In Reply.—

Here is the question: Are randomized trials so superior to other knowledge-generating techniques that we should not consider a fact to have been established unless it has been established by such a trial? If so, then the use of clinical interventions which have not been studied using randomized trials is wrong. if not, then we need to determine how such trials should be combined with other techniques, and how results of different techniques should be interpreted to lead to the best possible patient care, the incorporation of new therapeutic interventions into practice, and the timely discarding of techniques which are no longer sufficiently efficacious.

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