Todays New England Journal of Medicine contains an ugly picture (June 10 edition page 2151). It is not a skin lesion or a radiograph containing a foreign object, but it is a map of the United States. On that map, counties are color-coded according to their rates of death from heart disease. About half of the United States now dies from heart disease at a rate that is about twice that in the other half. The areas of high death rates are familiar. They are the areas of poverty defined by the courses of the Mississippi and Ohio Rivers the poor areas of the US