used type of epidemiological study that can be carried out by small teams or individual researchers in single facilities in a way that more structured experimental studies often cannot be. They have pointed the way to a number of important discoveries and advances. The case–control study design is often used in the study of rare diseases or as a preliminary study where little is known about the association between the risk factor and disease of interest. Compared to prospective cohort studies they tend to be less costly and shorter in duration. In several situations, they have greater statistical power than cohort studies, which must often wait for a 'sufficient' number of disease events to accrue. Case–control studies are observational in nature and thus do not provide the same level of evidence as randomized controlled trials. The results may be confounded by other factors, to the extent of giving the opposite answer to better studies. A meta-analysis of what was considered 30 high-quality studies concluded that use of a product halved a risk, when in fact the risk was, if anything, increased. It may also be more difficult to establish the timeline of exposure to disease outcome in the setting of a case–control study than within a prospective cohort study design where the exposure is ascertained prior to following the subjects over time in order to ascertain their outcome status. The most important drawback in case–control studies relates to the difficulty of obtaining reliable information about an individual's exposure status over time. Case–control studies are therefore placed low in the hierarchy of evidence. Examples One of the most significant triumphs of the case–control study was the demonstration of the link between tobacco smoking and lung cancer, by Richard Doll and Bradford Hill. They showed a statistically significant association in a large case–control study. Opponents argued for many years that this type of study cannot prove causation, but the eventual results of cohort studies confirmed the causal link which the case–control studies suggested, and it is now accepted that tobacco smoking is the cause of about 87% of all lung cancer mortality in the US. Analysis Case–control studies were initially analyzed by testing whether or not there were significant differences between the proportion of exposed subjects among cases and controls. Subsequently, Cornfield pointed out that, when the disease outcome of interest is rare, the odds ratio of exposure can be used to