I believe that an important issue not addressed in the article ("Franchising the Human Heart," March 2007) is the potential impact of the competitive environment on the teaching mission of UW Medicine. While we will deal with the Cleveland Clinic as best we can, the impact on our teaching programs should not be ignored. We are also a regional resource of great importance to the people of the state of Washington and serve to train medical students, residents, fellows, nurses and a host of others not only from this state but the surrounding states as well. The addition of the Cleveland Clinic to the community does nothing to serve this important mission.

LARRY S. DEAN, MD

Professor of Medicine and Surgery Director, University of Washington School of Medicine Regional Heart Center