The goals of this book have been to understand the factors behind the growing tension in the relationship between the pharmaceutical industry and society and to chart a sustainable path for that relationship in the twenty-first century. The extraordinary authors assembled in this volume have gone a long way toward achieving these goals. The insights and recommendations offered by these authors have been diverse, multifaceted, and far-reaching, and it would do them an injustice to attempt to summarize them pithily. Nevertheless, it is possible to discern a few basic themes. The chapters in this final section underscore these themes and point out paths to a sustainable future for the industry.

Public health and private enterprise: an imperfect match

One theme that has emerged is that the tensions between the industry and society derive from real conflicts that are endemic to the free market economic system and the current regulatory environment. Many of the authors have in one manner or other made the case that the interests of the pharmaceutical industry and society are imperfectly aligned. What is good for the bottom line of the drug companies is not always good for society. In this volume we have seen numerous examples of this divergence, such as research agendas that are guided by market size rather than medical need; marketing practices and objectives that emphasize increasing sales without regard for the medical priority of conditions treated; and monopolistic pricing policies that maximize revenue at the explicit cost of broad access.