the United States will die; and 65,000 women in the U.S. will be infected.

What am I missing? Why is a Phase III clinical trial necessary? The vaccine was shown to be 91% to 100% effective! Is the continuing trial going to try to increase that effectiveness? I do not understand why a preventive measure that is so effective will not be available sooner.

Dave Salvatore
New London, N.H.

The reason for the long timeline is that there are many steps to ensuring not only that a new drug or vaccine works, but also that it is safe—and over the long term as well as the short term. The thalidomide crisis of the 1960s and the Vioxx withdrawal of a few months ago (the latter a matter that was also covered in the Winter issue of Dartmouth Medicine, as it happens, on pages 3 and 24) illustrate what happens when those steps are not taken deliberately and carefully. Patients are, of course, always eager to benefit from medical advances. But unfortunately, there's an inherent con- flict between getting drugs through the approval process fast and taking the time to ensure they're safe.

"And we hope during the longitudinal follow-up of these women (and men, whom we'll enroll later) that the vaccine will also be shown to be effective in preventing some less-common HPV-16 and -18 cancers of the mouth, tongue,

We're always glad to hear from readers about matters pertaining to medicine at Dartmouth or to the contents of past issues of Dartmouth Medicine. Letters to the editor may be sent to DartMed@Dartmouth.edu. Letters may be edited for clarity, length, or the appropriateness of the subject matter.

pharynx, tonsils, sinuses, esophagus, anus, scrotum, penis, perineum, vulva, and vagina.

"Please encourage any women 15 to 25 years old who have not had an abnormal Pap test, and who have not been vaccinated against Hepatitis A (that's our control arm), to consider enrolling in the Phase III study. Information is available by e-mailing Vaccine@ Dartmouth.edu or by calling 603- 653-3692. They will know that they were among the pioneering women who made improved health care for other women a reality."

Community values
Thank you for offering your insightful publication to those who are interested in medicine. As someone who appreciates good, thoughtful writing, and the way in which it can strike a chord in readers, I find that the articles in Dartmouth Medicine really do cause one to sit back and examine issues in a new light or from a unique perspective.

The excerpts in the Fall 2004 issue from Mary Daubenspeck's diary are just one example. Though she was facing a long illness, her words show a woman who nonetheless was full of life, love, hope, and courage. There are lessons for all of us in her experience and perspective.

Also, as an applicant to DMS, I find that your magazine provides me with valuable insight into the culture and community values of the school. An academic community is made up not purely of those faculty, students, and staff who are present on campus during a given fouryear period, but also of the larger community of alumni who are out in the world and putting into practice the skills and values that were instilled in them during their own academic experience.

That is why, in my mind, it is useful to look to the paths of alumni to assess the culture of a school and to see how it fits with my own values. For this reason, "Ten Years After" in the Fall 2004 issue was of particular interest to me. The article's focus on the experiences of several nontraditional students was energizing and inspirational to someone who fits into that category herself.

Regardless of the results of the admission season, the stories and perspectives highlighted in the pages of your magazine surely will provide me with valuable insight into the possibilities present in the medical profession, the remarkable individuals (patients) whom it serves, and the varied ways in which physicians can put their medical degrees to beneficial use in furtherance of the greater good.

Megan A. Adams
Baltimore, Md.

Extraordinary excerpts
I would like to thank you for publishing the excerpts from Mary Daubenspeck's journal [Fall 2004]. In searching for answers to my own health problems, I came across the article on the Internet. She must have been an extraordinary woman. I sat crying like a baby as I read every word. What was obvious, despite her incredible ordeal, was her strength, courage, and optimism for the life and love she did have, and for the circle of supporters during all her difficulties.

I still hold on to threads of optimism and hope that someday things will turn out well for me. Reading of Mary's complex misfortunes, looking at her family pictures, and observing the humor she could summon up even at her weakest