I am grateful to Drs Wechaleker and Parande for their comments and insights presented in their letter to the editor.1 The comment on the epidemiology of CML being the most common leukemia in India, with an average age of 15, was initially brought to my attention at the joint India ASCO symposium in New Delhi in 2002, which was attended by several Indian oncologists. At a 2004 meeting in Houston, these data on CML in India were presented to me personally by a visiting oncologist from India. Because none of these physicians cited me a reference, I had not referenced the source. They emphasized accurate epidemiology in India is problematic, given the complexities of Indian society. Perhaps for accuracy sake, it might have been better to have had more qualifiers validate this. For me, this point was more of a reason to illustrate the need for more dialog between physicians in the developing and more affluent countries. The lack of access of the vast majority of the world's population to the basics of healthcare is a global problem. If my editorial2 has initiate helped discussion, then I feel it will have served one of its intended purposes. As physicians, we have an obligation to increase access to care for all. An international medical dialog on care can help all of us care better for our patients. Different economic circumstances should not be viewed as unpalatable options, but rather be utilized to broaden horizons in discussing options, where they exist, with patients. Perhaps it is unduly idealistic, but only through such dialogs can we improve care for all. There is a need to create and fund more venues for such dialogs. I also wanted to point out that medicine practice in affluent countries is not necessarily providing the best care, and that physicians in affluent countries can learn to create potentially better care options for their patients from the experiences of physicians from less affluent countries.
I am glad that Drs Wechaleker and Parande have noted that the poorest children of the Indian subcontinent not only lack access to transplant, but also to the basics of rudimentary healthcare. Although we have a moral responsibility to provide all children access to curative therapies, it is even more important that they have the moral right of access to basic education and nutrition. As the political system everywhere allocates values and economic resources, the physician's role as healer of human beings demands political activism on these basic issues of human welfare. Physicians should unite to promote the social goal of alleviation of poverty so that each life can be lived to its fullest.
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