“One fundamental problem may be a misguided perspective that health care is a binary world in which interventions are either effective or ineffective, appropriate or inappropriate. In truth, there are large gray zones in which an intervention is neither clearly effective nor clearly ineffective — zones where benefits are unknown or uncertain and value may depend on patients’ preferences and available alternatives. Much health care occurs in these gray zones, which are expanding despite insights gained from comparative effectiveness research.”

“…innovations comes increased scope for overuse, because the number of patients who can be treated without harm — and possibly without benefit — increases. To date, […] [research] has focused on evaluating and comparing individual therapies or elucidating disparities in care.5 These investigations assume that the inability to manage new technologies is an information problem, not an economic one. Expanding research programs to evaluate ways of combining reimbursement policy with comparative effectiveness research would enhance the return on investment.”

Chandra, A., D. Khullar and T. H. Lee (2015). “Addressing the Challenge of Gray-Zone Medicine.” New England Journal of Medicine 372(3): 203-205.  http://www.nejm.org/doi/full/10.1056/NEJMp1409696