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Background-A novel flavivirus has been described recently and designated hepatitis G virus (HGV). The virus is transmitted by the parenteral route but it is uncertain whether it is associated with chronic liver disease because liver biopsy is diYcult to justify in this group. Aims-To examine histological features of liver biopsy in patients infected with hepatitis C virus (HCV) according to the presence or absence of HCV and HGV RNA. Methods-One hundred and thirty one consecutive HCV carriers undergoing staging liver biopsy were studied retrospectively. In each, HCV RNA and HGV RNA were detected by reverse transcription polymerase chain reaction on serum samples collected at the time of biopsy. The presence of each RNA was correlated with histological features blind to the RNA results; individual histological features of inflammation or fibrosis were scored separately. Results-Nineteen patients were positive for both HGV and HCV RNA in serum, 91 were positive for HCV RNA alone, two were positive for HGV RNA alone, and 19 were negative for both RNA species. Neither age nor sex diVered between the groups; a greater proportion of intravenous drug users were HGV RNA positive, but this was not statistically significant. There was no eVect of HGV coinfection on the stage of fibrosis or any other histological parameter except steatosis; patients with HCV and HGV RNA had a higher mean score for fat than those patients with HCV RNA alone (p<0.05). Conclusions-HGV coinfection has no important eVects on histological features in chronic HCV carriers. It is unlikely that HGV infection causes chronic liver disease. (Gut 1998;42:103-106)

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Letters to the Editor are considered for publication (subject to editing and abridgment) provided they do not contain material that has been submitted or published elsewhere. Please note the following:• Your letter must be typewritten and triple-spaced.• Its text, not including references, must not exceed 400 words (please include a word count).• It must have no more than five references and one figure or table.• It should not be signed by more than three authors.• Letters referring to a recent Journal article must be received within four weeks of its publication. • Please include your full address, telephone number, and fax number (if you have one).You may send us your letter by post, fax, or electronic mail. We cannot acknowledge receipt of your letter, but we will notify you when we have made a decision about publication. We are unable to provide prepublication proofs. Please enclose a stamped, self-addressed envelope if you want unpublished material returned to you.Financial associations or other possible conflicts of interest must be disclosed. Submission of a letter constitutes permission for the Massachusetts Medical Society, its licensees, and its assignees to use it in the Journal 's various editions (print, data base, and optical disk) and in anthologies, revisions, and any other form or medium.The New England Journal of Medicine Downloaded from nejm.org on May 10, 2018. For personal use only. No other uses without permission.Copyright © 1995 Massachusetts Medical Society. All rights reserved. Nov. 2, 1995 able services for a voluntary and rationally negotiated fee from autonomous patients. No wonder there is a growing push for medical savings accounts as one method to empower individual patients and, by extension, their physicians. We should call managed care what it really is: a statist, collectivist, anti-individualist, antimarket system, masquerading as capitalistic and market-oriented. Consider your statement: "Because individualism and competition are increasingly celebrated, the principles of the marketplace now permeate our personal lives and even capture our judgment." If only this were true; on the contrary, it is a profound misperception. Unfortunately, we have a sham marketplace, because it is not a free marketplace. THE NEW ENGLAND JOURNAL OF MEDICINEThe medical profession and its leaders need to grasp the essential nature of managed care and the immorality of the pseudo-marketplace. Only then will we be able to avert the death of our profession. To the Editor: Manipulated by the artful rhetoric of antigovernment, antitax idealogues, the Congress has facilitated an unprecedented deconstruction and degradation of our health system. The process has placed the nation's standards of health in jeopardy.The realities of rising costs are the cover for this raid by corporate takeover experts. The billions to be harvested from the trillion-dollar health care enterprises are, of course, irresistible to the corporate firms whose function, fundamentally, is to maximize returns to their investors. T...