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Editor-in-chief Diana J. Mason responds: The photograph was taken in Bangladesh, and it is likely that the head of the bed could not have been raised. The standards we hold in the United States are quite different from those in countries with limited resources. In the photograph, the patient's head is elevated somewhat by a pillow. Just imagine how much a straw might have helped the nurse to give the patient a drink from the glass. That said, the photo and your letter provide a "teaching moment." I'm sure the practice exists in this country, as well as in Bangladesh.