We are not surprised that Dr. Bolan was annoyed by our article's title, but we deeply regret if he found it flippant or cynical. This was hardly our intent. As physicians in palliative medicine and pediatrics who care for HIV-positive patients, we are sympathetic to his position. However, we disagree with his suggestion that an entitlement is economically necessary to protect an investment. We fear that an entitlement would only widen the gap in access that separates AIDS and other diseases.

Dr. Bolan also proposes that an entitlement is ethically necessary. This claim requires additional justification, such as that offered by Dr. Bessenen and Ms. McCollum. They suggest that special funding for expanded access to HIV therapy is justified by the cost savings generated with this "preventive" approach. They also suggest that the yearly cost of HIV therapy compares favorably with the cost of treatment for cardiac disease. We find it interesting, however, that when patients with heart disease lack insurance or Medicaid, the federal government does not provide access to treatment. In light of Bessenen and McCollum's argument, we are surprised not that funding exists for AIDS, but that similar funding is not available for other diseases.

Regarding Dr. Frothingham's first point, it is not clear to us how access to protease inhibitors will help to slow HIV transmission. In fact, Bayer (1) notes that the debate over other exceptionalist policies governing testing and reporting was driven by the belief that these restrictions may facilitate the epidemic's rapid spread. Dr. Frothingham's second point regarding the benefit of HIV treatment raises a much larger issue. The real question, we believe, is not simply one of cost versus benefit. It is, rather, one of process. Who should make decisions about resource allocation? Should this be a matter of "science" or a question of values? Whose values? How can these values be presented and examined?

The fundamental question is whether adversarial processes of lobbying and political influence, the current standard of allocation, are the best way to allocate health care resources. We believe that a more just and compassionate process is possible. Members of the AIDS community have demonstrated remarkable creativity and empathy in reconstructing health care delivery for HIV. We hope that these advances will continue and that these remarkable qualities will guide our reconsideration of the process by which we determine our health care priorities.