Electroconvulsive therapy
EDITOR: Regarding the debate on electroconvulsive therapy (ECT) in the November issue, Robert Sipe in his quest for supportive statements from prominent neuroscientists, lifts a statement from Karl Pribrim out of context. After Pribrim alludes to the unpleasant appearance of brains following a series of shocks, his very next statement reads, "Not that it [ECT] can't be effective as a treatment if carefully used. The same is true of psychosurgery." While my knowledge of Karl Pribrim would lead me to suspect that he would be much more conservative in the encouraged use of ECT than is Bornstein, I think Sipe is irresponsible in not sharing with the reader the qualifications which immediately follow Pribrim's statement. Other verbiage from Sipe would be less questionably omitted.

In the statement from Philipp Bornstein, it is noteworthy that he summarily dismisses the data which indicates brain damage from ECT as bad research. This is to be contrasted with his uncritical acceptance of the data indicating that ECT is safe and effective.

Some of Sipe's criticism seems to refer to a use of ECT which Bornstein himself would oppose and consider improper. Many forms of intervention can be done inappropriately. This doesn't negate the possibility of appropriate application.

On the question of informed consent, I basically agree with Sipe, though I think he gets carried away in his amnesia discussion. Psychiatrists are not fully informed about the consequences of ECT. The shame is that they could be. Partly under the leadership of the late Russian neurologist, Luria, behavioral neurologists and neuro-psychologists have developed sophisticated procedures for assessing memory and other mental capabilities missed in routine medical higher-mental status examinations and IQ tests. There is nothing mysterious or esoteric about those procedures. Psychiatrists just didn't bother to develop them or encourage their development. Happily, there are a few that foster their use including Michael Taylor of the Chicago Medical School.

Since there are still folks who encourage the continued use of ECT, it is not too late to offer the patients a comprehensive neuropsychological assessment prior to ECT and at varying stages thereafter. If this is done with appropriate controls, this would allow us data which could be used for intelligent costs and gains discussions between psychiatrists and patients or patients' families. The statement, "I assure you it is safe," just doesn't make it. Even now, I have records of patients whose epileptic condition has been judged to be exacerbated by ECT as expressed by later medical opinion. I am convinced that we can help to clarify this cloudy issue by the neuropsychological procedures I suggest.

It is an error to discuss electroconvulsive therapy in isolation. The issue is what is an intelligent, patient-oriented comprehensive health care program? The effects of a variety of treatments are detrimental; so also are the effects of a variety of illnesses. All these considerations must be taken into account by the health care team.
      Jonathan L. Hess
      Associate professor, psychology
      Sangamon State University

On tax credits
EDITOR: I agree with most of Mr. Gruenberg's article on Congressman Mikva. However, I disagree with his comments on tuition tax credit and especially his format of stating his unsupported opinion as fact.

Tuition tax credit is not limited to parents of Catholic school children as he implied by using the code word, parochial. It applies to all parents of private school children without any mention whatsoever of religion. Additionally, there are over 2,500 private schools serving the urban poor in American inner cities. Those parents hardly represent a rich middle class able to afford tuition.

Mr. Gruenberg also belies the use of tax money for tuition tax credit. Who does he think paid all that money into the U.S. treasury? Mostly, the parents of private school children. Actually, the amount of money involved is about $350 million according to the Internal Revenue Service. Compare this to the admitted waste in the Department of Health, Education and Welfare of between$7.5 and $10.5 BILLION. Again, hardlya drain on the treasury by the people who paid the money into the treasury in the first place.
       Thomas W. Flynn
       Niles, Illinois

More than replacement
EDITOR: The euphoric discourse of Douglas L. Whitley, executive vice president of the Taxpayers' Federation of Illinois on the replacement of the corporate personal property tax which appeared in "The Rostrum" column of the October issue of Illinois Issues displays a naivete not usually found in one who has spending watchdog responsibilities.

While readily admitting that the replacement package has "a proven annual growth rate which far outpaces the former tax" and that "the pool of dollars available for distribution will exceed the amount of revenue available under the former tax," he suggests that local government might use these additional funds to reduce real property taxes or provide incentives for future business expansion.

He further states that "now is not the time to fall into the same pattern of distrust that prevailed during the past decade. Time must be allowed for the new tax system to function."

Finally he says, "There will be new leaders, new ideas and many elections which will shape and mold the replacement tax to reflect changing times."

28/ December 1979/ Illinois Issues

First of all, the framers of the 1970 Constitution, in the opinion of most constitutional scholars, intended to replace the dollars lost through the elimination of the personal property tax, not provide excessive revenues which give a bonanza to local units of government.

