A common problem that we have is that there is no such thing as the perfect drug. Any drug that is stronger than placebo will inevitably have side-effects (note that even placebo has side effects). It is always a cost-benefit and this is a tricky thing to fully convey to patients - what does 10% risk of side-effect mean? For the patient that gets the side-effect they usually have it a 100%.

I wish that we doctors were immune to the industry's influence but unfortunately we also sometimes fall prey to the cunning tricks. I think the OxyContin scandal says it all http://theweek.com/articles/541564/how-american-opiate-epide... Mind-blowing that doctors actually believed that there is a free lunch - a morphine product without addiction...

There is hope though, here in Sweden doctors during the 90:s were frequently taken to nice dinners and other events in the name of drug companies representative costs. In early 00 this basically disappeared and today we get a sandwich during lunch break in order to hear about the new thing that they want to sell us. I think the awareness of the "no free lunch" concept (see http://www.nofreelunch.org/) is much higher today than 20 years ago when I started med-school.

One cost that you have to be prepared for is that the system becomes "communistic": if we prescribe any drug that is outside the recommended set of drugs our clinic has to cover the costs. The adoption of new drugs is generally slower (although not for important drugs e.g. cancer treatments) and we are no longer allowed to make local deals with suppliers, everything has to go through centralized deals (even if we can get a better deal). In my mind it's a small price to pay if it keeps our patients safe and we get to spend the money on our health-care where it matters, but I think this system would never pass the American legislative system...