Massive Infiltration of the Skin by HIV-Specific Cytotoxic CD8+ T Cells

To the Editor: In his Health Policy Report on managed care and mental health (Jan.11 issue), 1 Iglehart inaccurately characterized my campaign for the presidency of the American Psychiatric Association.It was based on timehonored clinical and scientific values central to ethical medical practice, which place the sanctity of life before the sanctity of the dollar.I insisted that physicians have moral, ethical, and legal responsibilities to advocate, in the political and social spheres, for both the best patient care and excellent systems of care.My opponent, Steven Sharfstein, and I did not differ on these essentials.We differed on how best to advance and maintain health care for the chronically underserved mentally ill of America in the current mean-spirited, bottom-line climate.I challenged the belief that managed care could be changed from within.My view has been vindicated both by Sharfstein, who acknowledges that the market has driven the seriously mentally ill from hospitals to shelters, and by the "good" managed-care companies that are being forced by the "bottom feeders" to cut services to survive in the shark-infested waters of unfettered capitalism.Those of us who treat patients every day painfully witness the tyranny of the bottom line, giving rise to the "tyranny of the healthy over the sick."[2][3][4] Physicians have a sworn duty to attend to the health care of our citizens.It is paradoxical that those who profess concern about limited fiscal resources are not attacking profiteers leeching a system in which fewer than one in five mentally ill persons receives treatment.It is a national travesty.