Clinical Trials and Effectiveness Research
HAROLD J. BURSZTAJN, M.D.
Cambridge, Mass.
Am
J Psychiatry 157:152, January 2000
© 2000 American Psychiatric Association
To the Editor: Kenneth B. Wells, M.D., M.P.H, has made an important contribution
with his article [1]. It may be helpful to keep the
following considerations in mind in interpreting both efficacy and effectiveness
studies for both clinical and policy decision making.
Outcomes are most often defined in terms of easy-to-measure markers.
Features such as autonomy or authenticity are rarely considered and are
also never measured in either type of study. Yet they are most relevant
in terms of the utility of given outcomes to individuals, as well as
our culture and our society (2–4). More easily measurable
outcomes continue to dominate the studies reported even in this Journal.
Should all outcome studies carry at least an explanation of why the particular
outcomes were chosen and why meaningful outcomes were not considered?
References
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Wells KB: Treatment research at the crossroads: the scientific interface
of clinical trials and effectiveness research. Am J Psychiatry
1999; 156:5–10.
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Bursztajn HJ: Efficacy research
and psychodynamic psychiatry (letter). Am J Psychiatry 1991;
148:817–818.
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Bursztajn HJ, Hamm RM: The clinical
utility of utility assessment. Med Decis Making 1982; 2:162–165.
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Bursztajn HJ, Feinbloom RI, Hamm RM, Brodsky A: Medical
Choices, Medical Chances: How Patients, Families, and Physicians
Can Cope With Uncertainty. New York, Routledge, Chapman & Hall,
1990.