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Growth hormone replacement in adults

the age chosen. Many other topics, such as AIDS, can be supported by presenting information on international variations or time trends. In each case the underlying assumptions determining what measure is used must be justified and debated. Evidence must be up to date and must be reviewed systematically, as in the work of the Cochrane Collaboration. When uncertainty exists it must be recognised. Basic epidemiological and evaluative principles must be adhered to. Guidelines must be developed independently of the pharmaceutical and medical technology industries, with full disclosure of conflicts of interest. This, in turn, places an obligation on governments to support these activities. Some method of incorporating the views of the public and patients must be sought. Health professionals should not seek to speak on subjects that they know little about. At a high level meeting such as this it is surely as inappropriate to have a clinical cardiologist talk about economics as it would be for an economist to describe the finer details of lipid metabolism. It must be recognised that health care evaluation is now multi isciplinary. Meetings such as last week's forum may be counterproductive. There may have been a case for a "Europe against heart disease" programme, but those contributing to this meeting did not make it. The social affairs commissioner, Padraig Flynn, has repeated his determination to develop relevant and appropriate policies, but at the forum he emphasised the need to define effective interventions. Cardiovascular disease is an important topic requiring action at a European level. Within Europe, rates vary widely, and several European Union policies inhibit necessary changes in diet and tobacco consumption. But if professionals are going to influence politicians at a European level they need to do much better than this.