ABSTRACT
There are benefits for patients and probably for the economics of health care; there may also be benefits for practitioners too, though these may be more obscure. If the grand strategy for National Health Service research and development and its practical offspring of clinical effectiveness and evidence-based medicine have any real purpose then the main beneficiaries should be those who receive health care. That better and more effective treatment will produce better outcomes for patients is clear enough. What is less clear is how these health gains will manifest themselves in the population. Delivering health care which works needs to be set in a context of the provision of health care which is appropriate. Health care is less costly in systems which are based on comprehensive primary care. Even legitimate nihilism is under attack from patients, who expect to be given treatment even where none is appropriate or available.
