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March 1, 1995

The Appropriateness of Tympanostomy Tubes for Children

Author Affiliations

Ear, Nose, and Throat Associates Syracuse, NY

JAMA. 1995;273(9):698. doi:10.1001/jama.1995.03520330027018

To the Editor.  —As chairman of the American Academy of Otolaryngology—Head and Neck Surgery Quality Improvement Committee, I feel obligated to share my observations regarding the article by Dr Kleinman and colleagues.1Before the April 27, 1994, issue of JAMA, no attempt was made by VHS or its insurance company clients to disseminate their criteria among the very physicians they now criticize. As one can easily see in their Table 2, there are 64 scenarios with 43 inappropriate choices, 15 equivocal choices, and only six appropriate choices. It seems miraculous that only 23% of the proposed surgeries were found to be inappropriate! Dr Kleinman and associates have set themselves up as judges in a kangaroo court, and I find that professionally and morally offensive.The methods permitted the authors to change a rating from appropriate to equivocal arbitrarily. One could have rated more of the equivocal in the appropriate

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