There's a spectrum of efficacy on one end and effectiveness on the other. Effectiveness studies really want to look at treatments under conditions that more typically approximate usual care, tend to be more feasible, more representative patients, tend to be conducted in the community setting. These studies are going to emphasize external validity. You want your findings to be as true for real world populations and settings as possible, generalizable. These studies have "higher generalizability". The big challenge is, how do you conduct research focused on effectiveness and still deliver standardized interventions? If your internal validity goes out the window, it actually decreases what you can say about how generalizable these things are. And again, typically these studies will focus on longer term outcomes. There's generally less detail.

Suffice it to say that people are now doing studies that are really hybrids of these things. We're doing a study now that's essentially a double-blind placebo-controlled study of citalopram for recurrent belly aches in kids. We're doing it, though, in primary care settings and in a traditional specialty clinic. We're doing, after we break the blind, we're continuing to follow these folks to just see durability of response, whether the pediatrician's going to be willing to pick up the prescribing, that sort of thing. That's more towards an efficacy study for sure. There are other studies that... There is a spectrum.

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