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Letters to the Editor: Fall 2017

Letter to EditorI write to inform your readers of issues not addressed in the articles in the Fall 2017 issue “A New Era in Biomedical Education” and “Home Improvement.” There has been a uniform rush of medical schools to eliminate lectures from the curriculum. A recent op-ed in the New England Journal of Medicine noted that the University of Vermont medical school now advertises that its students will have no lectures. The op-ed outlined the accepted belief of medical educators that no student can attend for more than 15 minutes, the material is too extensive to be mastered and, in any case, all the doctor of the future needs is to master the ability to access information on the fly and does not need prior knowledge of the subject to be a knowledgeable doctor. After the Libby Zion case in the 1980s and the subsequent Libby Zion Law, the training hours of doctors have been reduced in the belief that tired doctors make mistakes. Studies have shown no improvement in outcome by changing doctors into shift workers. The program directors have not considered the harm that has been done to medical care by releasing inadequately trained doctors into the community who believe that they leave after eight hours and make no decisions except by teams. I ask the educators who have moved medical education down this path, "Did you ask your graduates whether they were served well or hurt by lectures that covered the materials of the basic sciences?" "In your present format, what assurance do you have that your students will cover all the information?" "On what basis was it decided that it is preferable to train teams of doctors rather than to produce well-trained individual self-reliant doctors who know their material and make their own decisions?" Sadly, these questions have not been asked. As the comic strip Pogo said, "We met the enemy and he is us.” It is time to explore the other side. It may be too early for the medical schools to pat themselves for a job well done.

Isaac Gorbaty, MD (FEL ’79)
Tarzana, California

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Letters to the Editor: Summer 2015

Letter to EditorI read Veronica Meade-Kelly’s article, “What the Songbird Tells Us”, with a heavy heart. Many species of songbirds are disappearing from around the world — extinct or endangered due to loss of habitat and climate change. For instance, the Rusty Blackbird has seen its numbers decline by 85-to-99 percent over the past 40 years. This is one of the most rapid declines of a population’s health in the world. While such a loss is tragic in its own right, Meade-Kelly’s article demonstrates the effect on the human family as well. The inspiration that Dr. Arthur P. Arnold drew from songbirds helped to usher in medical research from which we can all benefit — whether birder or not. Preserving biological diversity and the health of all animals is good for both us and them.

Benjamin Bechtolsheim
San Francisco, California

What an amazing woman Reenie Harris is (“To Life!”) — skydiving, playing paintball with her grandkids, walking five miles on New Year’s day in the Rose Parade and earning the right to take that walk by giving a kidney to a complete stranger! Reenie’s energy, zest for life and generosity that have undoubtedly brought her 70 years filled with rich and rewarding and exhilarating experiences are so nicely shared in her piece in U Magazine. Reenie’s story reminds us that there are no automatic age limits to helping others. And she shares a remarkable facet of the story that her donation in New Jersey was transplanted at UCLA, 3,000 miles away, highlighting a living-kidney cross-country sharing system that was pioneered by UCLA and OneLegacy and has helped make kidney-chain donation the success it is today.

Thomas Mone
CEO, OneLegacy
Los Angeles, California

Thank you for your Epilogue article by Maureen “Reenie” Harris. It was wonderful to share Reenie and Natasha’s journey as part of “The Never Ending Story” 2015 Donate Life Rose Parade Float Program of the OneLegacy Foundation. Living donation is such a gift to the recipient. And I have heard from altruistic kidney donors — those like Reenie and Natasha who give from their hearts to a complete stranger — that they feel they receive more than they gave and do not regret their decision for a minute.

Anne Grey
Executive Director, OneLegacy Foundation
Los Angeles, California

It was with great joy that we read the article about Maureen Harris and her daughter Natasha Kruse and their altruistic kidney donations. We were blessed to meet these two incredible women as they walked alongside the 2015 Donate Life Rose Parade Float. What an inspiration these women are to offer a kidney to a complete stranger. Their story is one of selfless giving and true love.

Vivian and Larry Lefferts
Normal, Illinois

It was with great joy that we read the article about Maureen Harris and her daughter Natasha Kruse and their altruistic kidney donations. We were blessed to meet these two incredible women as they walked alongside the 2015 Donate Life Rose Parade Float. What an inspiration these women are to offer a kidney to a complete stranger. Their story is one of selfless giving and true love.

Vivian and Larry Lefferts
Normal, Illinois

Your coverage of Reenie Harris and her daughter Natasha’s donation story and participation in the 2015 Donate Life Rose Parade Float Program was inspiring. Donation is one of the greatest gifts that can be given. It is an unforgettable experience that bestows intangible gifts to both recipient and donor. The Donate Life Rose Parade program also thanks Reenie and Natasha for the bravery and generosity in sharing their story.

