EDITOR, - Trevor Sheldon's critique of the research into the outcomes and effectiveness of treatment carried out by the US Agency for Health Care Policy and Research and, in particular, the patient outcomes research teams, which are supported by the agency, is based on a fundamental misunderstanding of our programme, mission, and methods.1 The US Congress created the Agency for Health Care Policy and Research in December 1989 to focus on a set of important issues that were not being addressed by existing research institutions. Specifically, the law establishing the agency and the medical treatment effectiveness programme mandates a new, hard look at the effectiveness and appropriateness of current health care practice in a wide array of clinical conditions. It requires examination of a broad range of outcomes (not merely mortality and morbidity but relief of symptoms, functional status, quality of life, and cost) as achieved in nonselected patients and practices.

Many of the agency's studies of outcomes focus on conditions and procedures that are not life threatening but that impact appreciably on the quality of life - that is, low back pain, cataract, benign prostatic hyperplasia, and hysterectomy. Because many of these conditions and procedures have not been studied before, the agency's first generation of studies invested heavily in fundamentals-documenting practice patterns, …