Comparative effectiveness research has been touted as one of the most important paths to bending the health care cost curve downward. In the long run, medical evidence will undoubtedly rationalize the delivery of health care and help control costs, but what about the short term? The Dartmouth Atlas Project has documented a 2.5-fold variation in per capita Medicare spending in different parts of the country, most of which cannot be explained by variation in prevalence of illness or patient preference. These studies suggest that as much as a third of health care dollars are wasted on unnecessary care, the delivery of which is driven in part by a lack of evidence. We can’t wait until the evidence is in. What are some other possible solutions to addressing the problem of unwarranted variation?

Shannon Brownlee is a writer and essayist who is currently serving as a Visiting Scholar at the NIH Clinical Center, Dept. of Bioethics; a Woodrow Wilson Visiting Scholar; and a Senior Fellow at the New America Foundation, in Washington, D.C. Her articles and essays have appeared in such publications as the Atlantic Monthly, BMJ, New York Times Magazine, New Republic, Slate, and Time. She is a recipient of the Association of Health Care Journalists Award for Excellence, the Victor Cohn Prize for Excellence in Medical Science Reporting, the National Association of Science Writers Science-in-Society Award, and the Sigma Delta Chi Award from the Society of Professional Journalists, among many other awards. Her most recent work focuses on the lack of evidence in medicine and the problem of unnecessary health care, which accounts for as much as a third of the nation’s health care bills. Brownlee’s book, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, was named the best economics book of 2007 by New York Times economics correspondent David Leonhardt. She holds a Master of Science in marine science from the University of California, Santa Cruz.