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March 1, 1995

The Appropriateness of Tympanostomy Tubes for Children

Author Affiliations

University of Washington Seattle

JAMA. 1995;273(9):699. doi:10.1001/jama.1995.03520330027021

To the Editor.  —The current national preoccupation with health care costs has fostered a new research genre. Instead of prospective randomized clinical trials or evidence-based guidelines, we now have politicized research pitting the opinions of a group of physicians against the clinical judgment of individual physicians caring for specific patients. Even that approach might have merit if fully developed and carefully applied. However, in the report by Dr Kleinman and colleagues,1 the physician's judgments for surgical therapy were categorized by insurance company employees using a hitherto secret computer algorithm developed by a for-profit corporation (VHS). While I am concerned about the obvious conflicts of interest, the accuracy of the data (which were collected for insurance rather than research purposes), and the substantial lack of agreement among the members of the physician panel on which the algorithm was based, I am more distressed by the major conceptual flaw of this

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