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Themes for Bandolier are sometimes planned, and sometimes they just creep up without one noticing. This month it is the latter, and only when it is written does the theme become clear. Each item demonstrates the way in which we, all of us, including researchers, just fail to see the obvious.

The obvious, of course, varies, and trying to define obvious is not easy, but we all know obvious when we see it. For instance, with inhaled corticosteroids the adverse event of oral candidiasis is obvious, and a review tells us that the risk is twice as great with inhaled steroids. But what is the actual rate? How many people in a hundred using inhaled steroids suffer it? No answer in a review, nor much in the literature, despite anecdotal comments that range from rare to 15% or more.

With methotrexate for ectopic pregnancy, the obvious is missing randomised trials, and we don't know which of two regimens is right, even though we suspect that doctors are treating the right patient right.

With noncompliance issues, more anecdotal reports suggest that vast proportions of prescribed drugs are never used, but hard evidence is hard to find. If it were true, the costs would be enormous, and it would be an obvious target for change. But not many brownie points for academic pointy heads there, though.

With pharmaceutical company economic submissions, most had serious problems, at least in Australia up to 1997. Most of the flaws were obvious. If pharmaceutical companies are some of the most powerful organisations in the world, with more neurones per square inch than any other, how come they didn't spot the obvious?

With obesity, a study tells us what we know, that overweight people die younger and lose about seven years of life compared with their thinner brothers and sisters. But it's obvious, so why are we getting fatter not thinner?

And with diagnostic tests, we know that most reports suffer from massive bias. Yet here the obvious needs to be hammered home. In a review of hysteroscopy, probably only one or two of 65 reports were bias free. Yet 25,000 women were studied, and the result is probably that we just don't know how good the test actually is. It's obvious that diagnostic testing needs a new major effort to drag it into the evidence-based age.

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