In Reply.— I have read Dr Sinnreich's letter many times and have come to surprising conclusion that he is accusing me of conspiring with Drs Ellwood, Relman, and Roper to impose on medical community notion that quality medical care can be measured only by referring to outcome. Dr Sinnreich's last paragraph implies that the respectability of their [Drs Ellwood, Relman, and Roper] pursuits depends on the theoretical rationale of my argument. I am honored to be associated with endeavors of these renowned physicians, but I urge Dr Sinnreich to accept my disclaimer that any conspiracy exists. If these physicians find or fail to find some value in my article, it will not be because of some collusion between us, but because they have read with open minds my independent attempt to clarify notion of quality medical care. If Dr Sinnreich believes that I equate outcome
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