As you show in your three-page briefing on health tourism, health care has turned into a thriving global business (“Operating Profit,” August 16, 2008). Now that Americans have joined the fray, and in growing numbers, everyone is starting to pay attention to the old trend of people from rich countries going for health-care services to poor countries. It is thus the right time to ask, as you do, what will be the effect on the health-care systems of rich and poor countries alike. One of your conclusions concerning the latter is obvious enough: health tourism will help poor countries by increasing the quality of their medical services. This will be done by reducing administrative incompetence and corruption, reversing brain drain, improving equipment and facilities, and so on. What you failed to mention is that the main beneficiaries of these changes in the poor countries will again be the rich from these very countries. Obvious enough, is it not?