Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: Many JAMA readers practicing
in developed nations may have searched in vain for a personal role in global
health, the theme of the June 2, 2004, issue of JAMA.
Yet I believe there is a call for clinicians in the Commentary by Lee
and colleagues.1 As funding from groups
such as the Global Fund and Gates Foundation facilitates basic research and
evidence-oriented field trials,2 the limiting
factor becomes "whether poor countries have the capacity to put additional
resources to effective use. . . ."1 The
overarching systemic challenge—scientifically, ethically, and politically—continues
to be "going to scale" with what the world already knows. The sine qua non
of scaling up is the practicing and teaching of quality clinical and public
health care at district/regional hospitals worldwide.3 In
dramatic contrast to Chad,1 which has 1
physician per 40 000 citizens, or even Bangladesh (1:4000), the United
States (1:350) has had an abundance of physicians.
Pust R. Individuals and Global Health Improvement. JAMA. 2004;292(11):1303. doi:10.1001/jama.292.11.1303-a