Need for expertise based randomised controlled trials

Need for expertise based randomised controlled trials -- Devereaux et al. 330 (7482): 88 -- BMJ
Surgical procedures are less likely to be rigorously evidence based than drug treatments because of difficulties with randomisation. Expertise based trials could be the way forward.
Quality of the tryal is obviously the great challenge to get a good scientific based reference. But even satisfying this premise the application of theory to an individual case may be difficult.