Americans like to believe that the medical care we get from our doctors is based on solid scientific evidence. We hear often that American medical care and medical research are the best in the world. Yet between 2003 and 2010, three different laws were enacted, the most recent being the Affordable Care Act of 2010, that mandated new federal investments in a type of clinical research called comparative effectiveness research, research into what works best in medical care. In this book, we tell the story of how—and why—the federal government decided to make comparative effectiveness research an ... More

Americans like to believe that the medical care we get from our doctors is based on solid scientific evidence. We hear often that American medical care and medical research are the best in the world. Yet between 2003 and 2010, three different laws were enacted, the most recent being the Affordable Care Act of 2010, that mandated new federal investments in a type of clinical research called comparative effectiveness research, research into what works best in medical care. In this book, we tell the story of how—and why—the federal government decided to make comparative effectiveness research an important feature of health reform. Despite significant legislative uptake of policy proposals on comparative effectiveness research, support for federal mandates took dramatic twists and turns as bipartisan alliances fell apart, special interests resisted, public opinion was mobilized, and compromises were reached. We examine where comparative effectiveness research fits in the production of scientific evidence about the benefits and harms of treatments for human diseases and conditions, and offer sobering confirmation that contemporary American medical care falls far short of the evidence-based ideal. While more research is needed, payment policy will be required in order to align medical practice with what the evidence shows works best in specific clinical scenarios, improving patients’ outcomes and enhancing the value of health care expenditures. Moreover, if we are to deal constructively with the vast uncertainties in medical care, policies are needed to make the generation of high-quality evidence an inseparable part of routine medical care.