Dr. Evans' editorial [1] and the Task Force's position paper [2] delineating guidelines on ways to conduct research using economic analyses were excellent. As economic analyses become a standard for evaluating medical outcomes, protocols will be needed. The Task Force's operational definitions will certainly reduce misunderstanding, but I believe the ability to really "monetarize" quality of life, or even health, is debatable, given that such concepts are defined differently and change over time.

Dr. Evans' discussion of the ways in which marketing outcomes affect pharmacoeconomic research is poignant. Sponsorship does, unfortunately, affect the validity of the research. The outcome of research should leave room for the unexpected, but because positive findings are more desirable than negative ones, compromised research integrity is always possible.

As medical research consumers, we expect that, regardless of sponsorship, we would be informed of positive and negative findings. This is probably an unrealistic expectation. One possible solution to this problem is a "consumer research approach." Another would be an institute of medical research funded by medical technology manufacturers, regulatory agencies, the health industry, and donations from the public. Under such a system, manufacturers would pay a fee to have the institute evaluate their products and interventions. They would, in essence, agree to accept the institute's unbiased evaluation of the quality and value of their products and interventions.

Perhaps in this way, evaluation research can still be conducted independently by those with expertise and funded by those with the money and incentive to provide useful products and interventions. All of us who are most likely to gain or suffer from the quality and value of such products would be the beneficiaries.

Betty C. Jung, RN, MPH

Guilford, CT 06437