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Previous Volume 328:1274-1279 April 29, 1993 Number 17 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: The study by Mitchell and Sunshine (Nov. 19 issue)¹ contains serious technical flaws. Fundamental principles of experimental design dictate that a study must control adequately for confounding factors. The study by Mitchell and Sunshine, however, relies on a comparison between two unmatched and probably vastly different populations of patients. Its findings are based on medical data comparing the intensity of treatment in Florida with that in the United States as a whole. It attributes observed differences entirely to the higher percentage of facilities owned by referring physicians in Florida. The study fails to eliminate numerous alternative hypotheses, . . . [Full Text of this Article]

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