Thank you for the March 31 article, "Changing the script," which discussed the issue of pharmaceutical companies marketing programs and gifts to physicians to seek to promote products.

While we may laugh about banning the distribution of pens and notepads, the real issue is that physicians are expected to, and should be held to, a higher standard of professional conduct.

Our patients deserve our adherence to an ethical standard that assures them of our responsibility to care for them, to place their interests first and to be their advocate in a complicated and not always "patient-oriented" world.

The Allegheny County Medical Society supports a clearly defined, limited and transparent reporting of business relationships with physicians.

We respectfully suggest that similar standards be considered for other business relationships concerning health care.

DOUGLAS F. CLOUGH,
President
Allegheny County Medical Society

In disbelief I read the article reporting that a Chinese firm was just awarded the contract to provide the exterior glass for the building replacing the World Trade Center Towers. ("PPG Criticizes Foreign Glass for WTC Tower," April 3).

The Chinese were selected over a bid by Pittsburgh-based PPG Industries, which provided the specs for these windows. This is both incredulous and insulting to those Americans who lost their lives on 9/11. Not only is this unpatriotic given the nature of this project, but it also flies in the face of the "produce and buy" American products message espoused by our political leaders.

What in the world was the Port Authority of New York thinking when they made this decision? I implore our elected officials to make this outrageous decision more visible on the national stage and to do whatever is necessary to get this overturned.

MIKE HUDAK
Pleasant Hills

You recently published a letter from a former health insurance spokeswoman lauding the industry's proposal to reduce premiums for sick Americans, in exchange for a federal mandate requiring that all uninsured folks buy coverage.

On the surface, this seems like a reasonable request. The letter argues that by increasing the number of young and healthy people with insurance, the cost -- and risk -- of covering sick and elderly patients will be spread among a wider pool, and premiums for everyone will be reduced as a result.

In reality, such a deal will not reduce the cost, or improve the quality, of private insurance unless other concrete steps are taken.

Let's look at Massachusetts as an example. Private insurers there promised to sell policies to all applicants at a lower cost once the state mandated that the uninsured buy coverage in 2006. Currently, insurers there cannot deny coverage or charge higher premiums to folks with pre-existing conditions, although they do charge more based on a person's age.

Now, with 97 percent of the population insured, the cost of private insurance in Massachusetts is still rising -- premiums are growing at a rate of 10 percent per year. The state, and its small businesses, cannot keep up with the cost of subsidizing coverage for low-income folks, and some middle-income earners have been exempted from the mandate so that they are not forced to break the bank buying coverage.

At the same time, the insurers are increasing co-pays, reducing benefits and offering "bare-bones" plans to keep costs down. So as the price continues to rise, the quality of many of the plans is sinking.

Mandating that all Americans buy insurance from for-profit companies won't reduce the cost of our health care system. We need greater oversight of the private insurance industry, physician payment reform or a new approach entirely, such as a national single-payer insurance plan.

The mandate will, however, deliver another 47 million customers to the open arms of the private insurance industry. It's no wonder that industry spokespeople are encouraging Congress to pass this legislation quickly.

JULIA NAGLE
Bloomfield

I grew up in Pittsburgh and lived here most of my life, and I find the area to be absolutely brutal for jobs.

I moved to Columbus, Ohio, for an opportunity that I could not get in my hometown. I sold advertising for a year until my grandmother became critically ill and I had to move back home to Pittsburgh. My boss said because my sales and performance were so outstanding I would not have difficulty finding another job in Pittsburgh. But I found myself unemployed from January 2005 until July 2006. Once more, I had to move out of state (this time to Cincinnati) to land a decent job in sales.

Unfortunately the only jobs available in the Pittsburgh area seemed to be low-paying jobs: customer service, retail, restaurants and call centers.

I find the region to be extremely harsh toward working women. I have found firsthand that the wage gap between males and females in the city is extreme. People still have the mentality here that a man needs to support his family, but a woman should be willing to take anything.

I realize that Pittsburgh is not as bad as Detroit, Florida and other parts of the country. But I understand all too well that in this city you have to know people to get good jobs because what you know does not seem to be as important as who you know.

LISA C. NICOLETTE
Cincinnati