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The physicians and medical students surveyed had little training in herbal toxicities and drug interactions. They generally rated their familiarity with these topics as 'poor', and their scores on the quiz bore out this assessment as correct. Educational efforts might improve physician knowledge of the adverse effects of herbal remedies.

d) or placebo. 8 Even one of the most impressive treatments in our therapeutic armamentarium, which, in the MIRACL study, lowered low-density lipoprotein cholesterol level by 40%, led to far more modest risk reductions in cardiac events requiring hospitalization than the reductions reported for enhanced depression care in the COPES trial. Indeed, most of the effect of high-dose statin treatment in the MIRACL study was due to a 26% relative risk reduction and 2% absolute risk reduction in hospitalization for myocardial ischemia. Thus, while the results of the COPES trial are provocative and exciting, they must be replicated in larger, appropriately powered trials before the promising reduction in hospitalizations can be used to calculate potential cost savings.Ladapo et al 2 should be congratulated for addressing the economic impact of their findings and for conducting a randomized controlled trial in patients with ACS, a difficult enough task in and of itself. However, the task before medical professionals when interpreting studies like this is also challenging. Coping with rising health care costs requires us to carefully examine all the resources that would be involved in implementing "more health care" and then, equally, to carefully determine whether this would actually lead to "better health" by evaluating the net gain to patients and society. Whether the COPES trial is good value for the money remains unclear.

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