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October 25, 2000

Effects and Ethics of Sanctions on Childhood Immunization Rates—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(16):2056-2057. doi:10.1001/jama.284.16.2053

In Reply: Dr Maclure and colleagues caution against shooting the messenger—ie, the evaluators of the PIP1—when, in fact, the Georgia legislature and Department of Human Resources developed and implemented the potentially coercive statewide immunization policy under study. In our Commentary, Dr Lantos and I placed the responsibility for the welfare of Georgia's Medicaid beneficiaries in the demonstration project with state and federal authorities, not with the program evaluators.2 We agree with Maclure and colleagues that society benefits when evaluations of policies make the effects—positive and negative—of such policies more transparent. In the case of welfare program demonstration projects with waivers from the US Department of Health and Human Services, policy evaluations by objective investigators are mandated by federal statute.3 Certainly, objective policy evaluators should not be criticized for any unethical aspects of the programs they study.