I read with interest Mark Wilson's recent article, "The New England Journal of Medicine: commercial conflict of interest and revisiting the Vioxx scandal". I believe this is an important contribution that underlines the aphorism "Those who don't know history are doomed to repeat it." As Vioxx is a seminal example, it is important to place it in its proper context, examining if this malfeasance extends beyond the VIGOR study. While the epicentre of this conflict of interest surely begins with the sponsor, I believe the following essay demonstrates that this wave of egregiously unethical behaviour can exist and be propagated only with the complicity of academic investigators, medical journals, a flawed peer-review system and an uncritical medical readership. Perhaps the most troubling is that the factors that coalesced into the Vioxx scandal are, if anything, more ubiquitous today, mandating increased vigilance to decrease the probability of "getting fooled" again.