Abstract: Salim Yusuf, John A Cairns, A J Camm, Ernest L Fallen, Bernard J Gersch BMJ Books, £130, pp 1200 ISBN 0 7279 1171 6 Rating: ![Graphic][1]</img>![Graphic][2]</img> Studies comparing clinical practice in different countries always show a remarkable lack of consistency in the way patients are treated. In cardiovascular disease there is a huge variation in, for example, the use of coronary angiography and percutaneous transluminal coronary angioplasty after acute myocardial infarction, and even in the use of relatively cheap treatments such as digoxin and diuretics in patients with heart failure. Why should this happen? The medical community is international, there is little debate about which are the leading journals, everyone goes to the same international meetings, and everyone has essentially the same access to the evidence on which treatment is supposedly based. One would have thought that there would be considerable consistency in the investigation and treatment of patients with … [1]: F1/embed/inline-graphic-1.gif [2]: F1/embed/inline-graphic-2.gif