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Richard W. Starrett, MD
Los Gatos, Calif

JAMA. 1988;259(13):1947-1948.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—"Three Procedures Overdone, Study of Medicare Charges" was the front-page headline in my local newspaper this Friday the 13th. I am not surprised. In the article entitled, "Does Inappropriate Use Explain Geographic Variations in the Use of Health Care Services?"¹ the authors conclude that "differences among sites in levels of appropriateness were small" and that "differences in appropriateness cannot explain geographic variations in the use of these procedures." Specifically regarding carotid endarterectomy, they implied that an astounding proportion, 65%, of the carotid procedures performed on Medicare patients studied in 1981 were either questionably indicated or inappropriate.

An alternative interpretation might well be that the criteria on which the authors based their conclusions about carotid endarterectomy are flawed. The surgeons who performed these procedures in each geographic location that was studied apparently differed with the "experts" on the appropriateness of surgical indications in the majority (65%) of . . . [Full Text PDF of this Article]

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