Is pharmaceutical R&D just a game of chance or can strategy make a difference?

The pharmaceutical industry is currently experiencing turbulent, yet exciting times. Despite widely expressed negative sentiments regarding productivity there are now signs that innovation could yet win the day and bring a fresh wave of breakthrough drugs. Nowhere is this truer than for oncology, which previously was dominated by cytotoxic drugs. Today, however, this field shows exciting progress with the emergence of kinase inhibitors, as well as various antibody-based mechanistic approaches. Similarly, new drug mechanisms have transformed HIV therapy. Are these chance events, or have they come about through strategy? Here, we argue that a complex interplay of chance and strategy is at work in pharmaceutical R&D, separated in time by 10 years or more.