I appreciate Dr Bresnick's thoughtful letter and support the four ways he describes for OR and RTCs to work together. Also, he is correct in observing that OR and RCTs are not mutually exclusive but supplementary. However, he misses the primary point of my Editorial: there is a gap between OR and traditional RCTs that leaves many treatments without scientific evaluation. Concern over how this gap is to be filled has already created considerable discussion—and some polemics—in the literature.1,2 Part of the problem with RCTs in this country is that those of us who plan them have attempted to incorporate principles of good laboratory science into clinical research, emphasizing uniformity and control. In addition, because we are dealing with free-living, nonuniform human beings and because there are always confounding factors we cannot control, we have needed large sample sizes to reduce variation and randomization to take care
Hillis A. Cost Containment-Reply. Arch Ophthalmol. 1995;113(4):402–403. doi:10.1001/archopht.1995.01100040016004
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