Beyond information: exploring patients' preferences.

quired not only to produce the same level of health as the current ones but also to be substantially less expensive. Showingtheprivatesectorthatcomparativeeffectivenessfunds will be used in this way could change the entire research and development process in the US health care industry. It could also help the current administration achieve its goal of making health care more affordable for all US citizens. To adopt these 2 criteria for funding comparative effectiveness research, the agencies that release funds must make tough decisions. The agencies will be accused of sponsoring rationing. A strong case can be made that this does not represent rationing but rather uses research dollars to produce therapies that are better and substantially less expensive. After all, when a computer is purchased today at a small percentage of the cost of computers produced years ago, it is not believed that the private sector has rationed computer chips. Instead, the research and development model in the computer industry has been to make better machines and to make them at increasingly lower costs, thereby making computers affordable to many more individuals. It is time to use public funding and comparative effectiveness research toaccomplish the same thing inmedicine. If this opportunity is missed, another one is unlikely to come along. Thenrationingmayactuallybecometheonlywaybywhichreductions in health care expenditures can be achieved.