Many of the books we use and the articles we base our practices on are produced by academic physicians and PhDs who have a variety of conflicting interests. They range from the allocation of public health dollars to issue advocacy. So to what degree can we actually trust that what we are taught to do in medical school is training us to actually safeguard the one interest that Hippocrates held sacred: the well being of the individual we are treating at a given point in time? I ask this question as I ponder the increasing intrusiveness of "it costs this much to do this" and "outcomes measured in dollars per patient life year" into medical education. I also ask it as, moving through my clinical years, I've seen a series of middle aged doctors play the odds in clinical practice...with no goal other than to see if they could "get away" without ordering particular tests or imaging studies. Sometimes they got away with it. Other times they ended up ordering them after a delay that caused the patient in question extra pain, suffering, or a delayed cure without permanent harm. Occasionally it has even resulted in a patient's demise (usually in the internal medicine setting). I have half a mind to go out and buy a set of 20 or 30 year old textbooks of medicine when I'm done to get the perspective of those who came before us whose clinical reasoning may not have been tainted by such extraneous concerns. I didn't go to medical school to become some HMO's hatchet man.