Components of Effective Care

To the Editor: Initial concern has given way to grave misgivings about Gordis's article, “Effectiveness of Comprehensive-Care Programs in Preventing Rheumatic Fever”” (N Engl J Med 289:331–335, 1973). Comparability between the control group and the comprehensive-care group varies greatly in performance of throat cultures. “… in one recent year, 80 per cent of all cultures from Baltimore residents processed by the State Laboratory were from patients in comprehensive-care programs”” (p. 334). Since throat cultures for Group A beta-hemolytic streptococci and treatment of patients with positive cultures are the preventive measures for acute rheumatic fever, any group using this bacteriologic test ….