Last century if a patient presented with chest pain or dyspnoea the only laboratory examination we may have considered was a visual inspection of the urine, and the treatment options might have included blood letting and foxglove. Today we enjoy a far greater ability to investigate and treat. This technological luxury has lead to rising health care costs and the consequent need for cost controls, either implicit or explicit. Health care managers may have to consider whether to allow tissue plasminogen activator (t-PA) rather than streptokinase for acute myocardial infarction, which patients should be allowed HMGCoA reductase inhibitors, whether intravascular ultrasound should be available, and what should be the access to coronary bypass, stenting, and angioplasty. The list grows ever longer. An article in this issue asks us to consider abciximab in preventing restenosis after angioplasty in high risk patients.