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Researchers need to overcome the evidence paradox of 18 000 randomised trials being published each year but almost every review concluding that not enough hard evidence exists to actually inform decision making, experts have said. Sean Tunis, the founding director of the Baltimore based Center for Medical Technology Policy, which aims to improve the quality of research, warned about the lack of useful evidence at a US congressional briefing on research into comparative effectiveness on 30 July. Dr Tunis told the briefing: “This is a structural problem, a systemic problem. It won’t be solved by doing more of the same thing. Gaps in evidence …

One serious structural problem for communication in medical encounters is the primacy given to diagnosis (and other technical goals).1 Doctors don't even listen properly to the first thing a patient says before launching into a series of directive questions designed to produce a diagnosis, or a …