Nicole Olivas Jenkins
Donate Life Rose Parade Float Program Manager
Los Angeles, California

Thank you for publishing the inspiring story of Maureen “Reenie” Harris and her daughter Natasha. Natasha made the decision to altruistically donate a kidney to a stranger. Then her mother saw firsthand the power of this remarkable gift. She, too, decided to donate her kidney to a stranger. Reenie did not simply assume that her age of 70 disqualified her from living donation. She sought out the facts. Reenie’s donation and the connections she made brought her unexpected gifts. Her story shows us all that there is no age to stop giving to others and no age to stop celebrating life.

Carol Harrison
Montclair, New Jersey

As a former editor of many UCLA school of medicine publications, I thought the profile of Dr. Noah Federman (“Surfin’ Safari”) perfectly captured the soul of UCLA Health — a place where physicians truly want to heal people. I’ve seen Dr. Federman interact with teenagers with cancer in the past and have marveled at the ease he has in connecting with them. That he is comfortable donning a wetsuit with these kids is further evidence of his willingness to show a level of caring not often apparent in doctor-patient relationships. Kudos, too, to the photographer; the main picture was as impactful as the story.

Jacqueline Michels
Marina del Rey, California

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Letters to the Editor: Spring 2015

Letter to editorWhen the Winter 2015 issue of U Magazine arrived at my home, your cover story entitled “What Makes Us Fat” caught my eye and piqued my curiosity to read all the articles in the magazine on this subject. I have never had a weight problem myself, even after giving birth to two children. I have been blessed with a good metabolism and good genes while being committed to eating a healthy diet and exercising on a regular basis. That said, we all know someone who faces serious weight problems, and, sadly, some fall into the category of obese. I can only imagine how difficult and overwhelming it must be to think of losing substantial amounts of weight. The many psychological, behavioral and genetic components that come into play make this an extremely difficult and complicated issue. I applaud the scientists, doctors and researchers at UCLA and throughout the country for recognizing this as a dire public-health epidemic and for devoting time, energy and resources to gain more insight into the complexity and causes of obesity. It is encouraging to learn that strides are being made in this area of study. My hope is that people struggling with their weight have the opportunity to read these articles to better understand themselves and become more aware of the serious health risks associated with obesity. It is a difficult, if not impossible, subject to raise with a loved one or friend; therefore, the more information disseminated to the public, the better. Good health is a gift, and everyone is entitled to be the best they can be. At the same time, we, ourselves, are responsible for making it happen. Thank you for bringing such noteworthy and fascinating articles to our attention.

Janis Susskind
Los Angeles, California

It’s not easy! As the wife of Daniel Galorath, featured in “Appetite for Change”, I want to thank you for educating people on the hard work and determination it takes to make changes to long-standing lifestyle habits that are required to lose unhealthy weight. For my husband, losing weight was life-changing; actually it changed the lives of our entire family — I have my husband back, and the children have their father back! Physically, the extra weight made him miserable — his feet hurt, his knees hurt. He didn’t even enjoy walking. There is no quick fix when you are overweight, but programs like the UCLA Risk Factor Obesity Program can provide the help, support and education that some people need to make healthy lifestyle changes. Hopefully, articles like this can help educate the public on the dangers of obesity and help provide reassurance that changes can be made to reverse this trend.

Judy Galorath
Rancho Palos Verdes, California

Thank you for the article “Appetite for Change”. Eating and lifestyle habits are very personal, and the article by Dan Galorath opened a picture window on his victory. Losing the weight is one thing, but keeping it off for nine years is a triumph. From what I understand, the UCLA Risk Factor Obesity Program is serious about weight loss, serious as a heart attack. Safely living on 920 calories a day requires professional oversight, but I suspect the most significant aspect is the training and emotional support to build a new lifestyle. The signals we get from our bodies about what and how much to eat seem to be all wrong. My take away from the article is that knowledge and disciplined mental exertion coupled with an understanding of habits and motivations coming together in a lifesaving collaboration have changed a life.

Sam Westover
Leesburg, Virginia

I appreciated the diversity of approaches discussed in the article “What Makes Us Fat?” The old, simplistic paradigm of eat-less-and-exercise-more, while true in the case of certain individuals, cannot be depended upon to solve the overarching complexities of the obesity epidemic. I found it especially interesting that Dr. George A. Bray’s research, which points toward a high-protein diet as a part of the solution, seems to validate, at least in part, the recommendations of Dr. Robert Atkins, whose Atkins Diet has been alternately applauded and demonized over the past several decades. Even more remarkable were the results of the “Super-size Me”-style experiments performed on the hybrid-mouse diversity panel by Dr. Brian Parks. With body-fat-percentage increases ranging from 0-to-600 percent on the same diet, there can be no question that obesity is not a simple game of calories-in/calories-burned, good fats vs. bad fats or simple vs. complex carbohydrates. The breadth of the research presented in this issue substantiates the belief that the human conditions that contribute to obesity — both biological and psychological — are highly individualized; therefore, solutions to the epidemic need to be equally tailored to the individual. For both humanitarian and financial reasons, the current trend that leads to a majority of the U.S. population being overweight or obese by 2050 must be reversed.

