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Marcia Angell, MD
Deputy Editor The New England Journal of Medicine Boston

JAMA. 1986;255(10):1288.

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In Reply.—

I thank Drs Ross, Matthews, Blondell, and O'Brien for their thoughtful comments. I agree with Dr Matthews that the amount of testing that goes on in teaching hospitals may be different from that in nonteaching hospitals and in the outpatient setting, and for this reason I limited my consideration to teaching hospitals, for which we have reasonably good data. However, Dr Matthews' estimate that no more than 10% of laboratory tests in his hospital could be considered unnecessary strikes me as unusually low. In any case, I would certainly not argue for a czar to review orders, but for a change in education and practice styles that acknowledges the limitations of testing. By and large, education does work, and like most physicians, I prefer it to regulation. Dr Blondell is similarly mistaken in thinking that I was calling for peerreview mechanisms to decide which new technologies are beneficial; . . . [Full Text PDF of this Article]

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