We greatly appreciate the interest of Drs. Myles, Scheinin, Langsjo, and Helwani in the Michigan Awareness Control Study (MACS). We are delighted that the study provoked a wide range of commentary from the semantics of clinical research terminology to the fascinating developments in the neuroscience of consciousness and anesthesia. Dr. Myles states categorically that the metliodology of MACS is not consistent with comparative effectiveness research (CER), referring to the Institute of Medicines definition for support. The Institute of Medicine defines CER as:
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