Ma Montesu

Susceptibility to human herpesvirus-8 infection in a healthy population from Sardinia is not directly correlated with the expression of HLA-DR alleles

nothing other than minimal and reversible side-effects. There should be more to the drawing up of guidelines than the evidence base: expert and experienced clinical opinion should be taken into account and, in many instances where the drug concerned was introduced into clinical practice before the age of the clinical trial, should predominate. An absence of trials does not mean an absence of effect. More trials might really be needed. Meanwhile, patients come to us hoping for treatment and the onus should be on detractors of an intervention to prove that it is ineffective or unjustifiably dangerous (or both) before suggesting that needy patients should not be so treated. This is not the place (and it is not my intention) to anathematize guidelines in general but colleagues may be interested to read, if they have not already done so, Professor Hampton’s recent essay, Guidelines—for the obedience of fools and the guidance of wise men , in Clinical Medicine: you get the gist from the title. A librarian (in fact, our librarian here at the Chelsea and Westminster Hospital) has written of his concerns that textbooks are not now opened as readily as perhaps they should be, in favour of more rapidly accessible electronic sources of information. Textbooks are probably not routinely consulted in the development of guidelines. How dreadful to contemplate that the textbooks of the future might be nothing but bland compendia of guidelines.