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Another way of phrasing this might be "Is making EBM appear so out of reach for 'ordinary' doctors harmful?". In trying to make doctors, nurses etc jump through more hoops it is less likely to make that approach (ie EBM) adopted. I have been running a service for GPs over a number of years call ATTRACT. We receive the question, answer it and reply in as little as 6 hours, often we just rely on abstracts of peer-reviewed journals. I acknowledge that this is not ideal, but our aim is not to do a systematic review but to do better than the hard-pressed GP would. If we say 'only using accessible papers is harmful' then the logical conclusion is that the only harmless answers to clinical questions would be arrived at via systematic reviews. As these cost tens of thousands of pounds and takes months that's a non starter. This would also make 'EBM' more academic and less real-world than it already is! If we want people to adopt EBM principles we need to move further away from academic purism and into clinical pragmatism. jon Jon Brassey TRIP, Support Manager Director, ATTRACT Wales http://www.attract.wales.nhs.uk http://www.tripdatabase.com Phone: 01495 765105 Mamhilad House, Mamhilad Park Estate Pontypool NP4 0YP Wales "No-one is completely worthless, they can always serve as a bad example"