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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I would like to address one issue in Feinstein's superb (that establishes my age) commentary.¹ In the last paragraph he states that "the absence of better monitoring from within the health profession may allow the threat of lawyers . . . to become a patient's best protection against negligent errors."

A similar issue has arisen in connection with the failure of the educational message of the American Diabetes Association regarding glycemic control to penetrate into practice patterns.^2-3 I commented that

Since physicians have not incorporated these standards into practices, consumers should be encouraged to insist that third party payors, government, HMO's and providers adhere to them or else. ADA should address the ". . . or else" as part of its mission to improve the lives of diabetic patients. This may bring confrontation. If this is the only way to move the process, we should be willing to do so . . . [Full Text of this Article]