Editor—Creese attacks user fees but fails to make a proper case against them in Britain, basing his arguments predominantly on evidence from countries in the second and third worlds.1 Creese's statements about the disadvantages of user fees may be true for underdeveloped nations, where absolute poverty is common and the main diseases are infections and illnesses associated with real deprivation. The situation in first world nations is different. Both the media and politicians have encouraged what …