Ping
An additional point: while all industries change, the pharma industry has undergone a sea change in the last dozen or so years, in that it has gone from a primary care focus (family practitioners, internists, pediatricians) to specialty focus. Why? Well, many of the common diseases that primary care docs treat (high blood pressure, chronic lung disease, diabetes, acute infections like ear and bronchial and throat) can be handled quite nicely by drugs originally developed by big pharma, but are now off-patent and thus available generically. The profit is out.
And while I am not saying that increased improvement in these areas cannot occur, to get insurance and managed care and/or Medicaid/Medicare to agree to pay for new drugs is very difficult. If a generic antihypertensive works for high blood pressure and costs 8 cents/day, why would managed care pay for a new drug costing 3 dollars/day that is only a bit better?
The future is in expensive oncology drugs not primary care drugs. Things will get even more interesting in the next 5 years...