The last third. R&D: the return on our investment

"The challenge is to balance what is good for the individual against what is in society's best interests without providing disincentives for product development." This quotation from a 1988 JAMA article by Peter Jacobson and John Rosenquist exploring contrast media issues goes beyond the usual scope of concern and also crystallizes why the low osmolar contrast agent (LOCA) controversy is so typical of the dilemmas that healthcare and society as a whole will continue to confront. The first two-thirds of this quotation presents a challenge that has been the subject of the LOCA debate for some time now: how to weigh the benefit to the individual versus the cost to society. The last third of this challenge acknowledges the importance of research and development, which has been largely ignored although it represents a vital ingredient for future healthcare improvements.