Abstract
In 1994 McWhinney and colleagues reported the failure of an attempt to assess a palliative care home support team using a randomised controlled trial.1 Problems included attrition of study subjects because of early death and difficulties with recruitment, consent to randomisation, data collection, and timing of outcome assessment. In an accompanying editorial McQuay and Moore argued that assessment of palliative care packages by randomised trials remained mandatory despite these difficulties.2 Skating around the ethical problems of randomisation, they restated the evidence movement's demand for proof of effectiveness. Five years down the line, are we any further forward?