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Dr. Tunis rightly notes that the, " . . . failure to communicate these knowledge gaps back to the evidence-generating community leads to the gradual accumulation of ignorance inside the cell, resulting in a toxic environment . . . " Likewise, I would postulate that research unpublished by the clinical research enterprise may accumulate outside the cell, and contribute to a toxic external environment that can ultimately result in cell death. The BMJ should be commended for recognizing this mechanism prior to its molecular description by Dr. Tunis and supporting the AllTrials Campaign (http://www.alltrials.net/).