Practice Guidelines-Reply

In Reply.—  Developing valid practice guidelines is emotionally difficult and intellectually challenging, and I am appreciative of Dr Woolf's and Mr Goldschmidt's comments on my article. Unfortunately, parts of my article appear to be misinterpreted.In particular, Dr Woolf argues that I recommended that guidelines be used by insurers, courts, etc. I argued that they might be used by these agencies. If physicians aggressively pursue the development of valid practice guidelines and modify their practices to reflect their content, then such use might be unnecessary. It might be even in physicians' interest for each of us to contribute $100 per year to the development of publicly available and valid practice guidelines that would shape the future of American medicine. Willingness to help finance this activity might help convince the public that physicians want to use guidelines, as Dr Woolf suggests, for the purpose of continuing improvement.In terms of the