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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