EDITOR, — A “knowledge based health service” would seem to be something of which we might all approve. Yet the means proposed for reaching this desirable end give serious cause for concern. A new regulatory scheme is proposed whereby research managers will evaluate the evidence on science and health technologies and will “see that the results are introduced into practice.”1 Clearly, this process would be prone to the political influences, exploitation by pressure groups, and short term expediency that have affected all other aspects of NHS management.

The old model for incorporating science into clinical work was based on education and the self motivation of professionals.2 This model was able to respond to the development of scientific medicine throughout the 20th century to produce massive changes in health service practices. Of course this model is imperfect; nevertheless, remarkable progress towards evidence based medicine has been achieved, especially in …