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Comments on the changes in academic medical facilities that have caused many to reorganize as they adopt tighter management to reduce costs. Reasons for the changes; Concern that the preoccupation with costs and revenues might distract them from their traditional missions; Example of the new order as seen in the partnership between GE Medical Systems and New York-Presbyterian Hospital which itself is the result of a merger of Cornell University Hospital and Columbia University Hospital; Potential problems with the arrangement which locks in the facility to GE products only; Other possible conflicts of interests in the arrangement; Call for GE Medical to help the hospital to responds to the incentives it faces.

A letter to the editor is presented in response to the report of the Diabetes Control and Complications Trial on the effect of intensive treatment of diabetes mellitus by David M. Nathan and colleagues in the September 30, 1993 issue.

A response by Alan M. Garber and colleagues to a letter to the editor about their article on drugs for treatment of Gaucher's disease in the December 3, 1992 issue of the journal is presented.