What is evidence-based medicine? Trying to define it is like the old story of the blind men feeling the leg, tail, and trunk of the elephant and all describing it differently. In this month’s Notebook, the editors therefore have tried to describe the full elephant and relate this to the various evidence-related disciplines such as evidence synthesis and clinical quality improvement. We welcome suggestions about missing bits of the elephant and other creatures in the evidence jungle.

For those wishing a more face to face discussion of these issues, you might like to attend the 3rd International Conference of EBM Teachers in sunny Sicily. Details are available on the web (http://www.ebhc.org). This is just one of many related conferences. A recent visit to China and Hong Kong opened my eyes to the degree of interest and development of EBM around the world. With nearly 300 delegates from 30 countries, the 3rd Asia-Pacific EBM conference was a testament to this worldwide interest and to the efforts of the Chinese Cochrane Centres.

The Cochrane Collaboration has taken up the challenge of doing systematic reviews on diagnostic tests, and a handbook should be available in 2005. Given there are fewer studies in diagnosis than therapy, and the quality is generally lower, it will be interesting to watch how this develops. Its pleasing to see in this issue, though, that there are 4 diagnostic articles: on the clinical diagnosis of dehydration in children, protein dipsticks in pregnancy, the CAGE questions for alcohol abuse, and tests for acromioclavicular joint pain. We hope this is part of a trend to better diagnostic studies.