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Lawrence C. Kleinman, MD, MPH
Children's Hospital Boston, Mass

Jacqueline Kosecoff, PhD; Robert W. Dubois, MD, PhD
Value Health Sciences Santa Monica, Calif

Robert H. Brook, MD, ScD
RAND Health Science Program Santa Monica, Calif

JAMA. 1995;273(9):700-701.

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

In Reply.

—We are pleased to have generated discussion. We respond with general and specific comments. Length limitations make it impossible to address all concerns.

Three of the authors are practicing physicians, and one (L.C.K.) provides primary pediatric care to inner-city children. Our purpose was to increase the appropriateness with which tympanostomy tubes are used and, thus, to improve the quality of care provided to children. The article does not discuss whether better use of watchful waiting and antibiotics will increase or decrease the cost of care. If it were to decrease the costs of care, then using this money to improve the access and quality of care to children would be consistent with what we have written.^1-3

Virtually none of the letters criticize the content of the criteria that were used in this study. This suggests implicit acceptance of their content validity. The recently released federal guideline for . . . [Full Text PDF of this Article]

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