Although both the entrepreneurial spirit of individual investigators and development of new therapies by the pharmaceutical industry need vigorous encouragement, we can no longer rely completely on information provided by these sources to determine how well treatments work and which ones work best. Enumeration of problems described above leads naturally to suggested specific solutions; I acknowledge that medical editors, especially, have moved toward adoption of some of them. However, none of the suggested solutions has been broadly and successfully adopted, and without a concerted effort, especially by medical editors, these problems will remain, and information about the efficacy and safety of treatments will be incomplete and, in some cases, inaccurate. Although the proposed solutions (Table 2) represent small steps toward the ideal state described earlier, most of them will not be easily accomplished, and other approaches certainly exist. Nonetheless, I believe that consideration of these issues is timely, and that a debate regarding possible solutions is warranted.