It is often said that the pharmaceutical industry only adapts in response to a crisis, and Vioxx might instigate the most dramatic of all changes. The withdrawal of Vioxx has exposed many scientific, clinical, regulatory and business issues that are fundamental to the industry's future. With the integrity of the drug-safety system under scrutiny, companies urgently need to understand how these problems arose, and how they can be prevented in future. One year on from Vioxx's withdrawal, Nature Reviews Drug Discovery asked people closely involved in the development and use of COX2-selective inhibitors what they think are the biggest lessons that can be learnt from this debacle.
