I was surprised and dismayed that your Editorial 'Clean hands, please' (Nature 454, 667; 2008) should be so careless with the evidence in addressing the question of relations between the government and the pharmaceutical industry in Italy.

In Italy, the pharmaceutical industry is obliged to maintain the lowest prices in Europe. The new government has left these regulations unaltered in its economic programme for the next three years.

At the time of the unfortunate events of the Duilio Poggiolini era 15 years ago, Italy's per capita spending on pharmaceuticals was slightly below the European average. This spending has today fallen to €194 (US$290), against a European average of €270 — even though Italy has easier access to therapies than many other European countries and has more elderly citizens than any of them.

In the past seven years, governments of various political colours have made 18 separate cutbacks on pharmaceutical spending. The 30% difference from the European average indicates that our industry has not enjoyed government favours.

The pharmaceutical industry has nevertheless fought back against this difficult situation. Its exports have risen from 10% of total production to 53%, and today it boasts a surplus in its trade balance for medicines.

The replacement of the manager of the Italian medicines agency AIFA, as mentioned in your Editorial, occurred after a judicial enquiry. This was ratified by an independent judicial decision.

The pharmaceutical industry in Italy is represented by an association that belongs to the Italian employers' federation Confindustria. This association has implemented rigorous ethical rules to govern its members' conduct and, in representing the interests of the industry vis-à-vis the public institutions, totally respects their autonomy. Its sole request is that public institutions provide a regulatory framework that is fixed over time and can guarantee timescales and procedures in their authorization processes, in the same way as those in force in other European countries.