In 1976, while I was in medical school, the lecturer in biochemistry explained why the optimum dose of aspirin to prevent clotting in heart vessels was 82mg, or one baby aspirin a day, not the two-aspirin-a-day regimen used up to that time. Yet in 1996, when I was first in practice in Arizona, I noticed that most patients were still taking two full aspirin (650 mg) for this purpose--a dose shown 20 years previously to work against the beneficial effect on platelets by turning off the anti-clotting mechanism of the arterial wall. I was shocked to think that doctors were practicing 20-yea-rold medicine that was in direct conflict with basic biochemistry. Subsequently I have learned that this is not the exception, but the abysmal mode of practice in America. There are at least three major factors contributing to this sad state of affairs--state medical boards, clinical "groupthink," and an ineffective approach to information gathering. Sadly, even this current sluggish progress in medicine may come to a complete halt with implementation of "evidence-based medicine" and "best practices."