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Dear List I agree with Tanya that there is an inherent contradiction between EBM methodology and Google. Permit me to digress a bit on EBM methodology EBM is based on clearly defined and explicitly declared search criteria, such that the search is reproducible. This makes for greater transparency in EBM results but does it make for better searches? You have 'search criteria' definitions that miss the point. You end up with nonsense dressed up as EBM - the type of Evidence Based Medicine that appeared recently in the widely respected BMJ journal, Archives of Diseases in Childhood. The EBM researchers arrived at the clinical bottom line 'No evidence was found to support the use of the glass tumbler test as a predictor for diagnosis of petechiae'. (Pariekh A, Maconochie I. What is the use of the glass test? Arch Dis Child 2003;88:1355) The flaw was the use of the search term 'glass tumbler test' We searched for 'Glass test' and embarrassingly came up with evidence for the test in the same journal (Wells LC, Smith JC,Weston VC et al The child with a blanching rash: how likely is meningococcal disease. Arch Dis Child 2001;85:218-22) [See electronic response in the Arch Dis Child article of Parikh and Maconochie: Evidence based investigation into the relation between Sexual Intercourse and Pregnancy : Reductio ad absurdum and EBM] Amit brings up the point about need for critical thinking rather than critical appraisal Too much defining of terms is the bane, not the strong point of EBM. The human mind is capable of lateral thinking. When we try to recall something, the brain does not use 'search terms'. In this aspect Google does better than EBM techniques. Google will even allow for spelling errors. But is EBM prepared for lateral thinking? Jacob Puliyel MD MRCP M Phil Consultant Pediatrician West Middlesex University Hospital Middlesex -- ___________________________ Jacob M. Puliyel MD MRCP MPhil Sara Varughese FRCS eFax UK 07092-124285