Appropriateness of Carotid Endarterectomy

To the Editor: Studies such as those reported by Winslow et al. (March 24 issue)* contain valuable data that are likely to influence future management. However, they may also prove to be hazardous if used as definitive guidelines by government agencies, third-party insurance organizations, or worse, the legal profession. The "inappropriateness" of any treatment strategy depends on how arbitrarily the "appropriate" criteria are established, and these are clearly subject to tremendous bias, in spite of the appearance of non-bias. Therefore, the inappropriateness becomes a self-fulfilling prophecy. For instance, how are the authors so certain that surgery is always inappropriate for . . . No extract is available for articles shorter than 400 words.