—Dr La Puma is correct in noting the gap between our vision of how medicine should be practiced and uncomfortable realities. Leaders in medicine have a responsibility to forcefully articulate appropriate norms and use their leverage to influence practice arrangements and the education of future physicians.We believe our recommendations have more potential (and are more controversial) than La Puma's characterization suggests. We called for disclosure of physician incentive payments and suggested that the Health Care Financing Administration's proposed regulations were too limited, but even these regulations face vigorous opposition. We oppose physician-sponsored health care plans because they further confuse conflicting interests between plan financing and organization and physicians' responsibilities to their patients. Even more important, we believe that the profession of medicine must use its educational and regulatory opportunities to reaffirm repeatedly its commitment to full and open communication with patients and speak vigorously in support of this ethic.