I read with interest about the randomized clinical trial of endobronchial ultrasound with and without aspiration in the recent article by Casal et al1 in CHEST (September 2012). In this study, neither participants, nor bronchoscopists, nor pathologists were randomly assigned to comparison groups. Instead, the study was designed as a prospective comparison of two different bronchoscopic techniques, with each participant serving as his or her own control subject. Easy to miss, save for a single sentence in the “Materials and Methods” section, the unit of randomization was which procedure was performed first. Although this was a potentially rigorous design, the relevant details were not adequately captured by the “randomized clinical trial” designation, which was somewhat misleading.