To the Editor: In their Commentary, Drs Hennekens and DeMets1 correctly stated that large clinical trials can produce better evidence than smaller ones, can detect therapeutic effects that other types of studies cannot, and may be superior to meta-analyses. The availability of evidence from large-scale randomized controlled trials (RCTs) has certainly resulted in more reliable methods of treatment during the half-century or so that they have been in common use.
Vosk A. Evidence From Randomized Controlled Trials, Meta-analyses, and Subgroup Analyses. JAMA. 2010;303(13):1253-1255. doi:10.1001/jama.2010.364