The medicine cabinet: what's in it, why, and can we change the contents?

The failure of the pharmaceutical industry to produce drugs for common chronic diseases, emerging diseases, and the potential threats of bioterrorism or the spread of tropical diseases contrasts sharply with the industry's output of lifestyle and "me-too" drugs. In this paper we review the decision-making process that resulted in our current portfolio of medicines and offer several alternatives to better align business incentives with medical need.