t is estimated that one third of therapies are useless. The difficulty is determining which third. It is one of the major legacy issues, from a previous era, facing modern medicine. Poor quality medical treatment is costly but more importantly it is potentially harmful. It is now widely accepted that the best way to deliver best care to the patient into the future is through the practice of evidence-based medicine 1,2. The upstream activity that provides the best evidence is the RCT.