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Tsars are the limit
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     EDITOR—Russia's tsars were despots.1 Their lineage lost ground in the late 19th century and some time later ended in bloody murder. Tsars were not appointed: they inherited power and abused it. Sometimes their power was usurped by those with the ear of the throne.

    Credit: BAL

    Peter the Great sought favour with the French court and played at boats with William of Orange. There was only one tsar at a time.

    How can a title so suffused in historical imperfection ever be taken seriously? Or was that the intention?

    James N Hardy, general practitioner principal

    Bethnal Green Health Centre, London E2 6LL james.hardy@nhs.net

    Competing interests: JNH has strong republican tendencies.

    References

    Burns H. Health tsars. BMJ 2004;328: 117-8. (17 January.)