Aostara Kaye
UCLA Transplant Services

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Letters to the Editor: Winter 2015

Letter to editorI wish to convey my congratulations on the publication of “To Heal the Human Instrument.” This article, explaining the work of Dr. Gerald Berke and colleagues through UCLA’s Voice Center for Medicine and the Arts, reminds me of a bedtime story — “The Little Engine that Could” — as I reflect upon the significant advances in the understanding and treatment of a rare and devastating voice disorder. The bulk of such advances results from the singular pioneering work accomplished by Dr. Berke and colleagues. Without hyperbole, Dr. Berke and his colleagues are providing what amounts to daily miracles. From all of us who have experienced the devastation of losing the ability to speak, I sincerely express my gratitude to Dr. Berke, UCLA and U Magazine for your outstanding service in this effort.

Spasmodic dysphonia (SD) affects hundreds of thousands of people worldwide. Thirty years ago, when I was diagnosed with SD, I was fortunate to benefit from the courageous invention of another California surgeon, Dr. Herbert H. Dedo of UC San Francisco. In the intervening decades, refinement and dissemination of surgery as an effective treatment for SD was eclipsed by the advent of chemical therapy in the form of Botox injections. Dr. Berke is kicking it up a significant notch through persistence, courage and surgical skill. Dr. Berke’s consistent dedication to helping not only his patients, but also SD patients all around the globe, is remarkable. Recently appointed chair of the National Spasmodic Dysphonia Association’s Medical Advisory Board, Dr. Berke will without doubt be in a position to do even more in the coming years to advance the availability of effective diagnosis and treatment of SD.

Your article delivers accuracy and awareness to public understanding of effective treatment for SD. Medicine at its best is science in the service of human lives, and these stories illustrate that priority very effectively.

Mary Brady
Member, National Spasmodic Dysphonia Association
Baltimore, Maryland

As the facilitator of the Comforting Hearts Family Bereavement Group, I want to thank U Magazine for the beautiful coverage of this important program. All of the parents in this support group were given the magazine with the article “At the End of Too-few Days”, and they were very touched and impressed by the article. As you can gather, it is hard enough getting through each day as a bereaved parent, so many have asked me to share with the magazine their very positive responses and gratitude for the article. The pictures were particularly beautiful and touching and portrayed in a very artistic and sensitive fashion. Our parents would like people to know that the Children’s Pain and Comfort Care program is vital to their survival and that Jeannie Malabanan’s story is one that conveys the needs that all families caring for a dying child may have. Thank you for sharing their stories and the vitality of this UCLA program with this story and photos. The group is grateful to UCLA in all ways!

Gina Kornfeind, MSW, MS
Mattel Children’s Hospital UCLA

Thank you for the article “At the End of Too-few Days,” highlighting the outstanding Children’s Pain and Comfort Care program at Mattel Children’s Hospital UCLA. We are very fortunate to have this program here and a multidisciplinary team of experts in this area who “get it” and know how to help patients, families and staff alike during the most difficult of times. Kudos to everyone on the CPCC team, and thank you to the parents who shared their experiences with the team and the Comforting Heart Family Bereavement Group for this article — their openness and desire to give back are deeply appreciated.

Nancy Hayes
Manager, Care Coordination and Clinical Social Work
Mattel Children’s Hospital UCLA

What can the past teach us about Ebola?
Lest we forget:

Hardly a man is now alive
Except for those over 95
But in the influenza epidemic of 1918
548,000 Americans died
And over 20-million worldwide.

Something the Centers for Disease Control and Prevention and the White House should think about. My maternal grandfather was one of the 548,000, and my mother, born in 1916, never got to know her father. Funny how things like that, or my sister Sheila dying of her smallpox vaccination in 1942, can come back to haunt you.

Richard Rofman
Van Nuys, California

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Letters to the Editor: Fall 2014

Letter to editor As a practitioner and an educator, I was delighted to read about innovative patient-education mechanisms designed to prepare patients for informed decision making regarding their healthcare, as presented in Shari Roan’s article “Partners in Care.” The programs described in the article offer accessible, interactive and personalized education aimed at yielding better patient comprehension, compared to traditional handouts or time-consuming face-to-face conversations. Follow-up by trained professionals such as health coaches provides patients with an opportunity to assess their learning and understanding and devise the best plan of action for their healthcare. I look forward to integrating some of these concepts into my practice. Nonetheless, it is important to point out that simply educating people does not ensure that they become equal partners in decision making. Partnership and shared decision making must be valued and desired by both sides of the partnership. As patients benefit from earning more about their options and clarifying their values and choices, physicians, too, must become proficient in facilitating partnerships that promote shared decision making. Learning how to collaborate with diverse patient populations requires commitment and specialized training for all healthcare professionals.

