As of 2023, and probably for a long time to come, the most robust evidence of a treatment's efficacy comes from comparative trials, conducted in accordance with a rigorous methodology to ensure that the comparison was not biased. In other words, when seeking to determine whether a treatment is more effective than another, or more effective than no treatment, nothing is as robust and reliable as double-blind randomised comparative trials that use meaningful clinical endpoints (see "Proving a treatment's efficacy" p. 162 of this issue). It may not be popular among those who consider that this step delays patients' access to "innovations", and propose saving time by using the results of "real-world" observations together with new methods for their statistical analysis, or by using artificial intelligence to create "virtual control groups", but it is nevertheless true.
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