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External validity is also an ethical consideration in cluster-randomised trials of policy changes: the author’s reply
  1. Karla Hemming
  1. School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK
  1. Correspondence to Dr Karla Hemming, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK; k.hemming{at}bham.ac.uk

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We would like to thank the authors of the FIRST trial for responding to our paper on ‘Ethical implications of excessive cluster sizes in cluster randomised trials’.1 We are pleased that our paper has generated this interest. The science and methodology of trial design are constantly evolving and will evolve faster, to the future benefit of science, if we can …

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