Liat Gafni
Assistant Professor of Occupational Therapy
Saginaw (Michigan) Valley State University

Dr. Robert Vinetz hit it on the head (“In Box,” Summer 2014) when he pointed out that a big reason why U.S. healthcare is so costly, compared to other countries, was the comparative overhead costs. He cites the example of Medicare’s overhead cost of less than 3 percent versus insurance-companies’ costs of 15 percent to 25 percent. That extra cost will never be overcome as long as the insurance companies can influence the legislators and in so doing preclude them from fixing the system. The Accountable Care Act is a small step forward, but there’s still a long way to go.

Dan Olincy
Los Angeles, California

In response to Dr. Robert Vinetz (“In Box,” Summer 2014), who favors a single-payer system for healthcare, I’m unconvinced. Granted, a “Medicare-for-all” system would eliminate the costly middleman — the privateinsurance company, with its inherent confl ict of interest (profi t vs. claims payment) — but I doubt that it would lead in the long run to high-quality care with effi cient utilization of resources. Remember, in a national system of single-payer health insurance, the payer will be the government. This is the same government whose ever-compounding missteps have gotten us doctors to where we are today; the same government that fostered health insurance in the first place, irrationally linking it to employment, and then monopolized elder care; foisted HMOs, PPOs and managed care on doctors and the public; fixed physicians’ fees; instituted an extravagant, unfunded prescription-drug scheme; and topped it all off with the non-affordable Affordable Care Act. I’d sooner believe that pigs can fly. It’s more likely that regulations will proliferate, bureaucratic inefficiency will thrive, claims will increasingly be denied and therapeutic innovation will be stifled. Toward the end of his letter, Dr. Vinetz cites the need to “engage the patient from the get-go” in order to develop his/her understanding. The goal is laudable, but universal Medicare won’t achieve it for the reason that the patient will remain (as now) the only passive member on the healthcare team, disconnected from the costs of care, uninformed of alternatives in care and, at best, only dimly aware of how things work or why they are done. Instead of universal Medicare, I propose two complementary innovations: medical scrip and personalized medicine. Medical scrip (or vouchers for healthcare) would put the power of the purse into patients’ hands, creating a free market in care and maximizing choices. Scrip could be spent at a medical-doctor’s office, local hospital, HMO or with an insurer. It would be dispensed by the government on the basis of demographics, medical needs or both. Unused scrip could be saved for future health needs, in the manner of a health-savings account. By way of comparison, vouchers for food (food stamps) keep indigent families well-nourished, if used wisely. Vouchers for education promote educational quality by offering more choices to consumers and thereby fostering competition. Medical scrip should enjoy success similar to that of vouchers for other basic human needs. The other innovation, personalized medicine, has been gaining traction for several years. A quick Google search reveals a dozen prestigious institutions with established or nascent programs in genetically based, individualized medicine. Clinical application is sparse at present, but when widely available, personalized medicine will stand in stark contrast to our statistically based, one-size-fits-all medical model predicated on the fallacy of the “average human.” Human beings are, because of Mendelian genetics, by nature diverse and individual, not interchangeable. A system that recognizes that will maximize patients’ choices, lower costs and achieve the best outcomes.

Richard P. Huemer, MD ’58
Palmdale, California

Thank you for your article “Body Language” that details UCLA’s Surgical Science Laboratory and the work of Dr. Warwick J. Peacock. As a layperson, I found it fascinating to know that the David Geffen School of Medicine at UCLA is using innovative techniques to train surgical residents. It is clear Dr. Peacock has a mission and teaches anatomy from an enthusiastic, joyful mindset. The writer describes the “bubble of excitement” experienced by these residents, and as a reader, I could feel it. I also loved reading about Dr. Peacock’s personal journey as a physician, first as a pediatric neurosurgeon who developed new techniques for treating children with cerebral palsy and then his battles with authority to improve patient care along the way. What a force he was to stand up to apartheid policies embedded in hospital care in his native South Africa at the time and move black children from their overflowing ward to the nearly empty white-children’s ward. That same forceful personality is why UCLA has its Surgical Science Laboratory. Kudos to the writer, Lyndon Stambler, for providing so much rich detail about Dr. Peacock’s life and giving us a strong sense of his empathic character and his enthusiastic and humorous personality. His saying to residents, “Make sure you’re not cutting into the bowel. It spoils the day,” made me laugh out loud. As a teacher, I want to share this article with other teachers; Dr. Peacock models how important it is to transfer enthusiasm to students. That is what teaching needs to be about everywhere. Finally, I was impressed that UCLA treats the donated bodies with such dignity, even building rituals of respect and gratitude toward the deceased into the training for these residents.

Cheryl Miller
Los Angeles, California

“Picturing Pain” was a great article, one of the many I enjoyed in U Magazine. Artwork is a great way to connect with the suffering of patients. Compassionate care resulting from understanding the nonverbal world of our patients is something I have worked with for many years as a gastroenterologist caring for patients who have chronic disorders or cancers. I found the article validating and inspiring to continue the journey toward healing the body and spirits of people in need. And many of the artworks were deeply moving in ways beyond words.