Because the General Assembly failed to place any type of restraint on the growth of the replacement revenues, business by 1990 will be paying almost $ 1 billion yearly in additional taxes over what would have been needed to match the growth of the personal property tax by that year had it remained in effect. And the cumulative effect of the new taxes over the next decade is even more startling with excess revenues totaling over 54.8 billion going to local units of government from the new taxes on business.

Secondly, to believe that local governments will reduce other taxes or use this new found wealth to produce incentives for business expansions, flies in the face of rapidly expanding budgets at the local level which consume every available revenue dollar irrespective of its source.

Thirdly, to suggest that future state legislatures may moderate the growth in replacement revenues runs counter to the massive escalation in state support of local government, particularly in school aids, resulting from the pressures of local governments on the General Assembly which are rarely denied. Once local governments become accustomed to spending the new revenues (and that shouldn't take long) no legislator desiring to remain in office will tamper with this new found benevolence.

Finally, all of the replacement revenues, irrespective of any comparison with lost personal property taxes, will go to local governments with no strings attached and without control over their disposition by local taxpayers.

For these and other reasons the Illinois State Chamber joined in the lawsuit before the state Supreme Court contesting the constitutionality of the new tax package and set forth in its brief, detailed figures on the excess revenue features of the new taxes and the severe economic impact this will have on all businesses in Illinois.

Plain and simply the replacement taxes constitute a substantial increase in Illinois business taxes draining away millions and millions of dollars which otherwise could be used for business expansion, modernization and badly needed job creation.
      Lester W. Brann, Jr.
      President
      Illinois State Chamber of Commerce

No-fault faulty
EDITOR: Those of us who read Illinois Issues have come to look upon the publication as one which attempts, on balance, to present an objective view of its subjects. It is for that reason that I was greatly disappointed in Ms. Collins' article on "no-fault" automobile insurance in the August 1979 issue.

To charge that it is the trial lawyers who have prevented the enactment of no-fault automobile insurance in Illinois is patently unfair and incorrect, as incorrect as the reasons advanced by Professor O'Connell in fostering the theory and relied upon as fact in Ms. Collins' article.

While everyone injured in an auto accident would recover something under a no-fault system, the basic concept not only underwrites carelessness but is highly discriminatory as between the careful and innocent victim and the careless perpetrator. A child, for example, can be seriously injured through no fault of his own or that of the driver of the vehicle in which he is riding, but the child could only recover his medical expense and nothing for pain and suffering. On the other hand, the driver of the car causing the child's injury could be wanton or grossly negligent in causing the child's injury, but if that driver suffered disability for even a short while, he could recover untold thousands of dollars, paid for in part by all the careful drivers. To permit such a distortion of the common law of the land is neither equitable nor just.

Other conclusions of the article are equally incorrect. Studies by the U.S. Department of Transportation and the National Association of Independent Insurers of premium costs in "no-fault" states have shown that $1.07 to $1.12 have gone out for payments for each premium dollar taken in. And for those otherwise unacquainted with developments in the field, Nevada has totally repealed its "no-fault" statute and Massachusetts has partially repealed its law.

If today we deny a person a right to seek redress for his injuries — of which pain and suffering are very material elements — what further abridgment of our individual rights can we expect in the future?
      H. H. Braverman
      General Counsel
      Associate Executive Director
      Illinois State Bar Association

Most retirements voluntary
EDITOR: In the September Illinois Issues, Anderson and Weagant present a good overview of age discrimination and mandatory retirement. However, the authors seem to imply that, but for mandatory retirement policies and other forms of age discrimination, the labor force participation rates of older workers would be much higher.

This is probably not the case. The primary reason for the decline in labor force participation of older workers is the increasing availability of reasonable pensions. Furthermore, even before the 1978 amendments to the federal Age Discrimination in Employment Act (ADEA), it had been estimated that only 10-12 percent of retirements could be considered mandatory retirements. The minimum age to qualify for a full pension appears to be a much stronger determinant of when most people retire than the maximum age allowable under the ADEA.

This is not to say that age discrimination does not occur, nor is it to condone mandatory retirement policies. Commitment to the principle of equality of treatment under the law necessarily leads to the belief that performance on the job, not age, should be the criterion for judging continuation of employment. But it is important to realize that retirement has become an expectable and desirable life event for many people.

Incidentally, readers of Illinois Issues might be interested to know that although the 1978 amendments to the ADEA push the lowest allowable mandatory retirement age for most workers to age 70, the law still permits discrimination in terms of benefits to which workers past the normal retirement age (usually 65) may be entitled. For example, employers are not obligated to add years of service beyond the normal retirement age toward total years of service for purposes of vesting the employees pension or calculation of benefits. This aspect of the law has not yet been tested in the courts. Similarly, employers need not provide life and health insurance policies to older workers which are identical to those for workers younger than the normal retirement age.
      Harry J. Berman, Ph.D.
      Gerontology Program
      Sangamon State University

December 1979/ Illinois Issues/ 29