The pharmaceutical industry today is operating in an environment whose main feature is an unprecedented pace of change. In most markets the rising costs of health care are of increasing concern, and the medicines bill is being targeted for savings. New constraints are limiting the medicines that can be used and paid for in the system. In the United States health maintenance organisations use formularies, while European governments are resorting to various measures to control the pricing and prescribing of medicines and are increasing the range of medicines available over the counter. Medical practice is also changing for demographic reasons, and the health problems of elderly people are attracting increasing attention. Drug regulation is both costly and time consuming, particularly in the clinical phases. Now, in addition to the stringent demands for safety and efficacy, the need to show the economic benefits of a new medicine is increasingly emphasised. Although these changes may well sink some pharmaceutical companies, they should be seen as challenges to be met to ensure the future of both the industry and the communities who benefit from its activities. Undoubtedly, the pharmaceutical industry's future success will depend on innovative medicines that meet unmet clinical needs and provide genuine therapeutic advance. Fortunately, other …