A knotty (I almost wrote naughty) and vexing problem of long standing. I had to look at it recurrently and thoroughly while working on an ethics code for the William Alanson White Institute and before that for the American Psychiatric Association. Personally I would not use Dr. Forrest's letter to a patient because it tends to introduce and highlight the subject, bypassing as it were a face-to-face encounter preferably initiated by the patient. This does not detract from the merits associated with such approach and the involvement of a department of psychiatry otherwise used. Also, as a matter of personal experience I have not appreciated the requests for funds by hospitals or university programs and conjunction with my use of facilities connected with them. But, as my ancestors used to say, to necessity even the gods have to bow or be convinced. That is moot as the question may be. Also, there is the question of what is the actual meaning of who profits by what, directly or indirectly considering what is involved. No wonder we end up resorting