The opportunities to harm health are legion, from bench to bedside to boardroom to bombardment. Doing what’s right for health is easily lost in the throes of academic competition, professional rivalry, or the worship of profit—all of which are best consumed in moderation. The downside of competing priorities was evident at COP29, the rich world betraying the poor (doi:10.1136/bmj.q2651),1 again raising the challenge of decision making for public benefit by people conflicted by commercial or political interests. Transparency has got us only so far, argue Chris van Tulleken and colleagues. Foxes guard the henhouse, and we need disruptive change that’s “intentional, systematic, evidence based, and robust.” They demand zero tolerance of industry influence for all decision makers who influence health outcomes, including politicians, health leaders, clinicians, and medical and science …