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We love to hear positive feedback about stories in past issues (who doesn't like a pat on the head now and then?), but we love it just as much (well, almost as much) when readers have constructive or critical comments. Especially when, as one correspondent admits below, someone is impelled to read an article three times! And we figure that we must be doing something right if we amaze, annoy, impress, or even outrage 14 readers into sharing their thoughts and reactions.

Good for Goodman
The profile of Dr. David Goodman in your Winter 2006 issue ("Counting all doctors") was very interesting. I passed it on to the governor of Virginia, who recently announced the establishment of a new medical school in the Roanoke Valley. It's a bad decision, made for political reasons and with no consideration for the solid data noted by Dr. Goodman. We have six medical schools in Virginia and the D.C. area; in addition, the University of Maryland, Hopkins, and Duke are all close by.

I would certainly concur that a new medical school in a rural or semi-rural region will not solve the doctor shortages alleged in those areas. Health-care costs will just be driven up, particularly since the payment system is procedure-based.

William J. Frable, M.D.
Dartmouth College '56
Richmond, Va.

Frable is a professor of pathology at Virginia Commonwealth University.

System of sickness care
Dr. David Goodman is correct. It is not the number of physicians that determines health-care costs—it is the number of patients.

In fact, there is no health care in this country—there is only sickness care. The costs of sickness care are open-ended and grow exponentially as a population ages. The only way to control the cost of sickness care is with some form of rationing. True health care would teach one how to get and stay healthy and provide a meaningful reward for doing so. Without the development of a health-care system, rationing will persist and expand, disguised as a "non-covered procedure" or "experimental medicine" or "insufficient qualifying information."

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.

The current political climate seems poised to again launch an effort to nationalize health care in this country. It will likely happen at some time, because the politicians who appropriate the money answer to the voters, who want such a system and do not realize the adverse effects it will have on care.

I hope Dartmouth can once again think outside the box and be a leader in true health-care innovation. I propose that Dartmouth and Dr. Goodman collaborate with one of the nation's large, powerful unions to implement a study of the effects on "health-care" (read "sickness care") costs in a defined group of persons in partnership with the union. This study would take a sufficiently large and statistically diverse group of its members and launch real health care—a system that teaches these individuals how to get and stay healthy and then rewards them in some fashion that is meaningful to them for doing so. Then compare the costs of doing this with the sickness-care costs of a matched group over the designated time period and see if there is a lessening of patient load on the sickness-care system by such an effort. If that happened, and I believe it would, then Dartmouth would be the leader in developing implementation of these concepts and would likely attract a lot of grant money once it becomes obvious that this approach greatly saves on sickness care. Projected into the future,

the savings would be ever greater as the population that is trained and rewarded to be healthy ages.

This true health-care approach would attack the root causes of the increasing costs of "sickness care."

Michael J. McKeown, M.D.
DC '58, DMS '59
Portland, Ore.

Illogical premise?
I read the cover article in the Winter 2006 issue ("Compound interest") three times because I was sure I had missed the main point—why Dr. Sporn chose triterpenoids in his search for agents that prevent cancer and prolong life. I did not miss it. The reason given is so illogical as to be frankly absurd. The article quoted Dr. Gordon Gribble as saying that sequoias live a long time, almost all green plants and trees contain triterpenoids, and therefore Dr. Sporn started searching among triterpenoids. If this is really the reason he chose triterpenoids, it would go a long way toward explaining why he has trouble finding research funds.

Logic requires that only relevant factors be included in a premise, to maintain scientific exclusivity. While many green plants and trees live a long time, most green plants are short-lived (i.e., corn only lives one season), and most trees don't live more than 50 to 60 years. Sequoias are the one truly outstanding example of longevity. Logic would therefore require Dr. Sporn to search among sequoias for agents that prevent cancer and prolong life, such as extracts of sequoia bark or leaves. But to go after something so ubiquitous in the plant kingdom as triterpenoids is studying chlorophyll for these properties; in fact, there was an amusing chlorophyll craze back in the 1950s.

If triterpenoids were found only among sequoias, I would say Dr. Sporn was on to something. But since they are found in just about every plant known, the short-lived as well as the longlived, I can't for the life of me see why triterpenoids exerted such a pull on him. Most likely, writer Jennifer Durgin got it wrong.

Other than that, it was an interesting article, and I look forward to forthcoming publications by Sporn and his team.

John Barchilon, M.D.
Dartmouth College '60
Thousand Oaks, Calif.

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