Roman's article describing an epidemic of neurologic disease in Cuba is comprehensive and well documented [1]. I wholeheartedly agree that "physicians may need to use their influence to modify political decisions when these decisions result in adverse health consequences." Nevertheless, I do not agree that the U.S. embargo and the breakdown of the Soviet Union are the principal causes of the problems affecting Cuba in the 1990s. Undoubtedly, the U.S. embargo and its tightening through the Cuban Democracy Act of 1992 are a heavy burden on the Cuban government, particularly given the collapse of the eastern Europe network of trade, credits, and aid. The current predicament, however, is largely due to irrational and inefficient social planning and to the policy choices made by the Cuban leaders.

The government's closing of the peasant markets in 1986 and its subsequent refusal to reopen them in 1990 (when the food crisis first emerged) had much more to do with the origins of the epidemic than did the embargo. By most accounts, the reopening of these markets in October 1994 has positively affected the food supply. Had the markets never been banned, the food crisis of the 1990s—and perhaps the epidemic of optic neuropathy—might have been avoided. In this case, neither Washington nor Moscow is to blame. The fact that Cuba cannot feed its population and the subsequent ill effects of poor nutrition are primarily the responsibility of the Cuban government.

Although the responsibility of the current economic disaster lies mostly with the Cuban government, I do not condone the embargo because it contributes to the suffering of the Cuban people. Although I disagree with Roman's assessment of the importance of the causes of the epidemic, I thank him for his humane concern for the welfare of the Cuban people. I am critical of the U.S. policy toward the Cuban government and support a process of genuine and broad-ranging negotiations between the two governments with the aims of lifting the embargo and promoting a peaceful transition to democracy and economic recovery.