The metabolic syndrome conference, chaired by Alan G Harris (CMO, Manhattan Pharmaceuticals, Inc.), was a timely opportunity to review in depth the definitions, causes and novel treatments for the metabolic syndrome, a condition which, despite enormous scientific interest, remains an area bedeviled by controversy. Much of the interest in the metabolic syndrome stems from the fact that it is closely related to an increased risk of serious cardiovascular events. However, investigation and treatment of the metabolic syndrome is complicated by an inability to definitively separate the roles played by individual components (e.g., obesity and insulin resistance) from that of the syndrome as a composite entity. Put more simply, is metabolic syndrome more than the sum of its parts? This and other questions formed the focus of this multiday conference. Harris introduced the proceedings with a broad overview of the topic of the metabolic syndrome that charted its history from its original description by Ahmed Kissebah, to ‘Syndrome X’ by Reaven in 1988, to the advent of the multiple competing definitions of the metabolic syndrome that have been adopted between 1998 and 2005 (Box 1). The debate regarding the clinical utility and the relative merits and demerits of the metabolic syndrome as a composite measure of various interlinked cardiovascular risk factors has been particularly active over the last year. Major position statements and publications by Grundy, Kahn and others, in addition to multiple sessions at scientific congresses, have marked the progress of the debate over metabolic syndrome in 2006 [1–6]. Importantly for the field of drug development, 2006 has also seen regulatory agencies in the USA and elsewhere underline that evidence to support the metabolic syndrome as a unique entity with a unified underlying pathophysiology is lacking. Furthermore, the US FDA has stated that the metabolic syndrome as a discrete entity lacks clinical implications over and above those of its individual components. Some of the more recent reviews of this field have reemphasized the importance of focusing on treating known cardiovascular disease risk factors as the basis for prevention, whether or not patients fall within the definition of exhibiting the metabolic syndrome [1,5]. Indeed, as stated by Johnson and Weinstock, the important issue remains that physicians are encountering increasing numbers of patients with obesity and a variety of systemic vascular and metabolic abnormalities; these risk factors require urgent attention ‘for the health of the world’s population’ [6]. Therefore, despite the complicated landscape, the need for new drugs to treat components of the metabolic syndrome has never been greater. The goals of the conference were to obtain a clear understanding of the definitions of the metabolic syndrome, the pros and cons associated with targeting it as a composite entity versus treating its individual components, and to explore the tools and technologies underlying novel therapies that are relevant to the metabolic syndrome. In order to make the conference as relative as possible to the challenges of drug development in this field, a major focus was placed on the presentation of case studies from preclinical and clinical research groups from both the pharmaceutical and biotechnology sectors.