American Indian Medicine: Paternalism and Pluralism-Reply

Marsha F. Goldsmith
JAMA. 1986;255(15):2027-2028. doi:10.1001/jama.1986.03370150069026.
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In Reply.—  I appreciate Dr Smith's comments, particularly because they so admirably make the point that even in what she is pleased to consider "our melting pot society" considerable difference of opinion exists on the best way to solve many problems—the provision of good health care for American Indians among them.That Dr Smith "gets tired" of hearing about the destruction of Native American culture is beside the point. Facts are facts, and the fact that the culture of every Indian tribe, however one may characterize the varieties, was vastly altered by this continent's settlement is indisputable.Members of the Association of American Indian Physicians (AAIP) are very well aware of the pluralistic nature of the various tribes, and the association does not purport to represent them in all their diversity. What it represents is a collective concern over the gap in health status between Indian and non-Indian persons in


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