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Background Existing evidence should provide ethical, scientific and environmental justification for a new trial and users of randomized trials need to see their findings within the context of similar trials. Since 1997, Annals of Internal Medicine, BMJ, JAMA, Lancet, and New England Journal of Medicine have been assessed to see if results are placed in context and, more recently, to see if systematic reviews are used to justify the trial.

Randomised trial reports continue to be islands of evidence, with few continents in sight