In a series of articles in the February 10, 1993, issue of the Journal of the American Medical Association, researchers were said to have estimated that 2.4 percent of all bypass surgeries are inappropriate, and 7 percent are clearly unnecessary—roughly one-fourth as much as previously estimated. Similar results were found for coronary angioplasty and coronary angiography. Some analysts are using these results to claim the problem is now underuse instead of overuse. How do you define terms such as “inappropriate”

and “unnecessary”? What are the lessons to be learned about the use of outcomes research?