Joseph Heller’s Catch 22, published in 1961, has been described as both a dark comedy and absurdist fiction, and as one of the iconic novels of the 20th century. The term Catch 22, is defined by the Collins English Dictionary as follows: “If you describe a situation as a catch-22, you mean it is an impossible situation because you cannot do one thing until you do another thing, but you cannot do the second thing until you do the first thing.” As such, it has application to the recently published CHEERS 22 guidance for constructing imaginary pharmaceutical value claims and the belief system that supports it; indeed CHEERS 22 might, somewhat uncharitably perhaps, be described as absurdist fiction but not a dark comedy, unless one is unduly cynical.

The CATCH-22 dilemma is straightforward: if there is agreement that there needs to be a radical rewriting and overhaul of disease specific PROs then this would require recognition of the standards of normal science and the role of fundamental measurement, you cannot attempt to achieve the first without acknowledging the second, but you cannot embrace the standards of normal science and fundamental evidence without rejecting the current PRO situation even though you might view it as a major and unwelcome undertaking.

You either embrace the apparent information meme or you reject it; there is no halfway house. You either buy into it lock stock and barrel or you do not. This is why the role of protocols in formulary decision making is potentially groundbreaking in forcing attention to the need for empirically evaluable core values claims. Much as the approximate information meme is focused, following CHEERS 22 on imaginary modeled claims, it fails, as ICER demonstrates, at providing needed guidance and evidence to formulary committees. CHEERS 22 makes no reference to formulary committees or how the imaginary claims should be presented to committees. It is perhaps doubly unfortunate that both CHEERS 22 and CATCH 22 share the same numeric suffix.


Langley P. Core Value Claims, Protocols, and Formulary Evaluations. Maimon Working Papers No. 6  February 2022