Jesse Lachter, MD
Rambam Healthcare Campus
Technion-Israel Institute of Technology
Haifa, Israel

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Letters to the Editor: Summer 2014

Letter to editorTwo articles in the Spring 2014 issue of U Magazine particularly caught my attention, both linked by the economic crisis in our healthcare system. In “U.S. Ranks Near Bottom in Efficiency of Healthcare Spending.” Dr. Jody Heymann shows that “the United States healthcare system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives … [reflecting] a high price paid and a low return on investment.” Dr. Patricia Ganz, in her interview “Cancer Care in Crisis,” identifies “escalating cost” as a key factor in this crisis. As neither the cause of the economic crisis in healthcare, nor the solution to the crisis, is mentioned in either article, it is vital to identify them. The cause: the for-profit health-insurance industry. The solution: a single-payer health system. One of the worst aspects of the for-profit insurance industry is its overhead cost, which consumes 15-to-25 cents of every healthcare dollar before any healthcare is provided. Contrast this with the overhead of our government’s traditional Medicare insurance program, which is less than 3 cents of every dollar. At present, for-profit, investorowned health-insurance corporations exercise an economically crippling level of control over our nation’s healthcare. As a consequence, the United States spends twice as much per person as the average western European nation. A system of single-payer national health insurance, or improved “Medicare-forall,” is the solution for the United States. In such a system, a single public or quasi-public agency organizes healthcare financing, while the delivery of care remains largely in private hands. A recent study at the University of Massachusetts, Amherst, shows that upgrading the nation’s Medicare program and expanding it to cover everyone would yield more than a half-trillion dollars in efficiency savings in its first year of operation and could save $592 billion annually, enough to pay for high-quality, upgraded and comprehensive benefits for all residents of the United States, with no deductibles or copayments and at lower costs to most individuals, families and businesses. But we don’t have to wait for a national Medicare-for-all program; the Affordable Care Act allows the states to adopt their own Medicare-for-all-type system, beginning in 2017. Dr. Ganz, in her U Magazine interview, says that we need to “engage the patient right from the get-go in developing his or her understanding of what’s going on.” This is true. We need to educate ourselves, as well as our future patients and society at large, that with an improved Medicare-for-all program, we can have a healthcare system that is universal, of high quality, sustainable and affordable.

Robert Vinetz, MD
Los Angeles, California

We found the story “A Family Affair” to be both inspirational and informative. As the grandparents of Dylan Miceli-Nelson and the parents of Dr. Carrie Miceli, this is a story close to our hearts. We have many friends who ask about the progress of our grandson Dylan, but we find that they, as well as most people, do not really know much about this rare genetic illness. The article did an excellent job of helping people to understand more about Duchenne muscular dystrophy on a scientific level, while showing the human, emotional side to this devastating illness. We are so proud that all of those who work with the Center for Duchenne Muscular Dystrophy at UCLA to bring comfort and help to these boys and their families. Someday, their dedicated work will hopefully result in the eradication of this disease.

Tony and Barbara Miceli
Beverly Hills, California

It’s not hard to understand that the familyaffair factor of Drs. Carrie Miceli and Stanley Nelson resonates within the walls of academia as well as outside UCLA within the parent community of Duchenne muscular dystrophy. As the mother of a 24-year-old Duchenne man, I seriously question if our son would be alive today if the Center for Duchenne Muscular Dystrophy (CDMD) at UCLA did not exist. Perhaps we would still be roaming the hospital halls in despair, overwhelmed with feelings of incompetence by the impossible task of coordinating our son’s care on our own. To fully understand the need for care, one needs to understand just how devastating and relentless this disease really is. In social media, Duchenne parents call our boys warriors. I challenged myself as a mother to find a better description but I can’t; warrior is by far the most accurate. In Southern California, a soldier can return from combat without the use of his limbs and find a state-of-the-art rehabilitation center. An individual suffering from a progressive weakening of the heart can find excellent clinics with experienced cardiologists. Do you need respiratory care or treatment for pulmonary disease? Easy to find. Need a neurologist? I searched my insurance database and found more than 300 neurologists within a 10-mile radius. Did you have a bad fall and need an orthopaedic surgeon to fuse your spine? No problem. Psychological and mental-health care is also readily available. Duchenne patients and their families have all the aforementioned to cope with, and much more. The caveat for Duchenne parents is all these disciplines must be coordinated because these health issues are dependent on each other. Preceding the formation of CDMD at UCLA, there was no clinic administering coordinated comprehensive care, just scientific endeavors, bits and pieces of care, with no real experts to help SoCal families navigate through this challenging journey. Drs. Miceli and Nelson and their colleagues Drs. Melissa Spencer and Rachelle Crosbie- Watson understand the race against the clock better than no other. I believe their personal connection to Duchenne, combined with their expertise and environment, allows them to think in more-efficient ways as to how to approach the quest for a cure. The unique cocktail of intellect, resources, motivation and sense of community is the perfect recipe for optimizing care and finding a cure. I predict CDMD at UCLA will become the leading center for Duchenne muscular dystrophy in the nation. Let’s not forget they are a family of warriors too. Thank you for shedding light on the most-common lethal genetic disease. Duchenne is finally getting the attention it deserves on the West Coast.

