Five years ago I wrote to The Lancet speculating that parents might begin to sue the Royal College of Obstetricians and Gynaecologists because it had taken so long to promote use of prenatal steroids, which research had shown reduced the risk that premature babies would die or survive handicapped. I might have added that there would be a case for suing the health authorities and trusts which were acquiescing in underuse of prenatal steroids, particularly as they also reduce health service costs.

Both as a potential patient and a taxpayer, I was prompted by parts of Barbara Millar's article to ask when patients will begin to sue HAs and trusts for ignoring research. A mass of research evidence relevant to the well being of NHS users is available, much of it through the NHS R&D programme.

Over two years ago, in the NHS Executive's paper Promoting Clinical Effectiveness , it was made clear that 'every NHS trust should have access to up-to-date sources of information such as the Cochrane and Centre for Reviews and Dissemination databases'. Yet last year an article in the Journal ('Who's acting on the evidence?', 3 April 1997) made it clear that this advice was being widely ignored by trusts.

The scapegoating title and tone of Barbara Millar's article is depressing. It suggests that carrots have not been enough and that sticks are necessary to remind those responsible for managing the health service that they have responsibilities to seek relevant information themselves, rather than expecting to be spoon fed by an R&D programme allocated a mere 1 per cent of the total NHS budget.

I urge patients and patients' organisations to consider suing HAs and trusts which are ignoring the important information available through the NHS R&D programme. As a potential patient, I will certainly consider suing if I am not offered forms of care which have been shown to be effective for people experiencing heart attacks, strokes and trauma.

Iain Chalmers, The UK Cochrane Centre, Oxford.