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" Where is the wisdom we have lost in knowledge, and where," asked T S Eliot," is the knowledge we have lost in information?" There are perhaps 30 000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century.'2 Yet only about 15% of medical interventions are supported by solid scientific evidence, David Eddy, professor of health policy and management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only 1% of the articles in medical journals are scientifically sound23 and partly because many treatments have never been assessed at all." If," said Professor Eddy," it is true, as the total quality management gurus tell us, that'every defect is a treasure'then we are sitting on King Solomon's mine." What are the implications for those purchasing health care if the scientific base of medicine really is so fragile? Because …