We're all responsible.

The issues raised by Steven Miles's book, Oath Betrayed: Torture, Medical Complicity, and the War on Terror ("Malpractice," November 17, 2006) are central to the future of our society. Unfortunately, the review by Daniel P. Sulmasy misrepresents the book in many ways. Miles presents evidence of unethical behavior by military physicians, notably pathologists' mishandling of autopsy data and a lack of response by clinicians to reports about the mistreatment of prisoners. He also documents acts of courage by those willing to question abuse and the suppression of information. Miles's overriding message, however, is that the moral challenges raised by torture are problems for which we are all responsible. There is no claim, as Sulmasy implies, that torture by agents of our government is "wide-spread." The problem is not that it is widespread, but that it is permitted by our most powerful leaders and by ourselves if we quietly acquiesce.

As a practicing physician, I am grateful to Miles for calling on his colleagues to join the international medical community and the U.S. legal community in raising the alarm before we reach the point of condoning widespread torture as an instrument of public policy. More important, his call to human decency and responsible citizenship applies to all of us, whatever our work.

FREDERICK W. ADLER, MD

Arcata, Calif.