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R ichards et al in this issue of Circflation' contribute interesting data to the debate on the value of programmed ventricular stimulation,2-10 but I believe it would be very premature to base clinical management on their report. At issue is not whether a test provides information, but whether it supplies incrementally valuable information11-13 and how it should be applied to routine patient care. The ideal way to evaluate a medical treatment is a double-blind, randomized clinical trial. Randomization should distribute risk factors, both measurable and unmeasurable, equally in the two groups. Double blinding will eliminate any potential bias in the ascertainment of outcome. Multivariate analyses can control for imbalances remaining after randomization, and cost-effectiveness analysis can determine whether any incremental expense is warranted by incremental benefits.

Electrophysiological testing after myocardial infarction. A paradigm for assessing the incremental value of a diagnostic test.