In his criticism, Dr. Neff raises a few points we can agree with. It is precisely because there are so many entrepreneurs promoting treatments and products under the rubric of CAM that doctors and other legitimate health care providers need to be knowledgeable about CAM. As we point out, the average person needs help to sort out the unproven and possibly harmful treatments and products from those that are supported by evidence. Who better to supply this help and advice than a well-educated, knowledgeable physician? We also agree that CAM therapies should be tested for safety and efficacy and applaud the increasing efforts in that direction through funding for rigorous research by such agencies as the National Center for Complementary and Alternative Medicine and other institutes of the National Institutes of Health (1). To ignore the existence of CAM and omit it entirely from medical school curricula, as Dr. Neff suggests, would be to ignore medical practices and therapies used by more than half of the U.S. population (2). This would be a disservice to future doctors and to the patients who will rely on them for guidance about the use or avoidance of these therapies.

Dr. Manu has correctly interpreted our goal of educating physicians and other health care providers to be informed about the range of therapies and practitioners of CAM. As for the economic implications for primary care physicians, the reality is that most patients consult a primary care provider first and do not see alternative practitioners exclusively (3). It is a matter of sharing the health care dollar rather than competing for it. Predictably, primary care physicians who are knowledgeable about CAM practices and can coordinate care for their patients will be increasingly in demand.

Dr. Ernst makes a valid point by suggesting that U.S. medical educators look to countries, such as Germany, that have long incorporated familiarization of CAM into their required medical curricula. He is also correct that the medical school curriculum should present a balanced view of the proven benefits and potential dangers of CAM therapies. In our article, we point out the need to teach students to be skilled readers of the research literature and to critically evaluate all therapeutic options. Certainly the tendency to be "uncritical enthusiasts" or "uninformed skeptics" benefits no one and should be countered by appropriately trained faculty and a curriculum that includes all rigorous evidence concerning the potential of CAM for benefit or harm.