[Skip to Content]
[Skip to Content Landing]
October 20, 1993

Noninvasive Testing for Silent Myocardial Ischemia in Stable Coronary Patients-Reply

JAMA. 1993;270(15):1810. doi:10.1001/jama.1993.03510150043015

In Reply.  —In my Commentary, I expressed the hope that the study by Moss et al would cause us to reassess our assumptions concerning the clinical utility of risk stratification and to shift our focus instead toward the provision of therapeutic benefit.1 No such luck. Dr Thompson gerrymanders the reported statistical analyses and concludes, "In this era of health reform, it behooves us to be circumspect in denouncing [risk stratification] tests unless we are absolutely certain they have no value." Since value is inherently personal and in no way absolute or certain,2I take this to mean that in attempting to improve the quality of health care, we must strive to maintain the status quo. In this era of budgetary reform, must the taxpayer also be absolutely certain some social program or weapons system has no value before suggesting a possible reduction in its funding? Shall the boon