It is ironic that the final page of the recent article by Hall and Berenson [1] is shared by a quote from Plato, who himself was greatly motivated in the intellectual fight against relativistic thinkers of his day, in particular the Sophists. An example of this thinking is found in the claim that "It is untenable for the medical profession to continue asserting an idealistic ethic that is contradicted so openly by daily practice."

Despite the bold statement, the authors worry about the cynicism generated by rule instrumentalism that might "become so widespread that it destroys the beneficial ethos." Cynicism does indeed follow naturally and uncontrollably from ethical relativism and will eventually damage physician-patient relationships.

However, the most disturbing assertion is that "devotion to the best medical interests of each individual patient [will] be replaced with an ethic of devotion to the best medical interests of the group for which the physician is personally responsible." Clearly this is where such philosophy takes us, but at the cost of abandoning a "rule" that has supported the physician-patient relationship for millennia, across cultural diversity and beyond technological advances: Do unto others as you would have them do unto you. Although this universally applicable rule is fundamentally at odds with the authors' presuppositions, it has served as an excellent litmus test for the potential evils of any social system, including managed care medicine.

To the extent that managed care organizations are unable to include the best interest of patients in an honest, trusting relationship with their physicians, they will surely fail, and deservedly so. Therefore, let this be the "realistic principle" to which physicians rededicate themselves.