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[Editorial] The struggle for better research in surgery

Two decades ago, a Comment in The Lancet questioned the quality of research in surgery. What has changed since then? On the one hand, much has improved; on the other, little. Thanks to initiatives like the IDEAL Collaboration (an indirect outcome of the 1996 Comment), the recognition that evidence is needed to drive improvements in surgical care is broadly recognised; though imperfectly implemented. How evidence is acquired remains problematic, attributable to the paucity of universal outcome measures, a perceived undervaluing of technical skill, and widespread denial of equipoise.