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payers by and large and this is a terrible generalization uh look at the gold standard of randomized controlled trials as the best place to find evidence and of course the reason is because of randomization you can get rid of confounding and baseline and not have to adjust for it and then have controversies over the adjustments but having said that not everything in life can really be solved with a randomized controlled trial in order could be afford to do everything that way so increasingly payers are looking at observational data when theyamp;#39;re conducted well when theyamp;#39;ve been replicated in different populations and giving some credence to that kind of data as well i view real world evidence generation as being terribly important because when youamp;#39;re looking at a a product being developed in an academic medical center with a tight protocol of care and itamp;#39;s just a subset of people who are enrolled youamp;#39;ll get one set of findings but when itamp;#39;