In this journal, Macchi and Pavan [1] have described how, in Italy, a research hospital can be managed at the times of a global economic crisis and have pointed out that, as a matter of fact, sustainability has become the main concern for hospital managers and physicians. This implies to promote a more critical evaluation of health-care interventions leading in some cases to negative approval decisions. While other countries have debated the question of ‘saying No’ for nearly 20years particularly in the field of pharmaceutics and medical devices [2], Italy has had some delay not only in recognizing that these interventions of governance are needed, but also in effectively implementing the interventions themselves.
