In conclusion, Mueller and colleagues cast their argument in stark terms, such as “scientifically invalid,” “biased,” and “unethical.” A more nuanced view is that RCTs and DMCs must balance many competing and worthwhile medical, statistical, ethical, and social goals, which is why the literature in this area is so rich and why DMC deliberations that have been described are so difficult (36–37, 35, 39). The DMCs typically weigh all of the concerns articulated by Mueller and colleagues, and more (36, 40–41). As with juries, review panels, and other groups empowered with making difficult decisions (42), the outcomes of such deliberations can always be second-guessed, but algorithmic solutions to improve the process rarely do so. However, as implied by Mueller and colleagues' comments, not all DMCs have a sophisticated understanding of methodological issues and not all function optimally. The number of potential DMC participants with training and experience in the DMC process is relatively small, and efforts to expand that pool are badly needed (43).