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a colleague recently drew my attention to some interesting statistics: In the USA >70% of paediatric patients with cancer are entered into at least one clincal trial; only 2% of adults with cancer are entered into trials internationally (in the developed world at least) most children with cancer are treated according to a defined protocol - And, systems exist to facilitate sharing experience. In the past 25 years survival times and side-effects from treatment have improved dramatically for children with cancer (eg from 40% to 70% cure rates) in contrast to minor improvements for adult with cancer even though there have been no new "frontline" therapeutic agents. it seems that paediatric oncologists have been doing EBM for a quarter of a century: putting evidence into practice and getting practice into evidence although they do not use the language of the EBM/H/P community. this raises 2 questions which (at the risk of exposing my ignorance) i should like to ask: 1) why haven't EBM-ers looked to see why the paediatric oncology community seem to have go it right? 2) why have other specialities not followed the example of the paediatric oncologists michael power some references: Bleyer WA. The US pediatric cancer clinical trials programmes: International implications and the way forward. European Journal of Cancer 1997; 33: 1439-1447 Philip T. Lymphoblastic lymphoma and Burkitt's lymphoma in Caucasian adults: Please don't forget the pediatric experience. Annals of Oncology 1995; 6: 414-416 Simone JV, Lyons J. The evolution of cancer care for children and adults. Journal of Clincal Oncology 1998; 16: 2904-2905 ---------------------------------------------------------------------- Dr Michael Power, Department of Paediatrics and Child Health, University of Cape Town & Red Cross Children's Hospital, Rondebosch 7700, Cape Town, South Africa Tel (27 21) 658 5111 Fax (27 21) 689 1287 email [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%