To the Editor Louie and Lampiris1 summarize current evidence for the treatment of influenza infection with neuraminidase inhibitors. At first, they discuss the persistent uncertainty and inadequate evidence regarding the effectiveness of neuraminidase inhibitors in outpatients at risk for severe disease and in hospitalized patients. But they then come full circle and recommend prompt treatment of these patients based on data from observational studies and ethical concerns that would preclude randomized clinical trials.