The pharmaceutical industry is in both the best and worst of times. The industry is in a golden age of pipeline productivity- but as the focus turns to ever more sophisticated specialty treatments for highly defined, often very small patient populations, competition intensifies and payer tensions grow. The countries driving most of the industry’s return on innovation see budgetary challenge, rebate and discount growth and increased risk. Profitability has reduced, and the return on innovative launches has not kept pace with rising clinical development costs. Portfolios see faster, and more extensive, value erosion post loss of exclusivity as biologics experience low cost competition. Technology has hugely improved the availability of data to understand patients and conditions better, to demonstrate the value of new medicines and to guide pharma decision making. But often, companies struggle to make the best use possible of this data.