The answers to these questions will shape the evidence that is sought and analyzed. What counts as the "right" evidence, and the ways in which those who perform the studies are held accountable to the public, are politically and ethically embedded decisions. The challenge of applying the "principles of value-based drug pricing" pales in comparison to determining how to address these fundamental issues. While the proposals presented in the Viewpoint 1 might make the drug approval process more transparent, they would be strongly opposed by the lobbying power of those who currently benefit from minimal price controls, including Big Pharma and medical device manufacturers. The approach proposed by Robinson 1 reflects a strictly economic solution to a pressing policy issue. When invoking the German experience with price negotiations based on available evidence, the author ignored the societal factors and institutions that make implementation of these ideas so difficult. 4 Abstract models and tools based solely on economic models without recognition of the role of politics, culture, and societal values conjures up proposed ideal solutions that turn out to be neat, plausible, but simplistic given the current financing and organization of the US health system.