Questioning the outcome of the Building Blocks trial

Michael Robling and colleagues (Oct 13, p 146) are to be congratulated on conducting Building Blocks, a highly rigorous randomised controlled trial of the Family Nurse Partnership (FNP) programme in England, UK, and rightly highlighted the difficulty in showing changes similar to the US studies in a setting with comprehensive universal health services. The trial in the Netherlands, where FNP showed a positive effect on various primary outcomes, involved substantial adaptation of the programme to the local context, and was also more targeted in terms of risk