The many contributors who responded to my "Viewpoints" article about managed care in the August 2 issue have referred to me as provocative, slyly contemptuous, uncritical, wrong, improper, an ivory tower academic, inappropriate, mean-spirited, factually inaccurate, disparaging, and a Martian from a different planet.

Perhaps this earns me the right to restate my position. It can be paraphrased as follows: Principles of care management have evolved that now require providers to consider cost as well as quality. This is in synchrony with the sociopolitical zeitgeist and has resulted in tangible benefits to the people who pay for and those who consume health care. Some people have profited, but entrepreneurship is not an evil in America. Our own wealth as physicians places us in an ethically weak position to throw stones. Only if we overcome our anger toward managed care and learn to adopt new principles of care management will we regain control over its delivery.

This opinion has been categorized as a diatribe on behalf of all managed care, a ghastly exaggeration, and a Mussolini-like defense of managed care regimentation. I am accused of having pilloried our national organization, flagellating its membership, and insulting the integrity of all psychiatrists.

Among the replies there were also some salient points and fair-minded comments. My reason for cataloging the predominantly negative and nastier responses is to remind readers that the major point of my editorial was to suggest that our Association (why blame the leadership_we elected them) has lost its balance and perspective by turning managed care into an "Evil Empire" and attacking it with a fervor akin to McCarthyism. Rather than restore respect and dignity to our profession, this strategy may result in political rejection and public ridicule.

Demagoguery employs tactics that seldom succeed in a democratic society. When enough people shout loudly enough, they come to believe that they speak the truth. Those with a differing viewpoint are disparaged or discredited until dissent is stifled. Ultimately the opposition is deprived of its First Amendment rights if, as the secretary of APA suggested, disagreement is considered seditious and therefore no longer fit for publication.

I am thankful that the editors view Psychiatric News as an open forum for the opinions of all the members irrespective of how politically incorrect they may seem.

Barry Blackwell, M.D.

Milwaukee, Wis.

This is the final letter that Psychiatric News is publishing in response to Dr. Blackwell's "Viewpoints" article in the August 2 issue.

--Editor

(Psychiatric News, October 18, 1996)