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We feel very lucky to have readers who take the time to share comments, reactions, and recollections sparked by what they read in our pages. As well as readers who let us know when we, ahem, err—as is the case in the first letter below. Happily, our fact-checking process means that very few mistakes slip into print. But once in a while we prove that we're only human. Humanity is important in covering medicine as well as in practicing it . . . right?
Here a billion, there a billion
I read your Winter 2007 article about Jack Wennberg with great interest. I recall his revolutionary ideas well from my time as a DMS student in the early 1980s. I have often found his principles about variation in medical practice useful inmy role as medical director of our physician organization, in discussions with both doctors and payors.
I did note one small typo in the piece. One of the people who was quoted referred to health care as being a $2-billion industry. That should have read $2-trillion! But who's counting? (I am a huge fan of Dartmouth Medicine, by the way.)
Richard Parker, M.D.
Clearly, we weren't counting. We apologize for the error, which reminded us of Senator Everett Dirksen, who in the 1950s reportedly said, "A million here and a million there, and pretty soon you're talking real money." Parker is medical director of the Beth Israel Deaconess Medical Center Physician Organization. We appreciate his noting the error, which, as it happens, we caught before the issue was mailed—but after it was printed, so too late to fix at a cost our budget could bear (it being a few bucks shy of even a measly $2 billion). But we did fix it in our online edition.
Father knows best
I plan to forward a copy of your Winter 2007 article on Jack Wennberg to all my family members. I have a multiyear project organized to convince my adult children never to agree to a surgical procedure without first considering conservative alternatives and without getting a clear idea of the likelihood of a successful outcome from the surgical procedure.
Your article just may convince my kids
that their dad's advice is worth taking—at least on health issues.
James W. Ryan, M.D., D. Phil.
Dartmouth College '57
I enjoyed the reminder of my DMS days in the Winter 2007 cover article recognizing Jack Wennberg and his pioneering work in small area variations analysis. This tribute to Dr. Wennberg resonated with me, since I credit (blame?!) my exposure at DMS to him and his work for helping to inspire me to try the then-outlandish idea of combining careers in surgery and outcomes research.
And I can't help pointing out—given the emphasis in his work on the relationship between geography and medical care—an ironically and humorously appropriate juxtaposition: the issue with Dr. Wennberg on the front cover had a real estate ad on the back cover that declared the importance of "location, location, location"!
David W. Levine, M.D.
Jousting with windmills
I was much taken by the fine article in the Winter 2007 issue about Jack Wennberg's career. I have known Jack and admired his beliefs, convictions, imagination, and dogged persistence ever since he was involved in the Regional Medical Program (RMP) at the University of Vermont.
In the 1970s, he was an administrator with access to money, and we local M.D.'s were supplicants in need of help. Those of us then practicing in the backwoods of New Hampshire and Vermont were desperate for help—any help—to improvemedical facilities and services.
So, being a jouster with windmills, I suggested to Jim Russell, a resident at Hitchcock in '53-54 and later an internist in solo practice in St. Johnsbury, Vt., and Harry McDade, also a '53-54 Hitchcock resident and later a surgeon in Littleton, N.H., that the area would be best served by one multiservice hospital and clinic, centrally located somewhere in the geographic triangle bordered by Lancaster and Littleton, N.H., and St. Johnsbury, Vt. Such an arrangement would greatly improve and expand the limited and redundant services available in the seven small hospitals that then served Cooes County in New Hampshire and Essex County in Vermont.
Jim and Harry liked the idea, and the three of us decided to approach the RMP for help. We learned that Jack Wennberg was its nearest representative, so we went to many meetings in various locations, including at the regional center in Boston, which was dominated by a skilled and officious bureaucrat.
As you might guess, all we needed (but didn't have) was infrastructure, concrete plans, political savvy, and clout—not to mention money. The RMP was our hope for the latter, and that's how we got to know Jack. He eventually realized, I guess, that he, too, was jousting with a lesser windmill and directed his energies to other, more challenging windmills. I suspect that the RMP ended up being what Kurt Vonnegut would have classified as a "granfalloon." Nothing ever came of our idea, but Jack ended up as a realistic visionary.
I greatly admire and secretly envy his accomplishments. I suggested to a friend still practicing medicine in a small town in New Hampshire that she should seek out the article. I added that I believe Jack deserves a Nobel Prize. I truly do believe that.
Robert W. Christie, M.D.
Housestaff '51-53 and '55-57
Beltway insiders, listen up
I read the article on the evolution of