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March 22/29, 2000

Tube Feeding in Patients With Advanced Dementia

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(12):1563-1564. doi:10.1001/jama.283.12.1563

To the Editor: Dr Finucane and colleagues1 provide a comprehensive summary of the lack of acceptable evidence to support the effectiveness of tube feeding, but they do not distinguish the absence of proof vs proof of no benefit regarding tube feeding. All who help make the decision (for tube feeding) should be clearly informed that the best evidence suggests that it will not help, but this is not supported by the material reviewed in the article. The best evidence in support of no benefit is the descriptive studies that show that outcomes are no better for patients after GT insertion than in those patients who do not receive the intervention. To use these studies as evidence of no benefit requires that one assume that there were no substantial uncontrolled differences between those chosen for nasogastric feeding and those fed by mouth. This seems very unlikely, leaving little acceptable evidence of no benefit from feeding tube insertion.