Tyla Hamburg Bohbot
Los Angeles, California

Thank you so much for publishing the article “A Family Affair.” As the mother of a 12-year-old with Duchenne, I found this article extremely informative on many levels. I will definitely forward this to all my friends and family and anyone who’d like to understand a bit more what Duchenne is, what it’s like to live with the disease and the latest in scientific breakthroughs. The article is a great look at a family affected by Duchenne that is working tremendously hard to make it all so much better to deal with, for all of us. After many years of traveling back east for a clinic we could really trust, my family is thrilled to have the Center for Duchenne Muscular Dystrophy (CDMD) right here in L.A. We feel so much safer now, especially with all the new medical issues that pop up with Duchenne. We are also thrilled to know that our son can participate in clinical trials right here at home. Here’s a quote from Dr. Stanley Nelson which, to me, says it all: “We think the Center for Duchenne Muscular Dystrophy is the right model for how you tackle rare diseases. You have to take this team-science approach and team-clinical approach, and those two things have to work well together to generate new ideas and new knowledge with an eye toward biotech.” Many thanks to all the teams at the CDMD.

Cathy Jones
Hermosa Beach, California

Re. “Meeting the Future Challenge.” I believe Dr. Washington has missed the point. UCLA has problems that are unique. UCLA medical care is the highest priced in the nation. It will be excluded from the plans marketed by the state exchanges. It cannot compete with Kaiser and the HMO plans on price or efficiency. Its future is not in primary care but in tertiary care that can only be delivered at a handful of centralized hospitals in each large catchment area.

Isaac Gorbaty, MD
Tarzana, California

Dr. Washington responds: Dr. Gorbaty is correct when he writes that the cost of care at UCLA can be high, and that is something we need to take very seriously. But a number of points require clarification. UCLA is a part of Covered California, the statewide health-insurance exchange, through Anthem Blue Cross, and all of the UCLA products that are offered through Anthem are priced lower than what is available from Kaiser as well as being below the national average. Dr. Gorbaty also is correct when he states that tertiary care must be a significant part of UCLA’s future. As we move toward that future, we remain committed to providing tertiary and quaternary care of the highest level, as well as the best primary care possible.

Dr. William N. Valentine died on February 22, 2014. He was 96 years old. I met Dr. Valentine twice, about 42 years apart. The first time was as a medical student at UCLA. My final rotation at UCLA Medical Center was on Dr. Valentine’s service, where once I was asked by our chief resident to present a difficult case — of a man with psoriasis who developed arthritis and then endocarditis — to the professor. The chief resident gave me a few references, and I spent several hours in the library to prepare. Of course, I was nervous, but Dr. Valentine was gracious and asked me to not be timid, so I proceeded to present the case. He called me aside afterward and told me that it was a very good presentation. Three weeks later, I graduated, and my new bride and I moved to Denver, Colorado, for my pathology residency and beyond. When I retired, as professor of pathology at the CU Health Sciences Center, we moved to southern Oregon to be closer to our children and grandchildren. A few weeks after we moved to a retirement community, we went to dinner at one of the dining rooms and sat at a table for four. Soon another couple approached and asked if they could join us. “Of course,” my wife and I said, and we began to talk. The couple said their name was Valentine, and nearly at once I recognized my former professor. Kit, my wife, had never met him, and neither of us had ever met his wife Martha. We ended up having dinner together several times, with most discussions about our days at UCLA, where Dr. Valentine had been a chair of the Department of Medicine and where he did groundbreaking research to discover the underlying cause of hemolytic anemias. At that time, he was also in regular contact with Dr. Sherman Mellinkoff, the former dean of the medical school and a close friend. It was wonderful to become reacquainted with my old professor, whose encouragement meant so much to me.

Ray E. Stanford, MD ’66
Medford, Oregon

Letters to the Editor: Spring 2014

Letter to editorI was sitting at the kitchen table eating a bowl of soup. As we had just stopped our print edition of the San Francisco Chronicle and replaced it with the electronic one, I found myself with nothing to read. I shuffled through the pile of unrequested pieces of mail from the past week and ran across your journal (U Magazine, Winter 2014). I suspect that I’ve received other issues, but that they surely must have gone the way of their brethren, into the recyclables. I’m now sorry that those others were tossed. You have an outstanding publication. Usually, magazines of this genre start fairly interesting but quickly deteriorate into dullness for all but those named and those close to those named. Each of the articles that I read, or will soon be reading, was well-written and contained information of consequence to me as a retired doc. The photography was first rate, as was the layout. I will be on the lookout for upcoming editions and make sure that my wife knows that they not be lumped with J. Crew catalogs and Costco.com coupons in their trip to the dump.

