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Gerald B. Healy, MD
Children's Hospital Boston, Mass

JAMA. 1995;273(9):700.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—I am deeply troubled by the article by Dr Kleinman and colleagues¹ regarding appropriateness of tympanostomy tubes. There are several issues of significant concern.

Their article compares criteria developed by a panel of "experts" retained by VHS with indications for tympanostomy tube insertion found in the charts of a number of otolaryngologists across the United States. It then concludes, based on these criteria, that approximately 25% of proposed tympanostomy tube insertions did not meet VHS criteria. Of interest is that VHS selected a panel of individuals, declared them experts, and then asked them to write criteria for the use of tympanostomy tubes. In addition, the authors state that participation in the expert panel should not infer that all those individuals uniformly endorsed the proposed criteria.

One must be mindful of the fact that VHS is a for-profit organization that sells software packages to third-party payers who . . . [Full Text PDF of this Article]

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