I completely agree with Dr. Cush's view of current gout treatment. In particular I would like to underline the unhelpfulness of recent clinical trials for both febuxostat and lesinurad (last A & R issue). These studies, in the interest of promoting new drugs, have grossly mis-stated and mislead readers about appropriate urate lowering treatment (ULT) in 2 ways: First, both have stated or implied that the "Standard of care" for using allopurinol is to give patients 300 mg per day (or 100 mg per day in presence of renal insufficiency), rather than treating to target. It is not credible to call this the "standard of care"; and it's clear from the literature that these doses of allopurinol will leave many patients (almost all at 100 mg per day) above target. Second, there is an implication that if a patient is on a sub therapeutic dose of allopurinol, the 'right' thing to do is to switch to (febuxostat) or add (lesinuride) another drug rather than titrate the allopurinol dose to a therapeutic dose. It is indeed unfortunate that these studies have been published in high impact journals and will result in higher cost, but no more effective treatments for gout.