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Are God and Nature then at strife
That Nature lends such evil dreams?
So careful of the type she seems
So careless of the single life.
Tennyson, In Memoriam, 1850
Tennyson was contemplating his own mortality when he wrote these words and rueing the changes in the established order of things that had been set in motion by Darwin in his principle of natural selection. In many ways In Memoriam is a narcissistic lament, the sad acknowledgment that even the most entitled and celebrated of humanity would eventually be “blown about the desert dust, or seal’d within the iron hills”.
I paraphrase Tennyson because a similar phenomenon has developed with regard to that more prosaic form of creation, the randomised controlled trial. In the past, and even the recent past, the most celebrated trials, beginning with the famous James Lind trial of lime juice for scurvy in 1743, have been single ones attached to one or two researchers. But things are changing. There is a growing fascination of researchers, funders and editors with the highest tier of evidence, a meta-analysis of randomised controlled trials,1 and this fascination is reflected in the publications of Evidence-Based Mental Health. In the current scheme of things no trial, irrespective of its worth, …
Competing interests: The author is Editor of the British Journal of Psychiatry, which publishes both systematic reviews and individual trials in approximately equal number.
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