 The first reason is that, as we have seen above, medical decisions are always in part decisions about normative matters. No treatment is entirely without side effects and so if judgments about efficacy are to be of practical guidance, they must include a weighing of benefit (alleviation of disease symptoms) against cost (suffering from side effects)—even if economic costs and benefits are not to be taken into consideration. Second, government agencies such as the U.S. Food and Drug Administration (FDA) have to decide whether new treatments should be licensed to be marketed. These decisions often have significant consequences, and democracies tend to prefer to be able to hold someone accountable for making them. Drug approval therefore cannot be determined on the basis of evidence according to some mechanical algorithm.