It has the makings of a science fiction movie: Zap someone's brain with mild jolts of electricity to try to stave off the creeping memory loss of Alzheimer's disease. And it's not easy. Holes are drilled into the patient's skull so tiny wires can be implanted into just the right spot.

A dramatic shift is beginning in the disappointing struggle to find something to slow the damage of this epidemic: The first U.S. experiments with "brain pacemakers" for Alzheimer's are getting under way. Scientists are looking beyond drugs to implants in the hunt for much-needed new treatments. The research is in its infancy. Only a few dozen people with early-stage Alzheimer's will be implanted in a handful of hospitals. No one knows if it might work, and if it does, how long the effects might last.

Kathy Sanford was among the first to sign up. The Ohio woman's early-stage Alzheimer's was gradually getting worse. She still lived independently, posting reminders to herself, but no longer could work. The usual medicines weren't helping. Then doctors at Ohio State University explained the hope - that constant electrical stimulation of brain circuits involved in memory and thinking might keep those neural networks active for longer, essentially bypassing some of dementia's damage.

Sanford decided it was worth a shot. "The reason I'm doing it is, it's really hard to not be able, sometimes, to remember," Sanford, 57, said from her Lancaster, Ohio, home.

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By James Flory and Jason Karlawish

“If there’s a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that’s going to make you well?”

With these words, President Barack Obama not only demonstrated his hip sci-fi credentials—Morpheus’s choice to Neo was either to take the blue pill and remain happy but ignorant of the truth, or the red pill, which would reveal to him a sometimes-painful reality and also launch the lucrative “Matrix” trilogy of movies—but also his desire to take a 21st-century, data-driven approach to clinical decision making and health care policy.

Among competing treatments for the same disease, which one is best? Which one is worth the money? These questions are the core of comparative effectiveness research. Half of insured patients in the United States are on chronic medications for conditions such as diabetes, hypertension, and high cholesterol. Patients, physicians, and policymakers need reliable data to know what to take, what to recommend, and what is worth paying for. Typically, however, they don’t have these data.

The Affordable Care Act, better known as Obamacare, has implemented a number of initiatives to address this problem. One of the largest is the Patient-Centered Outcomes Research Institute, or PCORI. A core mission of PCORI is to conduct comparative effectiveness research that gives patients and their health care providers the best evidence to help make more informed decisions. As promising and common sense as this mission is—because why not pay half price?—solid gold evidence to answer a patient’s question “Should I take the red pill or blue pill?” is hard to obtain.

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