Let me be clear, answering questions like these is not easy. The Veterans Affairs Cooperative Studies Program is in fact preparing to take on the colonoscopy versus fecal occult blood testing question. The trial, which will involve up to 50,000 patients, will last a decade and surely cost millions of dollars.

Research like this takes more than grant money. For starters, it takes a research infrastructure that monitors what standard practice is — data on what’s actually happening across the country. Because of Medicare, we have a clear view for patients age 65 and older, but it’s a lot cloudier for those under 65. Basic questions like how common annual physical exams are and what testing is part of them are unanswerable.

It also takes a research culture that promotes a healthy skepticism toward standard medical practice. That requires physician researchers who know what standard practice is, have the imagination to question it and the skills to study it. These doctors need training that’s not yet part of any medical school curriculum; they need mentoring of senior researchers; and they need some assurance that investigating accepted treatments can be a viable option, instead of career suicide.

We have to move quickly. The administrative demands of clinical care, on one side, and the competition for research funding on the other, make it increasingly difficult for researchers to see patients. They become isolated from standard practice, and their ability to study it diminishes. Clinicians who are well positioned to study these issues are increasingly directed toward enhancing productivity — questions about how can we do this better, faster or more consistently — instead of questions about whether the practices are warranted in the first place.

Here’s a simple idea to turn this around: devote 1 percent of health care expenditures to evaluating what the other 99 percent is buying. Distribute the research dollars to match the clinical dollars. Figure out what works and what doesn’t. The Patient-Centered Outcomes Research Institute (created as part of the Affordable Care Act to study the comparative effectiveness of different treatments) is supposed to tackle questions of direct relevance to patients and could take on this role, but its budget — less than 0.03 percent of total spending — is far from sufficient.

A call for more medical research might sound like pablum. Worse, coming from a medical researcher, it might sound like self-interest (cut me some slack, that’s another one of our standard practices). But I don’t need the money. The system does. Or if you prefer, we can continue to argue about who pays for what — without knowing what’s worth paying for.