Quality and the Medical Marketplace

To the Editor: The editorial by Drs. Angell and Kassirer (Sept. 19 issue) 1 is cute but fails to answer the question, Where did all those elephants — whose excreta is unmanageable — come from? At a time of hand wringing in medicine, we seem to be blind to the source of the problem. We have fought for more and more investment in basic research and won. We have also refused to reduce our training mills, especially for postgraduate education. As the fruits of these investments flow into the medical marketplace, a diarrhea of elephantine proportions, we should remember who provided . . .