Pathologists are traditionally seen as being detached from everyday clinical practice, which explains why we were so pleasantly surprised when we came across the interesting article “A Better Lens on Disease,” by Mike May. Even before the digital revolution, pathologists had developed rudimentary ways (mainly photographs) to capture histological images and submit them to one another for a second opinion. Nowadays such a procedure is adopted usefully at small hospitals in developing countries to refer unusual or difficult cases to internationally recognized European or U.S. pathology departments.
The crucial role of histology in driving targeted therapies (both in cancer and in other diseases) calls for global efforts to ensure consistent histological assessments, and circulating images is fundamental to establishing solid diagnostic criteria. Pathology laboratories have basically changed very little in the past 100 years, and we welcome the digital revolution: it will make it easier for pathologists to conduct a worldwide discussion of their diagnoses and will result in more consistent diagnostic assessments. But the digitized lens is just a tool. It still takes the eyes of a well-trained pathologist to provide the biological rationale for 21st-century personalized therapies.
Matteo Fassan and Massimo Rugge
Department of Medical Diagnostic Sciences and Special Therapies
University of Padua, Italy
In “Revolutionary Rail,” Stuart F. Brown writes that maglev is “the only way fast trains could pass through much of the western U.S.’s jagged terrain.” But existing rail lines do go through these areas, and so could high-speed lines. A grade of 3 percent should not be thought of as a maximum for high-speed rail: the French TGV and German ICE high-speed trains have maximum grades higher than the 3 percent mentioned in the article. Long tunnels such as in the European Alps are also possible. Moreover, in discussing a Los Angeles to Las Vegas high-speed line, the article states that any high-speed line would have to scale grades of up to 7 percent. There are many route options where much lower maximum grades could be used. Furthermore, snow and ice can be more of a problem with maglev than conventional rail because maglev does not have contact pressure between wheel and rail that can cut through accumulated snow and ice.
Louis T. Cerny
Brown typically stresses the technological wonders of high-speed rail and blames the backwardness of the U.S. on “passenger trains [not having been] a federal priority for quite some time.” But there is a far more fundamental reason: with few exceptions, the population density of the U.S. is far lower than that of the regions of the world where high-speed rail has been successful. For example, the very successful Shinkansen lines of Japan connect points in a country with a population of 127 million. California, with about the same land area, has about one third as many people. On the other hand, such lines do attract dense populations. As a “refugee” from the Boston-Washington corridor, I’m not sure I want to see its density re-created on the West Coast.
Lawrence S. Lerner
College of Natural Sciences and Mathematics
California State University, Long Beach
The proposed half-billion-dollar “high-speed” rail link between Cincinnati and Cleveland should be covered in the Anti Gravity column. The system will require substantial subsidies, have an average speed of 39 (no typo!) miles per hour, offer poor frequency of service, and serve only a very limited number of cities. There is virtually no chance to increase speeds substantially without building completely new dedicated tracks. Buses today, operating without subsidy, offer dramatically shorter travel times, comparable fares, twice the frequency of service, and service to more communities. [Editors’ note: The proposal is for a project that would cost $400 million, not quite half a billion.]