Larry Hill, MD (RES ’69)
San Francisco, California

Thank you for publishing the lucid letter by Dr. Albert Stroberg (“In Box,” Winter 2014) regarding your article in the Fall 2013 issue, “Faith & Healing.” His letter clearly illustrates the problem Americans have concerning evidence and belief. Unfortunately, the other letters on this topic originate from minds already clouded by religious gibberish. Indoctrination of children is akin to abuse and should not be allowed in a rational society, but then again, America has never embraced rational thought. A good start for those wishing to escape ignorance would be Blind Faith: The Unholy Alliance of Religion and Medicine, by Richard P. Sloan.

John L. Moss, PhD, DDS
Santa Monica, California

I certainly enjoyed reading the article “Military Engagement.” This piece describes the incredible humanitarian vision that Maddie and Ron Katz possessed and put into action by facilitating a relationship between Brooke Army Medical Center and UCLA to deliver the best reconstructive surgery to our wounded warriors. What the Katzes did in supporting and facilitating expert care to our injured military personnel is truly remarkable. However, what I found missing in the article is the mention of Dr. Timothy Miller (MD ’63, RES ’70), who served as the chief surgeon of Operation Mend and performed more than 150 reconstructive surgeries on soldiers wounded in action in Iraq and Afghanistan. Dr. Miller was the chief of the Division of Plastic and Reconstructive Surgery at UCLA from 2002-2011. In recognition of his work for treating our injured servicemen and women, People magazine in 2010 named him Hero of the Year, and the U.S. Marine Corps honored him at a Barracks ceremony in Washington, D.C. Congratulations to Maddie and Ron Katz, and to Dr. Tim Miller, who led the UCLA Plastic and Reconstructive Surgery team in treating the injured heroes of our U.S. armed forces.

Ronald W. Busuttil, MD (RES ’77), PhD
Distinguished Professor and Executive Chairman,
UCLA Department of Surgery
Los Angeles, California

Letter to editor I enjoyed Shari Roan’s article, “Joint Liability,” on the issues surrounding joint-replacement surgery in the U.S. Overall, I found the piece balanced and thoughtful. In discussing the financial impact of these procedures; however, the article neglects one key question: Do joint replacements have to cost as much as they do? As the physicians quoted in the article correctly state, joint replacements are remarkably effective and can be life-changing for many patients. I watched my own father transformed from a hobbling old man back to an active charter-boat captain by bilateral hip replacements. But I can’t help wonder if these now-routine procedures can’t be done at lower cost. The cost of the joint hardware itself can vary almost 10-fold, and a recent study shows that even the surgeons using the prostheses don’t know how much they cost. Equally concerning is the cost of the implantation procedure. The American healthcare system is notorious for rewarding procedural care far more than conservative measures. If we need to decrease total expenditures on joint replacements, we can do it without denying individuals needed surgery. We need to work relentlessly to reduce the costs of the procedures — for devices, hospital care and physician services. The American healthcare system — and all of us as taxpayers — can no longer afford to pay top-dollar prices for medical procedures, especially when we’re pennypinching on services that might prevent the need for them.

Victoria S. Kaprielian, MD ’85
Professor Emeritus,
Duke University School of Medicine
Durham, North Carolina

Letters to the Editor: Winter 2014

Your writer confuses a positive outlook, optimism and fellowship, which are all tangible and probably useful attributes, with the nonsense of spirituality (“Faith & Healing,”). The article quotes Dr. [Harold G.] Koening, who has been looking at this issue since 1960, as saying, “Research in this area is not as clear as one would hope.” It is clear; after half-a-century of investigation, no support for the thesis can be found. There is no such thing as “alternative” medicine; there’s only stuff that works and stuff that doesn’t.

As a physician, I have always tried to be as clear and supportive as possible with patients and family, but that has never meant joining in their celebration of spirituality or magic. And as a patient with both non-Hodgkins lymphoma and stage IV melanoma, and coming as close to death as is possible, there was never a moment of doubt that god and spirituality are vacant pursuits. Americans’ grasp of science is already tenuous. People “believe” vaccinations are wrong or their cancer will go away if only they eat better and feel better about themselves, or bring god into their lives. But adults and children get sick, and some die grasping for something not there. UCLA should not be encouraging these medieval beliefs.

Albert Stroberg, MD (RES ’79)
Ojai, California

In the U.S., religion and spirituality are clearly an important part of life and culture for many people. It appears there is good reason for this. For patients where faith is a resource in difficult times (“Faith & Healing”), the benefits have been well documented by years of spirituality and health research. Attitudes that exhibit faith, hope and other positive emotions are simply healthier. The immune system tends to function more effectively when people engage their faith in a manner that helps manage their stress. The mind and the body are connected. So, not only are patients, who are struggling with health issues, psychologically benefited by a positive attitude, their health can be positively affected, too. Healthcare providers who understand this connection will practice patient-centered care that supports their patients’ faith practices. Of course, not all religious attitudes are helpful. Research identifies such conditions as despair or spiritual crisis as posing significant risk for poor health outcomes. A best-practices approach suggests that caregiving involves more than just providing clinical treatment. Though supported by many scientific advancements, at the end of the day, the practice of medicine requires artful skills.

