Wintertime Stew

First, slice the political sausage into thin cross-sections, throw in your favorite exploding spices-issues nobody can agree on-and mix thoroughly. Then stir fry with vegetables-or rather, plants, as in the conventional, biological, chemical, and nuclear weapon variety. Add age-old staples like cultural and religious hostility, territorialism, poverty, disease, and ignorance. And, if your tastes tend toward the new and exotic, fold in a little faux cloning and junk science at the end. Finally, put the whole ensemble over a slow but searing flame: the endlessly burning cycle of brutality and revenge, terror and war. It's this year's wintertime stew-an international dish sure to keep you warm on the coldest nights.

So what does that have to do with the price of pharmaceuticals? (You ask.) Three critical hot spots: public opinion, healthcare costs, and scientific innovation. And that's just for starters; countless ingredients of the industry's competitive base will bubble and churn along with the wider turmoil.

Public opinion has seldom seemed positive to industry partisans. Some simply dismiss the situation as hopeless; others gush with so much goodwill they scare people. Most industry insiders would rather have a positive image than a negative one-if only for the sake of peace at family picnics. But war and world upheaval will push companies toward more secrecy just as they were learning to become publicly transparent. Rx prices, already under fire, will feel greater heat from the general expectation of universal sacrifice in time of war. Even the slightest appearance of selfish behavior will stand out in stark relief. All companies, like all individuals, will have to do their duty. That means relieving human suffering on all fronts, with less leeway for big profits.

Healthcare costs will only rise on a steeper curve in the wartime environment-despite increased use of "cost-effective" pharmaceuticals. In the US market, where Rx prices have traditionally ranged free, customers will demand that industry share some of the growing burden. From regional HMOs to state–government alliances, customers are taking pharma, the stock market's favorite bull, by the horns to force its prices down.

Scientific innovation faces several dangers, despite some opportunities, in this winter's harsh stew. Though some US companies may prosper from an infusion of federal dollars into counter-terrorist research, the price of secrecy may be to impede the same and other research. Much of the cutting-edge science now under potential government purview cradles the next generation of medical breakthroughs. Early US resistance to, and misconceptions about, therapeutic cloning of stem cells-similar to how the country first reacted to in vitro fertilization-may impose further delays on innovation. You can't keep justifying high prices with breakthroughs that never materialize.

To the question of how this stew of events and issues affects the industry, there is an underlying answer: We all feast from the same kettle. This season, we're not just feasting; we're swimming in this war-fired stew. Everyone, even the industry, must adapt to the soup du jour-or risk drowning in the brew.