Sir.—I commend you for the indepth discussion in the May 1991 issue of AJDC concerning the increasing difficulty in providing adequate, not to mention equitable, care to children ad adolescents in this country.
As a pediatric gastroenterologist who treats many children with chronic disease, I am only too aware of the numerous obstacles faced by their families, many of which are alluded to in the articles by Miller and White1 and Allen et al.2 Families cannot afford appropriate medications or continuity of care and cannot obtain medical insurance coverage. Problems mount as industrious older adolescents and young adults are refused employment because the employer would face higher medical insurance costs if they were hired.
Pediatric teaching hospitals that, in the past, championed the needs of the disadvantaged are under increasing pressures to subvert ethical concerns in the interest of fiscal success. The message we are giving to