Our ability to understand fully the characteristics of clinically important adverse drug reactions is hindered by a lack of emphasis on biological mechanisms, patient susceptibility factors and long-term outcomes. Assessment of drug safety needs to move beyond industry and regulatory perspectives, towards a greater focus on evidence-based preventive and management strategies that will allow patients and physicians to deal with adverse drug reactions at the bedside. This would ideally involve close collaboration between clinical pharmacologists and pharmacoepidemiologists skilled at interrogating the increasingly sophisticated electronic healthcare databases. In light of the myriad safety scares that are constantly emerging, patients and physicians would be best served by a centrally funded independent network of rapid-response drug safety researchers who can use techniques of teleoanalysis to describe fully the magnitude of risk, the potential biological mechanisms and patients' susceptibility factors.