In Reply: Dr Gabel cautions that the reduction in overall anesthetic mortality may be less than we quoted for anesthesia in low risk patients, although the figure he cites, 1 in 15 000, is also 90% lower than the rate found in the 1950s.1 This progress in anesthesia mortality is even more remarkable, given that patients undergoing anesthesia today are older, have more comorbid conditions, and are receiving riskier and more complicated operations than before. Another measure of improvement is the dramatic decline in anesthetists' malpractice insurance rates.2 Anesthesia remains a powerful example of what can be accomplished by focusing on safety.