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A drug starts as one of ten thousand molecules in a screening library and ends as something a pharmacist hands across a counter. In between are nine distinct businesses, and almost none of them are the company whose name is on the box. This is who does what, what each part is worth, and how much of it depends on a single supplier.
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Nine businesses stacked bottom to top: what goes into a drug, who tests it, who makes it, who owns it. A biotech with a promising molecule owns almost none of the machinery that turns it into a medicine — it rents the animals, the factory, the trial and the trucks.
Value is distributed nothing like the work. Everyone who supplies, tests, manufactures and ships for the industry adds up to a fraction of it. The rest sits with the companies whose name goes on the box. Hover any company for its revenue, profit and margins.
Boxes are market value, scaled by how much of each company is actually a medicines business — Johnson & Johnson counts at 65% because MedTech is not a drug business, Bayer at 45% because crop science is not either. Readable areas compresses every box so the smallest companies stay legible; the figure printed in each box is always the real one.
Almost everything fails. Of a hundred molecules that reach a first human trial — already the survivors of years of screening — about seven are ever approved. Phase 2 is where they die: it is the first test of whether the drug does anything at all, and roughly seven in ten do not.
Each phase asks a different question, of a different number of people. Phase 1 asks whether the drug hurts anyone, and needs fifty. Phase 3 asks whether it beats the treatment patients already get, and needs a few thousand, across dozens of hospitals, for years. Every dot is one participant, at the same size throughout.
The expensive end of this industry is the visible one. The fragile end is a handful of chemical plants making ingredients nobody has heard of. Amoxicillin, ibuprofen and paracetamol are cheap, generic and ordinary — and their starting materials come, almost entirely, from one country.
Each bar measures a different thing — some are shares of world output, some of what the United States imports — so the basis is written under every label. Published estimates: read them as ranges of a few points.
Manufacturing is spread almost evenly across four regions. Invention is not, and it is moving fast: a decade ago roughly half the world's early-stage drug programmes started in the United States and one in twelve in China. They are now close to level.
A month of metformin and one dose of Lenmeldy are both prescription medicines. One costs four dollars; the other costs more than four million and is given to a few dozen children a year. The bar is logarithmic, because nothing else fits.
US list prices. Almost nobody pays list — insurers negotiate rebates and patients pay a copay — but it is the only figure published for every drug.