>>>OTOH you have doctors getting kickbacks from pharma corporations in various ways - which often leads to more expensive medicines being prescribed when functionally equivalent alternatives exist.
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>That's often stated, but when you do a study, this is more common: http://uanews.org/story/study-doctors-wary-research-funded-pharmaceutical-industry ... it seems many doctors adopt a "I don't believe you even if you're telling the truth" attitude toward big pharma, not the cozy favoritism some people like to imagine. ;-)

there are quite a few good doctors trying to curb cost.

> If you'd used orthopedic surgeons choosing very expensive implants it would be more true since industry definitely does woo the surgeons, but these days even surgeons are banding together to set regional policies based on efficacy and price.

As an implant hopefully will last the rest of your life, selecting more expensive ones I could understand, if there was a difference measured long term: remember the french breast implant scandal for an example to avoid.
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>>>Also the practice of changing recipes ever so slightlty just when the end of patent time comes near to keep users accustomed to the brand name with the product instead of switching to then possible generica... Bigger bucks often corrupt more.
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>Maybe you won't need to worry much longer as this becomes more common: http://seekingalpha.com/article/847111-eli-lilly-new-drug-nightmares-will-sink-stock-in-2013 ... if it's more profitable to compete in generic markets or design around blockbuster patents, companies won't want to do the research and there won't be blockbuster drugs to worry about. We need to be careful what we wish for. It's like doctors- beware the poor doctor! Also beware increasing the risks of research if you want to see cures for new diseases in our lifetimes. FWIW India and Australia both have initiatives underway to limit patents while NZ has a Pharmac agency tasked with bargaining with pharmaceutical companies for the best deals. Maybe should be grateful for the US since their comparatively astronomical prices are enough to pay for a lot of research.

Not enough knowledge on typical development cost and testing cost - but I know enough statistics to wonder about the subject selectiom and reliability, esp in studies paying participants. Perhaps easing the rules for not totally verified medications should be eased: yes, human guinea pigs on the one hand, perhaps lured into snake oil testing on another, might endanger participants on the third(HIV inoculation, if the stuff I read in nonmedical, but above standard literature is correct): but if all pertinent info on previous results was publicized, IMO perhaps a better way to let some air out of the start-up cost could be found. Also realizing that this could lead to 2 level medicine and selection errors, as probably the wealthier ill people will opt for paying for less tested new stuff.Also I realize this is easy to say without diagnosed malady... Or perhaps prolong the patented time span, but in last half or third switch over to a more FRAND like approach (which could again allow generica companies to cherry pick those with tiny production cost, I know...)

if I knew all the answers, I'd be constantly shot at ;-)

thomas