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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 . . . [Full Text of this Article]

Ronald Pust, MD
rpust@u.arizona.edu
Department of Family and Community Medicine
University of Arizona College of Medicine
Tucson

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