EDITOR, - In the issue that included an editorial discussing the importance of outcome research in clinical practice,1 the paper by D J Houghton and colleagues concluded that “general practitioners should no longer request sinus radiography” without measuring any outcomes at all.2

This was a descriptive study in which local general practitioners' knowledge of indications for sinus radiography was assessed. The authors extrapolated the fact that half the population have minor changes on such radiographs and concluded that the indications given were worthless. The requests perceived as due to patient pressure were dismissed on the grounds that general practitioners should invoke the college guidelines. Studies have shown that using the guidelines reduces …