Special Care Unit. He was 55 years old at the time of the accident and lived to be 86.

It has been in the back of my mind to write, but we did not have the wet spring here that was mentioned in your Summer

issue as a possible cause of all the letters that you had already received about the ICU article!

Barbara Huckins White
Tucson, Ariz.

The ICU photo that White refers to—on which the painting featured on our Spring cover was based—was included in a newspaper clipping dated 1957, so there appears to be no doubt about its vintage. White is a 1959 graduate of the Mary Hitchcock Memorial Hospital School of Nursing—which, as it happens, is the subject of a feature in this issue.

Kid-glove treatment
I enjoyed the "Facts & Figures" box about surgical gloves in your Spring 2005 issue, for a reason that will be obvious from the recollection which follows.

In the spring of 1968, I was an intern assigned to the cardiothoracic surgery service at Mary Hitchcock Memorial Hospital. My assignments one day included interviewing and examining a new inpatient, an elderly man whom I'll call Mr. Jones, who was accompanied by his wife. The interview proved to be intriguing and priceless.

Mr. Jones was the owner of a golf course that had gained worldwide renown when Dwight D. Eisenhower used it to retreat from his presidential duties. It was also famous throughout New England for the unique greens grass developed and marketed by Mr. Jones.

To let me know that she had some medical background, Mrs. Jones mentioned that she had been a nurse prior to her marriage. She said she had worked as the personal nurse for a neurosurgeon at Johns Hopkins, one Harvey Cushing, M.D.

"Have you heard of him?" she asked.

"Yes, I have," I replied, trying to subdue my exuberance and maintain my fledgling professionalism. Dr. Cushing was merely the most famous neurosurgeon in history, and there I was listening to his very engaging nurse!

Then she told me about the gloves. Surgical gloves were not routinely used in the early 20th century. During her duties, she developed a nasty rash on her hands.