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Adapting information from research to clinical practice can be difficult, and we are often forced to decide whether benefits reported in selected trials are adequate to justify widespread application of the intervention studied. This is particularly problematic when the “evidence” is scanty, the degree of benefit apparently small (if real), and the treatment potentially dangerous. In addition, it is always important to consider whether community physicians can replicate the success described in research studies, which are typically performed by experts working in the controlled setting of a well-funded study. To complicate matters, the use or non-use of new treatments may be subjected to the retrospective scrutiny of a courtroom whenever bad outcomes occur. Medicolegal concerns put even greater pressure on clinicians to adopt a new therapy, even if they are not convinced of a positive risk‐benefit ratio. This is particularly true when external forces (e.g., advertising leading to public demand, review articles written by authors with financial ties to the manufacturer, and questionable guidelines created by “experts”) speak in its favour. The US Surgeon General’s enthusiastic public endorsement of steroids for spinal cord injury, which was based on minimal and controversial evidence, led many physicians to accept high-dose steroids as the standard of care, despite widespread personal misgivings and published critiques. Similarly, recommendations by groups such as the American Heart Association (AHA) exert strong practical and legal weight on practitioners to use other disputed modalities or therapies with which they may not agree. The Position Statement on thrombolytic therapy for acute ischemic stroke, recently published by the CAEP Committee on Thrombolytic Therapy for Acute Ischemic Stroke,

Tissue plasminogen activator for acute ischemic stroke: Is the CAEP Position Statement too negative?