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	Since this article does not have an abstract, we have provided the first 29 words of the full text and any section headings.

In Reply: The second sentence of the Comment section indeed refers to the findings of our study, not the IOM study. I thank Dr Shortell for clarifying this point.

Claire Snyder, PhD
claire.snyder@alumni.duke.edu
Johns Hopkins Bloomberg School of Public Health
Baltimore, Md

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294:680.

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