Most of the current generation of senior clinicians have been trained to put the interests and needs of the patient first. The doctor-patient relationship is sacrosanct, a binding contract to strive for the best in diagnosis and management, and it is ‘blind’ to cost. In monetary terms, present day diagnosis and treatment of cardiovascular disease are not cheap, although in this context many management strategies offer impressive improvements in quality and quantity of life. It is the high-profile nature of cardiovascular disease, its high cost, and its perception as a killer by the lay public that force government intervention. The political issues concerning government are: cost containment, maximizing returns for expenditure, and achieving socially acceptable levels of disease containment. To a lesser but nonetheless positive extent, government intervention may also drive clinical expansion and research in new areas, although it can be perceived as interference by a number of clinicians in the speciality.