I read with great interest the article by Tsevat and Kotagal1 and the accompanying editorial by Pichichero.2 They reviewed the costs of diagnosing streptococcal pharyngitis, and agreed that diagnostic testing needs to be performed. Tsevat and Kotagal concluded that on a cost-effectiveness basis, the throat culture was the diagnostic method of choice, while Pichichero recommended either a throat culture or a well-performed rapid antigen test.