Drug safety and efficacy are central to the missions of government agencies, industry, and clinicians. The case of the market withdrawal of rofecoxib (Vioxx; Merck & Co Inc, Whitehouse Station, New Jersey), which has been extensively discussed in the mass media, professional journals, and the courts, raises questions regarding the adequacy of governmental oversight, the integrity of the pharmaceutical industry, the role of professional journals, and the involvement of academia in pursuing this mission.