For Caesar O'Neal, a nausea-free day is priceless. But for the hospital treating the 6-foot-8-inch University ofFlorida football player for liver cancer, the price ofdelivering that relief is becoming troublesome.

Mr. O'Neal has been getting massive chemotherapy, including a round last fall that left him vomiting so much that he nearly quit treatment. After that crisis, doctors gave him Zofran, a powerful antinausea drug. Now chemotherapy isn 't so frightening, Mr. O'Neal says as he sits on his bed sipping Gatorade. Instead of suffering anguish after each treatment, he can enjoy small pleasures such as video games, big meals or chats with relatives.

But Zofran is one of the most expensive drugs around—and a hot issue as hospitals and drug makers clash over the cost of medications. A standard 32-milligram dose of Zofran—less than a single teardrop—costs hospitals $143. Factor in expenses for stocking it and having nurses ad¬ minister it intravenously, and each use ofZofran can turn into a $300 patient charge. By weight, gem-quality diamonds are cheaper.

Many doctors and nurses, however, think they can slash Zofran costs without making patients feel worse. “We may be overusing the drug," says Robert Benjamin, an oncologist who treats Mr. O'Neal at the University of Texas M.D. Anderson Cancer Center in Houston. He and other doctors around the U.S. think Glaxo's official package inserts, though approved by the Food and Drug Administration, overstate the Zofran dose that many patients need.

M.D. Anderson is seeking to trim its spending on costly antinausea drugs such as Zofran by 10% this year. Other teaching hospitals, in Boston, New York and Chicago, are looking for cuts of 25% to 50%—mostly by drafting new treatment standards that lean on doctors to shrink dosages or try less costly substitutes.

a. What cost control strategy are health administrators attempting to employ for Zofran?

b. What are the ethical considerations in cutting drug costs by cutting doses and switching to less costly substitutes?

c. What is the ethical responsibility of the pharmaceutical manufacturer in set¬ ting the prescribed doses for medicines it develops?