After I wrote my column about the credibility problems of the pharmaceutical industry last week, I shared it with a friend at a major drug company.He got back to me quickly to explain why my advice was misguided. In the wake of new accusations against Hoffmann-La Roche, I suggested that firms share with the public concerns expressed by their internal medical experts about the safety and efficacy of their products. Hoffmann-La Roche, according to a lawsuit filed in Florida, failed to do just that after a doctor warned that its acne medication, Accutane, might cause depression and suicide. Instead, it followed the advice of its marketing people and kept its concerns under wraps. My friend's counterargument went something like this: The drug development process is long and complicated, and research scientists and physicians are inherently cautious, so no drug ever reaches the market without some safety concerns being expressed. A policy of complete transparency would result in a deluge of health warnings. That would lead to mass confusion among the public and an even greater deluge of lawsuits. I agree with all aspects of his argument but the conclusion. It's certainly possible - at least initially - that people would react to all this information with greater concern about the safety of the nation's drugs. For that reason, it would be incumbent upon the industry, as well as regulators, to make sure that the information is provided in its proper context, including an explanation of the development process, a quantification of the risk, and communication concerning the risk of not bringing such drugs to market. But if every pharma company followed the same approach, it would not take long before the public developed an immunity to all but the most serious warnings. Reporters would be unable to sensationalize every case, so they would learn to evaluate the information and bring only the most serious concerns to the attention of the public. Over time, we would see the emergence of experts who could provide third-party analysis on the various issues. On the legal front, attorneys might use the internal warnings as evidence of what the company knew and when it knew it, but that evidence would be far less damning than it is today, in part because jurors would understand that warnings of possible side effects are commonplace and in part because the company would have shared the information openly, rather than keeping it secret. Most important, it's information that will get out anyway. The challenge for communicators is no longer controlling the flow of information - an impossible task - but contextualizing it. That's what the pharmaceutical industry will need to do to win back the trust of consumers and avoid future crises.