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To the Editor: Dr Jarvik and colleagues¹ found that among patients with lumbar pain, those who had plain radiographs had similar outcomes as those who underwent magnetic resonance imaging (MRI). I am uncertain of the logic of this trial because plain radiography and MRI are diagnostic tests, but the outcome measure was functional disability. Diagnostic tests should be contrasted for their ability to render accurate diagnoses.

How physicians handle those diagnoses is a separate question. Whether treatment based on the diagnoses improves outcome (such as functional disability) is another important but different question.

Accurate diagnosis allows physicians to rule out other possible etiologies and to give a prognosis. Knowledge of the disease allows clinicians to choose treatments that might work even when they have not been well studied or shown to be effective. Unfortunately, accurate diagnosis does not always lead to improved outcomes, but that does not mean that such . . . [Full Text of this Article]

Louis R. Caplan, MD
Division of General Neurology
Harvard Medical School
Boston, Mass

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