Introduction: The Cochrane initiative stems from the assumption that clinical research is, to a large extent, focused on important clinical questions and that variations in study results mainly depend on random errors. As a consequence, a large emphasis is laid on the search for all the available data related to specific questions.

Discussion: We challenge this assumption in the area of dermatology where: 1) clinical research is mainly driven by pharmaceutical companies and does not necessarily reflect important clinical questions; 2) no tangible progresses have been made over the last twenty years on critical methodologic issues like the development of outcome measures, the assessment of patients' preference and attitude toward treatment and the assessment of prognostic factors. Few advancements can be expected in the lack of resources allocated to clarify these issues. In our opinion, the danger of performing data driven systematic reviews on unimportant clinical questions can be partly overcome by setting up clear priorities for conducting systematic reviews. The role of consumers in this task cannot be underestimated.