A continued decline in productivity as measured by the number of molecular entities approved per dollar of R&D spent. In fact, if you look at the data, productivity today is only about 1/6 of what it was 10 years ago. I would challenge you to find any other industry where top line revenue has grown profitably for so long while productivity has decreased. At the same time, drug development risk is increasing, driven by the pursuit of more novel targets, about which less is known. Less than 1 in 10 drugs that are tested in humans get approved.

Even worse news for bigPharma across the industry is that, in the face of upcoming patent expirations, the industry will have to come up with 35 new blockbuster drugs each year just to keep growth flat over the next decade. This means that either the industry will undergo revolution or most companies will no longer exist after a decade. The status-quo pharmaceutical business model is not sustainable.