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In 1979, Archie Cochrane awarded obstetrics and gynaecology a wooden spoon, as the specialty with the worst use of scientific evidence to support clinical practice – the fewest randomised controlled trials and systematic reviews.1 This provoked the first evidence-based obstetric text book, published in 1989, and the model for the subsequent cross-specialty Cochrane Pregnancy and Childbirth Database in 1993.2 Since then, the National Institute for Health Research (NIHR) Clinical Research Network has facilitated national recruitment to multicentre trials in all specialities, and the evidence base for decision making is growing. Despite this laudable progress in evidence-based practice, some areas of clinical research have remained …