Dialogue

Error in 'In Error'

In the article "In Error" [Evidence, Summer], you implied that malpractice costs are not a major factor in health care costs. You are correct that payouts of $1 million or more represent less than 1 percent of United States health care costs, but that is not the issue. The cost of malpractice litigation to the health care system is the cost of defense, as measured by the insurance premiums paid by hospitals, nursing homes, and physicians, as well as the cost of defensive medicine.

According to the American Academy of Orthopaedic Surgeons, one-sixth of the approximately 650,000 practicing orthopedic surgeons in the United States report a medical liability claim annually—that is more than 100,000 doctors a year. In Washington, D.C., my insurance premium was more than $60,000 annually. The premium costs are the costs of defense. Since 74 percent of claims are closed without payments, the payouts make up only a small fraction of the costs of medical liability.

According to PIAA (formerly called Physician Insurers Association of America), the average cost to defend a case that does not go to court is approximately $39,000. The total cost of defense of physician cases in the United States was $3.7 billion for the last 10 years. And that figure does not account for unnecessary tests done for defensive medicine.

Medical liability does play a significant role in national medical expenditures.

James C. Cobey, Med '69, SPH '71 Washington, D.C.

True Heroines

While I emphatically disagree with the demeaning reinterpretation of Rachel Carson's scientific ability and scholarship put forth in "Right Fish, Wrong Pond" [Summer], this letter specifically addresses the claim that Carson made no significant friends during her student days.

In 1930, Carson was assigned to assist Grace E. Lippy, A&S '26 (MA), in teaching basic zoology for the Johns Hopkins University summer school. Six years older than Carson, Lippy was a doctoral student and the only woman appointed as instructor in zoology during the Depression. Carson served as Lippy's teaching assistant for the next four summers. Lippy taught the course for 11 years.

Unlike Carson, who was forced to drop out of the doctoral program because of financial issues, Lippy left because she found full-time academic employment. She joined the faculty at Hood College in Frederick, Maryland, as assistant professor of zoology in 1933 and retired with the rank of associate professor in 1967. She died in 1994 at age 97.

Carson and Lippy came from similarly impecunious family circumstances, and both attended women's colleges as undergraduates. Lippy became a regular Sunday dinner guest at the Carsons' home. The two women roomed together in Woods Hole, Massachusetts, during the summer of 1932 when they were both named "investigators" at the Marine Biological Laboratory.

Lippy later recalled Carson as "very quiet, not much fun, and without much sense of humor." But she admired Carson, whom she described as an "avaricious reader" who was "always extremely well-prepared."

Grace Lippy and Rachel Carson never met again, but Lippy was not at all surprised by Carson's later scientific and literary success. She regarded Carson as "one of the nation's true heroines" and was enormously proud to have been her friend.

Linda Lear Author of _Rachel Carson: Witness for Nature Bethesda, Maryland_

Don't 'Like'

Normally, I enjoy reading cover to cover each Johns Hopkins Magazine. It was with great dismay that I saw in your Spring issue that you used an opportunity, in the article "Facebook Follies" [Dialogue], to post a submission mocking those Christians that support creationism theory and those on the right of the political spectrum who support former Alaska Governor Sarah Palin and Congresswoman Michele Bachmann. In the same issue, I found it interesting to read in the boilerplate section [Masthead] that this magazine supports the presentation of diverse views. Really? If so, how often would one see similar cheap shots taken in this magazine against positions supported by those on the left?

A bit of advice: Keep the focus of your magazine fair and balanced.

Vance A. Brahosky, Engr '02 (MS) Springfield, Virginia

'Hang Loose'

I was oddly shocked and sad to read about the death of former Johns Hopkins President Steven Muller "In Memoriam" [Spring]. I say "oddly," not because there's no reason to mourn the man but because he was not exactly one of those hippie liberal arts college presidents who had open office hours or told you to call him Steve. We undergraduates shook his hand exactly twice: once during freshman orientation week and again onstage at graduation. He was a distant bureaucrat and fundraiser known primarily for his preternatural tan and an unverified but persistent rumor that he played one of the von Trapp children in The Sound of Music.

And yet, as far as I know, he said the only thing outside of David Foster Wallace's now-famous Kenyon College address that anyone has ever remembered any speaker at any graduation ceremony saying. At my commencement address in 1988, he said that he knew some of us already had post-graduation plans. Others of us (myself very much among them, and secretly terrified) might not yet know what we were going to do next, and to us, he had this utterly unexpected thing to say (and I'm quoting verbatim): "Hang loose. You'll find your way." Coming from someone who seemed to us like the living embodiment of The Man, it was surprisingly reassuring.

It took me longer than I'd expected and a number of extended detours, but I did, eventually, find my way. Wherever he is, I hope the Man with the Tan is hanging loose.

Tim Kreider, A&S '88 New York, New York

Correction:

"Principles and Practice of Friendship" [Alumni News and Notes, Summer] incorrectly identified the board on which Barry Strauch serves. He serves on the board of Johns Hopkins Medicine.