How do we maintain the ideals underlying socially funded and equal health services under demanding conditions of the twenty-first century? Expenditure on health care throughout Europe has been rising more rapidly than any other public service, and pharmaceutical expenditure more rapidly than other components of healthcare [1]. The reasons underlying this tendency are well known: demographic changes, rising patient expectations, stricter clinical targets, and expensive new technologies [2]. To what extent is such pressure compatible with the aim of financing a comprehensive and equitable health service in Europe that is largely free at the point of delivery? In addition, what can be done to address these pressures? A two-day meeting involving 33 leading health care professionals from nine European Union (EU) countries was recently convened in Stockholm to address these issues. A deliberate decision was made not to seek external funding in order to ensure a free exchange of ideas from independent academics, regulators, and clinicians. Each delegate is actively involved either in registration, reimbursement, formulary listing, and/ or enhancing the rational use of drugs in his or her country. The meeting was hosted by the Karolinska Institute and Stockholm County Council together with leaders from the ‘Mario Negri’ Institute of Pharmacological Research in Milan and the universities of Heidelberg, Liverpool, and Marseilles. The meeting identified that optimizing the use of new expensive technologies represented the major challenge faced by health care services throughout Europe, especially with pharmaceutical companies seeking to overcome lost revenues from patent expiry estimated at over $100 bn USD per year over the next 4 years [3]. Whereas increasing the proportion of health care expenditure allocated to drugs is not intrinsically regrettable, ongoing pressure reinforces the need to ensure optimum stewardship of national pharmaceutical expenditure. This was encapsulated in the agreed vision which was “to ensure robust systems are in place in Europe to enhance the rational use of drugs, including new, expensive drugs, to improve health.” The delegates believed these objectives could be achieved by collaborating and developing pan-European strategies to shared problems and pressures that can be adapted locally. Guidelines and incentives are seen as beneficial to enhance rational use in line with an approach that has became known as the “five E’s,” namely: Evaluation, Economics, Enforcement, Education, and Engineering. Rational use of new, expensive drugs would also be enhanced through obtaining greater transparency in the information provided by pharmaceutical companies to regulators and national reimbursement agencies [4, 5]. Ensuring a basic infrastrucEur J Clin Pharmacol (2008) 64:1137–1138 DOI 10.1007/s00228-008-0537-z