Surely physicians are expert on medical facts (ie, diagnosis, prognosis, and treatment options). The real problem is the widespread assumption that physicians also have expertise on value judgments needed to determine the best treatment option. Evidence is lacking, however, that such expertise exists; in fact, physicians appear systematically skewed in their value judgments. We know that physicians vary widely on what they would recommend,2 and no mechanism exists for determining which recommendations are correct. If recommendations are made, patients will suffer random variation among practitioners. There is no basis for believing consensus value judgments are correct.