It would be fairly trivial to write a script that cycles through a list of email addresses and sends a personalized mail to each address. I wouild also imagine somewhere in MS's office package the mail merge feature could be tweaked to make this happen. Anyone who relies on email as a part of thier business to communicate with clients really ought to have something in place that manages contacts, keeps them up to date and facilitates distribution of information. I think the issue with this particular clinic is that they are most likely underfunded and can't invest in comms. Actually, this is something Google and MS should think about - they've been pretty proactive in small charity and related areas - easy to make a newsletter app happen in both Office and Gmail.