Dr Kripke’s commentary “Non Nocere, If You Really Care” [1] on my paper “Hypnotic Medication in the Treatment of Chronic Insomnia” [2], provides an outstanding example of civil discourse in exploring an important professional difference of opinion: the role, if any, of hypnotics in the treatment of chronic insomnia. His comments underscore that one can disagree without being disagreeable, a point some of our colleagues have yet to learn [3]. This does not mean that Dr Kripke is dispassionate in his concern about the dangers of using hypnotics over long periods of time. On the contrary, he urges that the practice stop until a more definitive study of the problem is undertaken to establish the risks and benefits, if any, of prescribing hypnotic medications long-term [4]. Unfortunately, I am constrained by editorial considerations to respond only to his commentary on my review [2] and not on his review itself [4] or his two earlier papers [5, 6] all of which I would urge the interested reader to examine. I want to state at the outset that Dr Kripke’s major recommendation that we undertake long-term controlled trials of hypnotic efficacy and safety is a recommendation with which I would, of course, agree. I do not believe that my concern about whether such trials could be successfully carried out reflects a hopelessness on my part. Rather, it is the recognition of the difficulties likely to be encountered and the desirability of considering additional strategies to monitor effectiveness and side effects. The development of large, systematic databases, as has been recommended recently [7] as appropriate to study some types of health problems, should be applied to studying the long-term use of hypnotics in chronic insomnia. Dr Kripke recognises the problems the clinician has in treating patients with profound insomnia. In the clinical illustration in my article [2], Ms B., an 87-year-old woman, had been on benzodiazepines for 15 years and has anxiety and a sleep complaint. She was urged by her physician to reduce her benzodiazepine as he was concerned that it might be harming her health. Ms B. had had her symptoms of anxiety and poor sleep since young adulthood. With her medication reduced by 75%, she described her