In the fall 2004 Ontario and Quebec swine producers started to see a significant increase in mortality generally beginning at four weeks into the finisher and lasting approximately six weeks. A diagnosis of PMWS with a subsequent name change to Porcine Circovirus Associated Disease (PCVAD) in North America was made. The impact on mortality has been dramatic. Many different intervention strategies have been attempted through the ensuing two years and in our clinical experience have little to no value. In no particular order: feed medication, vaccination type and timing, water supplementation, nutriceuticals, ration formulation changes, water acidification, feed manufacturing changes, sanitation protocols, injectable antibiotics, and sorting affected pigs have produced no consistent results and will have cost the industry more money on top of existing losses. As always in a desperate situation there are those that market the “silver bullet”. At this point there are very promising vaccine results with pig vaccines and pending results but too early yet on sow vaccine efficacy. Madec’s 20 point control program is not applicable to the current North American pig industry structure; however, components of it address common sense management of the pig and population. This paper summarizes some principles of disease control that are applicable and sustainable within the North American industry such as: all in-all out (AIAO) groups, sanitation, not co-mingling, limiting pig movement within AIAO group, effective sow herd immunity, biosecurity, effective pig care, effective diagnosis and monitoring of diseases, control or eliminate primary pathogen circulation in S-N-F, and having an effective information system. Even if these principles are addressed there are still challenges to the North American industry. There needs to be an assessment as to how far we have strayed from long term effective large population management, what the lessons from this devastating disease are, and how effectively we apply those lessons in the future.