[IrvineFriend]

It's very, very expensive to run a drug trial, and combinations create the need for a very large trial with more inclusion/exclusion criteria making recruitment harder.

The reality is, drug companies also have to show a profit to their stockholders, just like any corporation that is trading on the stock market. Even large drug companies take a major hit when when they don't meet their end points, especially during a phase III trial. Before starting a large trial, you have to be pretty sure you're going to hit it out of the park and get approval. If drug companies

Doctors and FDA are contrained by the box (laws and regulations and not just the bottom $$ line). On the flip side, if patients were hurt by "creativity", you bet there would be a long list of lawsuits in line and a special 60 minutes episode about drug companies pushing products that haven't been proven safe and effective and FDA being under more government scrutiny.