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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

With respect to the editorial by Alpert,¹ I believe that the health care situation we are in is not "a brain tumor," but a total depressive state. Managed care is here and will continue to change our profession as it pleases. I take pleasure in my career and everyday encounters with patients, in finding murmurs and giving visas to new immigrants, but I do not like any of the business aspects of health care. As long as we allow managed care to dictate our daily lives and as long as we accept it, we will have a "brain tumor" in our health care system; however, transient ischemic attacks and the big cerebrovascular accident, the big stroke, is coming. When it arrives, we will be replaced by physician assistants, nurses, or other clerks. Come on, let us get together and tell them this is enough. Medicine should be dictated by physicians, . . . [Full Text of this Article]

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