But this is how it's almost always done, because most research is designed to get drug B a market share by showing it's better than placebo and NEVER comparing it to established drug A, because then the new expensive drug might underperform.
There is a push going right now to throw out decades worth of tests against "placebos" because they don't have to tell us what's in the "placebo". Turns out that things which have been stated to be "placebo" are anything but. In one case it's now been shown that the effectiveness of a diabetes drug was extremely
over-exaggerated because the effectiveness was compared to the "placebo"... which just happened to contain... a form of sugar! In another case, a heart drug was tested against a "placebo" that evidently (records are spotty) that contained... fish oil. Even "placebos" can have an effect depending on what's in them.
I don't have my text of the "health-care" bill with me right now, so I won't get into that until I have direct cites.
On the "costs" of medicine, I do have two comments:
1] It is possible (and there is a significant number of people who are doing so) to get the equivalent health-care in other countries (where the MDs are trained in the U.S. & U.K.; they use the same machinery to perform the same tests; the hospitals are clean & modern; the same medications are available) for a fraction of the costs here in the U.S.
2] The U.S. system is setup so that those who work are paying for those who don't. Then when someone who's paid into the system finally needs the use of their insurance, they get shuffled to the back of the line while those who've either not paid or hardly paid get put to the front. Why not take care of those who've paid for it over time and let those who haven't paid for it get in line (like they do in a lot of other countries).
(I freely admit that this is my experience and observation for my family and myself over the last ~25 years. Two side notes on this: first, when my parents both got sick in the same year, their entire medical costs were $17k and the insurance company paid out $14k... My dad's premiums had been running ~$9k for years before that and went up to ~$15+k the next year... He could have been "self insured" and made out big time. On one occasion, the hospital made my parents come up with CASH before they would treat my Mom because they said the insurance company took too long to pay... in the same waiting room was someone who'd never paid into the system, but was covered by our government and they were given the red carpet treatment without having to come up with a dime because the hospital got their money without scrutiny from the government. Second, in my case, I've either paid personally or between me and various employers ~$12-15k/yr for a very long time - decades - and the most that has ever been paid out for me and/or my family in any one year has been ~6k... pretty damn lucrative for the insurance business, then again look who has the largest buildings. A couple of years ago I was denied a therapy recommended by two different MDs because the insurance company refused to pay the ~$3-4k for it. IF I had been self-insured I could have paid that 4 times over that year! BUT, government regulations make it basically impossible - and now illegal under this new health-care law - for me to privately pay for any of this. I HAVE TO pay through/using an insurance company! In fact, it was recently suggested to us by an MD that we would be better off going for the MA government insurance over private insurance because it wouldn't cost me anything and the coverage is really good... almost as good as what I'm paying ~$1500/month for! And I'm going to get taxed "extra" because I'm considered to have a "Cadillac plan"! Sorry for the rant...)
In the U.S., government regulations (protections actually) have caused our prescription prices to soar, alternatives to be ignored, created the need for hospitals and MDs to charge more in order to compensate for reduced insurance & medicaid/medicare payouts as well as a litigious society that punishes the good while protecting the bad.