The article "Evidence-Based Public Health: Moving Beyond Randomized Trials" by Cesar G. Victora, Jean-Pierre Habicht, and Jennifer Bryce discusses the limitations of randomized controlled trials (RCTs) in evaluating public health interventions and proposes the need for a broader approach that includes observational studies using adequacy or plausibility designs. RCTs are essential for assessing the efficacy of clinical interventions with short and simple causal chains, but they are less suitable for public health interventions due to their complex causal pathways and the potential for effect modification in different populations. The authors argue that RCTs alone are often insufficient for evaluating large-scale public health programs, which require additional evidence to support their impact and effectiveness. The article highlights the importance of internal validity, which refers to the strength of scientific inference supported by a study, and external validity, which concerns the generalizability of results to other settings. RCTs are considered the gold standard for internal validity, but they may not be feasible or ethical for public health interventions. Observational studies, particularly those using plausibility designs, can enhance the internal and external validity of RCT findings by addressing confounding variables and providing additional evidence of causality. The authors propose a classification of evaluation studies based on the dose of the intervention delivered and the compliance of recipients. They emphasize that the impact of an intervention is often influenced by multiple factors, including provider behaviors, recipient compliance, and biological effects, making it difficult to generalize results from RCTs to real-world settings. Adequacy evaluations, which document time trends in expected directions following intervention implementation, can also provide valuable evidence when the causal pathway is relatively short and simple. In conclusion, the authors advocate for a multifaceted approach to evidence-based public health that includes RCTs and other study designs. They call for the development of protocols and resources to facilitate the conduct and interpretation of plausibility studies, particularly for large-scale public health interventions with complex causal chains. This approach is crucial for making informed decisions about public health priorities and policies, especially in international health contexts where RCTs may not be feasible.The article "Evidence-Based Public Health: Moving Beyond Randomized Trials" by Cesar G. Victora, Jean-Pierre Habicht, and Jennifer Bryce discusses the limitations of randomized controlled trials (RCTs) in evaluating public health interventions and proposes the need for a broader approach that includes observational studies using adequacy or plausibility designs. RCTs are essential for assessing the efficacy of clinical interventions with short and simple causal chains, but they are less suitable for public health interventions due to their complex causal pathways and the potential for effect modification in different populations. The authors argue that RCTs alone are often insufficient for evaluating large-scale public health programs, which require additional evidence to support their impact and effectiveness. The article highlights the importance of internal validity, which refers to the strength of scientific inference supported by a study, and external validity, which concerns the generalizability of results to other settings. RCTs are considered the gold standard for internal validity, but they may not be feasible or ethical for public health interventions. Observational studies, particularly those using plausibility designs, can enhance the internal and external validity of RCT findings by addressing confounding variables and providing additional evidence of causality. The authors propose a classification of evaluation studies based on the dose of the intervention delivered and the compliance of recipients. They emphasize that the impact of an intervention is often influenced by multiple factors, including provider behaviors, recipient compliance, and biological effects, making it difficult to generalize results from RCTs to real-world settings. Adequacy evaluations, which document time trends in expected directions following intervention implementation, can also provide valuable evidence when the causal pathway is relatively short and simple. In conclusion, the authors advocate for a multifaceted approach to evidence-based public health that includes RCTs and other study designs. They call for the development of protocols and resources to facilitate the conduct and interpretation of plausibility studies, particularly for large-scale public health interventions with complex causal chains. This approach is crucial for making informed decisions about public health priorities and policies, especially in international health contexts where RCTs may not be feasible.