In Reply.—Dr Fried calls attention to a group of young people who have received adequate to excellent physical health care. As he points out, however, a "social illness" is directing them to an impoverished life. Unemployment and industrial strife are certainly two factors at work in the social illness. Many also would consider breakdown of the family structure, drug and alcohol abuse, discrimination, and exposure to violence as seminal.
Discussion of the problems of the poor rarely takes place in our pediatric journals, as Dr James notes. In a recent article by Dr Bazzoli1 entitled "Health Care for the Indigent: Overview of Critical Issues," 86 references were cited, but very few had been published in widely read medical journals.
The indignation expressed by Dr Berliner is unmistakable. One needs to work only briefly with those who appear to be victims of injustice before their helplessness and anger become