PICO recognition is an information extraction task for identifying participant, intervention, comparator, and outcome information from clinical literature. Manually identifying PICO information is the most time-consuming step for conducting systematic reviews (SR), which is already labor-intensive. A lack of diversified and large, annotated corpora restricts innovation and adoption of automated PICO recognition systems. The largest-available PICO entity/span corpus is manually annotated which is too expensive for a majority of the scientific community. To break through the bottleneck, we propose DISTANT-CTO, a novel distantly supervised PICO entity extraction approach using the clinical trials literature, to generate a massive weakly-labeled dataset with more than a million ‘Intervention’ and ‘Comparator’ entity annotations. We train distant NER (named-entity recognition) models using this weakly-labeled dataset and demonstrate that it outperforms even the sophisticated models trained on the manually annotated dataset with a 2% F1 improvement over the Intervention entity of the PICO benchmark and more than 5% improvement when combined with the manually annotated dataset. We investigate the generalizability of our approach and gain an impressive F1 score on another domain-specific PICO benchmark. The approach is not only zero-cost but is also scalable for a constant stream of PICO entity annotations.