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The letter by Dr Frumkin regarding our article raises two points of concern that bear response.His first point, that the article does not adequately express cautions concerning the results, appears to be muted by his direct quotation of caveats expressed in the article. He acknowledges that the authors seem to agree with his concerns. In particular, the need for a study that includes diagnostic data, in order to better trace any observed relationships, is clearly stated in the article. Further, the implication that the results rest on a single point would appear to ignore the trend analyses that were pursued for the five-year period.It should also be noted that the article reports that the analysis showed insignificant differences for outpatient costs, rather than "negative results," an important distinction. Evidence that higher health-knowledge levels were associated with higher outpatient and other health care costs might suggest that,
Jones RC. Worksite Health Promotion and Health Care Costs and Utilization-Reply. JAMA. 1987;257(20):2756-2757. doi:10.1001/jama.1987.03390200096014