INTRODUCTION

Running a research-driven health company in the twenty-first century is both exciting and challenging. We've discovered and developed clinically valuable modern medicines, devices, and diagnostics to improve the lives of millions of patients and their families; these advances also provide economic value by decreasing hospital stays, reducing the use of other expensive healthcare services, and increasing individuals' productivity. Yet, the media and politicians routinely identify the industry as a major societal problem. This image is reinforced because insurers and others are shifting costs, so patients are paying more for medicines than for hospital stays or doctor visits. Consequently, the public's appreciation of our contributions is at an all-time low.

As individuals and governments face real economic challenges in paying for healthcare, the clinical and economic benefits of new medicines often fail to make a favorable impression on the public. Growing premiums, co-payments, and administrative burdens are what the public and many healthcare providers generally focus on, because these are the challenges confronting them daily. And the overall value of new treatments is often obscured by segmental budgeting and cost shifting within our healthcare system. For example, a clinically important new treatment may allow a patient to leave the hospital sooner. Clearly, this is a good thing for patients, as well as their employers, if it allows them to return to work earlier. But financially, this breakthrough can have multiple effects. Insurance companies may save money because outpatient care is less expensive than hospital care.