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The role of non-peer-reviewed research (and forums like Keranet)

I’m not sure what the point of your original question was. You seem to be implying that if one of us shares his or her vast experience accumulated over decades of careful observations, until it’s published it isn’t in some sense “real” (or believable)
We are all very busy and unfortunately have to earn livings as well as contribute to the advancement of science in our field. I’m sure if Bill Gates decided to give any of us a stipend of $1mil/yr under the stipulation that we would drop all our other obligations and focus only on advancing the science, our careers and practice patterns would take a dramatically different trajectory!
There are many levels of “research” and to try to draw any line in the sand between “real” and “not real” is both impossible and pointless
For example, one possible “hierarchy” of research “quality” might look as follows
NEI funded multi-center controlled trial
Drug company funded research for FDA trial
Device company funded research for FDA
Meta analyses
Multicenter trial, top peer-reviewed journal
Multicenter trial, ok peer-reviewed journal
Singlecenter trial, top PR journal
Singlecenter trial, ok PR journal
Poster at AAO ASCRS or ESCRS
Publication in non-peer-reviewed journal
Large nonpublished observations (k-net?)
Drug company dinner talk
Published case report
Pearls an older doctor gives in the hallway
Observations from small sample sizes
As you can see, any line you draw in this hierarchy is necessarily arbitrary. Worse, you’d be ignoring important sources of “real life” validation and information (ie the items towards the bottom of this list)
Once something is published it doesn’t become “real”. It just becomes “more public”
If you perform research under IRB it isn’t automatically “safer and more ethical”. You’ve merely formalized the ethical review process that I’m sure we all engage in carefully ourselves, weighing the (acceptably low) risks to our specific patients against the (higher) chance of finding a substantial benefit for all our future patients (and those of other surgeons, if shared properly on forums like Keranet)
One of the main reasons I’ve rejoined Keranet as an active participant, after a hiatus of nearly a decade, is I’m planning on retiring soon, and have realized that my plan to publish many things I’ve learned about ASA in peer-reviewed journals isn’t going to happen. Fellows graduate and don’t have the time to turn posters into papers. We get older, have family obligations, and our careers, like our lives, pass by so quickly
The giants in our field seem to be able to “do it all.”  But we don’t ever see the full burden of their sacrifice.

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