In this response to the commentary on our original article (Clements, Rapley, & Cummins, 1999), we examine the rhetoric of the commentary as well as some of the substantive issues raised. Although there are areas of agreement we challenge some of the views put forward in the commentary, particularly those related to the institutional power of ‘‘science’’, the questions of accountability and the involvement of vulnerable people in research decision making. We argue strongly for action now to increase the checks and balances in the system and to promote more vigorously examples of good practice.