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Big problems, but no easy solution Across most, if not all, clinical disciplines, we face serious problems with the research we do. Many, if not most, studies are underpowered and/or severely biased, so the majority of ‘evidence’ on which we base our daily practice is probably false. When studies are clearly negative, an ‘important message’ is often looked for somewhere among secondary outcomes and post-hoc analyses or, even worse, studies are dressed up as positive ones.7,8 This continues to occur even in major respected journals, despite years of work attempting to increase the quality of clinical trial reporting.9 The impact of potential biases are often overlooked or underemphasised and conflicts of interest abound throughout the research endeavour and subsequent clinical guideline development.10,11 It is of little wonder that many clinicians take their academic colleagues with a pinch of salt. This state of affairs is driven by systemic rather than individual failures. Academic performance assessment and research funding are based on numbers of publications and self-promotion; research grants never cover the true cost of research; and the lion’s share of funding flows to large institutions, empowering the few rather than the many. Even more important is the fact that research is simply not considered a core business in many, if not most, hospitals, so it can be nearly impossible to do high-quality clinical research. Most hospital research groups depend on industry-sponsored trials to maintain their research infrastructure and with shrinking research budgets our universities encourage this; as the old saying goes, ‘never stand between an academic and a pot of cash’. During clinical training, most doctors receive, at best, superficial training in research methods. Many do not understand how flimsy the evidence often is for what we do, or the degree to which we are being manipulated by industry and ‘special interest’, and how we might be causing avoidable harm to our patients and the health system that serves them on a daily basis.6,12 As a result of all these factors, clinical trials are notoriously hard to do, and certainly hard to do well. In addition, there remains a divide between clinical work and academia. Clinician researchers are rare animals indeed. The emergency medicine environment presents additional challenges Bedside research in the emergency medicine environment presents additional, unique challenges.