In Reply.—I am grateful for the interest of those who responded to my editorial on standard setting in pediatric practice. I did not envision the amount of interest that my opinion would engender.
Dr Bader raises some generic and important issues. The "biases" that he speaks of are inherent in the process followed by expert committees intending to establish standards. Any committee that recognizes that its words are going to appear in court, in hospital standards, or in some other legal or semilegal context will head for a safe harbor in phrasing its recommendations. The difficulty is that data are incomplete on many issues, and yet the individual physician confronted with a single patient must decide on a course of action. Thus, the expert committee must steer between Charybdis and Scylla; Charybdis being a too cavalier recommendation, and Scylla, a too conservative one.
I am not certain that such