It’s an issue of methodological rigour, to be sure. But I suggest we should think twice before assuming that all the problem lies with “poorly controlled” studies from poorer countries. The responsibility lies at least as much with the funding bodies.

A recent paper by Rebecca Syed Seriff et al (from the PRACTIHC Mental Health group) recently looked at the proportion of RCT trials in mental health conducted in low- to middle income countries. Their conclusion was that there was very little RCT research in these countries. Funded research efforts were very poorly matched with the levels of need, internationally.

Meanwhile, we do know that the vast majority of psychology research subjects are from the “WEIRD” countries –Western, Educated, Industrialized, Rich and Democratic - and in addition, it seems that a very high proportion are students, since this is a readily available group for researchers to study, in the outrageously naïve belief that this implicit sampling cannot affect the findings of research.

Such research does more than prop up the West’s distorted belief that the values and perceptions, social relation (and implicit, embedded ideologies) are somehow “natural” and universal. But it also leads to vast investment of resources in apparently evidence-based treatments, such as CBT, simply because they can claim to have “an evidence base”, whereas research in the social determinants of health remains impoverished, and the underlying issues not tackled.

So, rather than excluding from journals research which does not meet the formal specifications of good design, we should be far more challenging of the research which apparently does. I am not in favour of shoddy design, or poorly written papers; but I am equally circumspect about "proper" design.

In the meantime, in journal which I edit, which aims for inter-disciplinarity, I will expect authors to be explicit about the methodologies chosen; but I would not impose any one model.

Robyn, even in the richer countries getting a clinical trial done is quite difficult. There are problems with negotiating around the bureux and services, and then problems with recruitment. With non Pharma trials, there is not a clear funding agency and people tend to use the best design you can afford -- but when you are trying to do a trial for 20 000 dollas (As I have done) you do it open-label, and then aim to get funding for a RCT.

Publishing protocols may or may not help. Having good peer review as part of ethical approval and registering trials does help.

But making partnerships with developing countries --- they are quite capapble of doing RCTs including psychological RCTs -- is a way forward. Perhaps we should be making partnerships at the learned college level to the aid agency level.

Thank you so much Robin Johnson Sir and Christopher Gale Sir for the valuable suggestions. I was seeing past 5 and half years in Nepal, there were several clinical trials in the title "RCT" without any blinding, randomization etc.. There is no funding and no protocol also. It reduced little because of our training programme here. But my doubt is why the medical journals are keeping the section "RCT" when they doesn't have a editor who knows the basics of RCT. If the patient dies because of this trial which is not insured the patient. Who will pay for the patient party whether the institution or the researcher?.

It sounds then as if we have several different issues interwoven here - methodological, publication policy (and bias), and thical/legal questions.

The first concerns whether RCTs as such deserve the pedestal position in which they are currently placed, in funding and in citation.

The second concerns publishers' and reviewers expectations over what is fit to publish.

The third is about people getting hurt, and without recompense, by unscrupulous research.

It's the third which would concern me most; and how to expose such practice.

The idea of registries and intrenational review of the same (the WHO has a system where all registries are collated) should allow us to see where unethical work is being done.