Needs the right resources and the right organisation

The person who did perhaps more than anyone to bring the rigours of systematic review into clinical research, Tom Chalmers, once asked: Why do doctors kill more people than airline pilots do? He suggested 10 reasons. These included the fact that pilots are required to have time off to sleep, that they do everything in duplicate, and that they follow protocols. But his final reason was that if doctors died with their patients they would take a great deal more care.

Taking more care means, among other things, practising evidence based health care, and, even to enthusiasts, death for failing to do so seems harsh. After all, as Gina Radford, director of Britain's new National Institute for Clinical Excellence, said at a recent meeting on evidence based medicine in York, no one goes to work to do a bad job. If they are to improve how they care for patients, clinicians need to know what they are doing wrong, or badly, and …