President's message: egalitarianism, medical care, and mental health.

Throughout the centuries, policy-makers and pressure groups have attempted to impose rules in the face of a recalcitrant reality. Montaigne observed, "Through presumptions they make laws for nature and marvel at the way nature ignores these laws." So too with health policy where one shibboleth plaguing society is the misuse of the concept of egalitarianism. In our society, that should mean equality of opportunity based on reasonable qualifications and equal protection under the law. Another so-called "egalitarianism," that of professional equivalence, is reflected in the attacks on organized medicine along with the concepts of "freedom of choice" and anticredentialism all of which are exemplified in a recent New York Times article. I Medicine is attacked, as usual, for being motivated solely by greed and monopoly. Actually, all groups seeking legal sanction and health care money should be scrutinized for the rationality of their position. The seductive cosmetics of egalitarianism do not justify the creation of more health guilds -particularly when services may be limited, harmful, or wasteful of limited funding from third parties or government. Freedom of choice is a good principle, if there are legitimate alternatives and knowledgeable selectivity. If laetrile has no effect on cancer, then it is not a legitimate choice, whatever its legal sanction. Similarly, it is no choice if it is not as harmless as the proverbial chicken soup to which it is so often compared (as far as I know, chicken soup, unlike laetrile, does not produce cyanide). The Federal Drug Administration attempts to limit freedom of choice where drugs are inefficacious or unsafe. So do medical licensing or related acts which limit the activities of those who call themselves healers. Nonetheless, the various states, under political pressures, have authorized health-related services and occasionally reimbursement by a melange of incompatible peoples and self-selected saviors. These include medical doctors, osteopaths, chiropractors, naturopaths, religious auditors, pastoral counselors, social workers, psychologists, massagers and masseurs, marital therapists, family counselors, nurse practitioners, midwives, physician's assistants, indigenous healers, and God-knows-what. This armada of "healers," all seeking status, money, or professional recognition, ranges from traditional medicine to the theoretically dubious and the overtly quackish. The one thing they cannot have, regardless of the rules of man, is true equality for they are very, very different.