Rating scales for disease in CTs are inherently limited by imprecision, inaccuracy, biases, and uneven training. They require more extensive training, evaluation, monitoring, and protocol guidance than can be provided for many CTs and for clinicians in practice. In important ways, progress in research and patient care in neuropsychiatry seems dependent on the development of biomarkers and surrogate endpoints similar to those that have reduced the physician’s dependence on subjective forms of judgment in other areas of patient care (65).
