Evidence is available for selected patients in selected units

doi:10.1136/bmj.310.6987.1135b

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J H N Wolfe

Consultant vascular surgeon Regional Vascular Unit, St Mary's Hospital, London W2 1NY

EDITOR,—The art of debate is to develop a persuasive argument however inadequate the data. Mark Lambert is to be congratulated on his adroit confusion of different problems (a time honoured politician's ploy).1 The problems of poor selection, poor investigation, and poor surgery are not to be confused with an ineffective operation.

Carotid endarterectomy is not appropriate for all patients with transient ischaemic attacks any more than appendicectomy is appropriate for all …