Drs. Weinstein and Wulff (in issue 1:3) have raised legitimate and important concerns about the ethical acceptability and feasibility of randomized control trials (RCTs) of diagnostic technologies. Their criticisms are all the more compelling in light of their strong advocacy of rigorous evaluation, and their insights into the advantages of RCTs and potential problems with alternative approaches as outlined with great clarity in Dr. Weinstein's paper. We shall not attempt a point by point rebuttal (partly because we are in full or partial agreement with most of their comments) but instead will highlight several issues which we believe merit further discussion.