Other social values are also at stake in debates concerning drug safety and pricing. The rising cost of health care, fueled to a large extent by prescription drug prices, is among the most serious financial challenges facing not only con¬sumers, but private businesses and government. Pharmaceutical companies point to the great expense involved in research, development, and product test¬ing. Yet real competition is constrained by patents and other barriers to entry faced by generic drugs. Reports that large pharmaceutical companies spend more on marketing than on research also casts doubts on the fairness of drug pricing. We consider some ethical issues concerning marketing of drugs in the discussion case in the next chapter.