Bruce Nelson
Director of Community Services
Glendale (California) Adventist Medical Center

I too, like Ann Donato (“Faith and Healing”), have a Catholic upbringing and have always relied on my faith to help steer me through life’s challenges and to help me understand how oftentimes good comes from challenges. In times of illness, it is natural and necessary to turn to the spiritual and to prayer, and I’m so pleased to see that UCLA has a Department of Spiritual Care with chaplains providing emotional support to the souls of patients. When doctors add this spiritual aspect to the care of their patients, it completes the relationship and strengthens the power of healing. I believe that when we open our hearts to heavenly help, we receive the courage and fortitude to tackle just about anything. I applaud the doctors and nurses who recognize the importance of faith, and kudos to UCLA for incorporating it into its physician training via the Doctoring 1 class!

Susan Honnold
Brentwood, California

How very inspiring it was to read the article by Douglas Yakich (“Patient, Advocate for Thyself”), who told a brief history of his experience as an ostomate. One reads of his initial and understandable concern that his serious Crohn’s disease and surgery leading to his being an ostomate would lead to a life not well lived, one he changed to being a life very well and fully lived as he found family and community support and, over some years, the confidence and enlightenment to become a social advocate for those like himself. His advice is excellent as to how one can become such an activist, and his story certainly deserves the attention
it is now receiving in this wonderful and useful publication! Thank you.

Elaine Livesey-Fassel
Los Angeles, California

Thank you for the article about deep-brain-stimulation surgery and Dr. Nader Pouratian (“Live from L.A.”). I have Parkinson’s and may need his help someday. I’ve met him already because he performed carpal-tunnel surgery on my wrist. He did a great job. On top of everything else, he’s a very, very nice man.

I thought it was interesting that you had a feature article about someone with a similar name, Nadereh Pourat, PhD, both in the same issue (“Conversation”). Funny coincidence!

Carol Hicks
Los Angeles, California

Letters to the Editor: Winter/Spring 2012

I cannot tell you how delighted I was to read the very well-done article about Santa Monica Hospital. It brought back so many memories for me! At age 7, I had my tonsils out in the original old red brick hospital building - I still remember the ward of 6 crying kids. Much later, I completed my family practice residency there and taught in the program for six more years. To see the amazing transformation over these last several decades is truly inspiring. The residency program has trained so many fine physicians, and always had great support from physicians in all specialties for teaching and patient care. I will always treasure my experiences and education at Santa Monica Hospital and am so glad UCLA is carrying on the strong tradition of education of physicians in a community setting. Bravo.

Jane M., MD '77

Overland Park, Kansas

I am not in the habit of commending organizations for their publications, but my husband, a UCLA alum, and I were very impressed with the contents, and most especially the design, of the Winter/Spring 2012 edition of UCLA Medicine. The articles were well written and their beautiful layout made them particularly accessible. Thank you for making the extra effort to put out this first-rate material.

Lisa R. and Walt L.

Pacific Palisades, California

Thank you for this latest edition of UCLA Medicine - always a most informing magazine and much appreciated. I have been involved with UCLA as a student and graduate and now as a member of the UCLA Affiliates and value my many years of involvement with this institution. I wished to say how very much I enjoyed the moving article "The Healing Medicine of a Wet Nose" since I am an active animal advocate and have volunteered with the HSUS producing the Genesis Awards for 26 years among other involvements and know how wonderful and inspirational this human-animal bond can be! Thank you for all your good and vital work and again, for this enlightening issue of UCLA Medicine! I would also like to express how elegant and attractive I found the architecture of the new Santa Monica hospital and how handsome were the art deco lamps! I am very proud of this magnificent structure, which does great credit to the decision makers and the Westside in general!

Elaine F.

Los Angeles, California

I attended high school with Sue Anne Mitchell, a granddaughter of William S. Mortensen, who, with August B Hromadka, founded the Santa Monica Hospital ("A New Face for an Old Friend"). I so appreciated your article and was very pleased to see this acknowledgement given to Drs. Mortensen and Hromadka. It is wonderful that you included this history of the hospital in this issue.

Susan S.

Los Angeles, California

I found your magazine to be a complete delight to read cover to cover. The layout was engaging, with a balance of pictures and text. Most of all, I found the articles to be well written and balanced - neither dumbed down to be of little benefit in understanding the scientific achievements, nor too technical for a non-professional to understand them.

R. Craig S.

Los Angeles, California

The Winter/Spring 2012 issue of UCLA Medicine is the best ever. It is sharp and tasteful without being too glitzy. I loved the coverage of the UCLA Santa Monica Hospital. The only thing I wished for was a picture of Denise Sur, M.D. ("Five-Star Care"). She was one of my medical students at UC Davis 30 years ago. Keep some coverage of primary care in every issue; it is the foundation of the healthcare system.

Joseph S.

La Quinta, California