“Compared to What” was a song composed and recorded in the 1960s by several jazz artists, with 1 rendition by McCann and Harris often mentioned as one of the best jazz live performances ever. The song addressed societal problems of the times, with lyrics “Nobody gives us rhyme or reason/Have one doubt, they call it treason.” So, is it reasonable or treason to consider alternative approaches to a definitive randomized clinical trial in bariatric surgery? Can large data sets, such as the one used in the article by Howard et al¹ in this issue of JAMA Surgery, contribute to filling knowledge gaps where larger randomized clinical trials do not exist? The answer is likely yes, but only if the novel methods are understood and accepted.

“Compared to What”是一首由几位爵士艺术家在 1960 年代创作和录制的歌曲，麦肯和哈里斯的一次演绎经常被称为有史以来最好的爵士现场表演之一。这首歌解决了时代的社会问题，歌词“没有人给我们押韵或理由/有一个疑问，他们称之为叛国罪。” 那么，考虑替代方法来进行减肥手术的最终随机临床试验是合理的还是叛国的？大型数据集，例如 Howard 等人¹在本期JAMA Surgery的文章中使用的数据集，是否有助于填补不存在更大规模随机临床试验的知识空白？答案可能是肯定的，但前提是新方法被理解和接受。