The book is very well edited, if repetitive at times, and it contains some very useful facts and references. However, anyone expecting a balanced discussion of interactions of medicine with industry with realistic and novel ideas for change will be frustrated by incessant reminders of the avarice of industry, the weakness of physicians, the lack of scientific rigor of researchers, and the flimsy regulation by government of medication use. Many of the points that are made are important and valid, but without adequate consideration of scientific and clinical issues in pharmacotherapy, they only evoke a negative reaction toward the entire field. For example, the reason why all negative effects of new treatments are not apparent at the time the treatments are released is not just that manufacturers conceal or minimize negative results: it takes three times as many patients to find important adverse events as it does to find a therapeutic effect, and it takes much longer to find rare but serious adverse effects. A new treatment may not be better than existing ones for a majority of patients with a particular disorder, but it may present considerable benefit for a subgroup for which the cost is justified by the benefit, as occurred with gefitinib, an epidermal growth factor receptor antagonist that was not statistically superior to existing treatment for refractory lung cancer but turned out to be highly effective in a small percentage of patients with a particular genotype. The benefit of a new treatment may be more apparent in combination with another medication than by itself. Overall, I had hoped for more suggestions about teaching clinicians how to interpret scientific data in the context of marketing, rather than another book about the pharmaceutical "evil empire."