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March 1, 1995

The Appropriateness of Tympanostomy Tubes for Children

Author Affiliations

Children's National Medical Center Washington, DC

JAMA. 1995;273(9):699-700. doi:10.1001/jama.1995.03520330027023

To the Editor.  —The report by Dr Kleinman and colleagues1 was as inflammatory as it was enlightening. Despite the provocative title, the study did not assess the efficacy of one treatment compared with other alternatives. Rather, the study simply measured the degree to which a recommendation for insertion of tympanostomy tubes met a set of criteria established by VHS, a for-profit corporation.Kleinman et al have not demonstrated that watchful waiting or administration of antimicrobial agents in the treatment of otitis media are better choices than insertion of tubes. We have no idea what happened to the patients in the study sample. The outcomes desired were not specified and no follow-up data were provided. This being the case, we should recognize that what we have feared for so long (ie, the influence of a growing group of detached number crunchers on the practice of medicine) is not in the

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