The original Hippocratic oath and, sometimes, much more outspoken contemporary variations of the oath, allude to COIs that should be avoided.26 The recent Memorial-Sloan Kettering revelations about briberies given in connection with oncology protocols, as well as many investigative journalism opinions and shocking testimony presented at Senate hearings in the United States and worldwide concerning the very questionable support and bribery of academia by pharmaceutical and other companies have become eye openers and an embarrassment for many in the medical profession and beyond.30 Too many well-known and highly regarded academics simply lied about their financial dependence on third-party interests. In some institutions (including one of my own), aggressive preemptive explorations by a former assistant state attorney general, for example, caused most unpleasant altercations, partly based on misunderstandings and misinformation. I received personal lawyer-client protected communications and had to appear to defend their strong suspicion of fraudulent activities, based on a complete misunderstanding of protocols. It happened to other colleagues and when the lawyer’s accusations were found too often to be baseless, he was finally dismissed. At that time, senior faculty, including myself, were urged to join educational programs about administrative accountability and responsibility for those working in the not-for-profit world. If you are a doctor or a banker on the Board, you would be held accountable, in a different way from being the Very Reverend representing the protestant churches of the city of Philadelphia. It was for me another truly fascinating eye-opener. It was among the unacceptable Pharma practices that included being lured into night clubs and baseball games many years ago that drove me away from clinical viral hepatitis research despite, on occasions, very fruitful collaborations with various companies. Critical questions were raised that meant that I suddenly no longer was invited for “Advisory Board meetings” and other activities in magnificent resorts. It is true that these were also events where many friendships and projects were started. However, a major research grant was suddenly canceled for no identifiable cause and much later major apologies came from the company CEO, about the retaliative nature of that unjustified decision. During my tenure on the AASLD Ethics Committee, more than a decade ago, conflicts of interest were the most dominant agenda topic. Among the dilemmas was the notion that true experts are as much wanted by professional societies as by industrial partners. How can we, in an ethically sound way, mutually benefit each other? Should volunteers on an academic committee incur costs, because divesting their interests was mandatory to permit the continuance of their committee tenure, entailing foregoing certain income and interactions with industrial partners? Could Committee members still sit on educational panels, would they have restrictions after their tenure, and are such rules enforceable by more than moral standards? Conflicts of interest may also impact access to treatment, study protocols, that is, minimal recruitment criteria, and joint ventures versus competition elsewhere. This brings us to other ethical standards that apply to the medical practice business, hospitals, and ambulant care centers. Excessive investigation, be it endoscopic, laboratory testing, imaging, etc, is a fact of life these days. It is daunting for many of us to realize how far we are replacing sound clinical thinking and allowing too many thoughtful considerations to go by the wayside, as we barely have time to step back and wonder what are the goals that we are hoping to achieve. When I recently called a Chairperson of an Imaging Department in a big regional hospital and asked how it was possible that an 18-year-old man came 4 times in a single month to the Emergency Department and each time had a completely normal computer-assisted tomography scan for abdominal pain, the Chair admitted that his department was too busy to critically review the indications for the scans. Each reader will recognize this type of problem, but even our own professional societies often appear busier with Medicare reductions for reimbursements than with quality control. When will the ethical auditor arrive in our system?Dirk J. van Leeuwen consults for Elsevier.