It is difficult to overestimate the quantity, quality, and speed of change that have occurred in the healthcare communications environment since 1990. The research community raced to achieve the spectacular basic scientific, clinical, and diagnostic advances outlined by Gilbert S. Omenn in 'The Science." At the same time, elected officials in the United States grappled with issues of universal access to healthcare in the face of spiraling costs and debated ideas for the reform of health financing. They also tested the various levers of control, as described in both "Policies and Politics" by John Kamp, Esq. and Wayne L. Pines, and "The FDA" by Kenneth P Berkowitz, Esq. During this same period, the regulated industries—pharmaceutical, biotechnology, diagnostics, and medical device manufacturing—consolidated their holdings and expanded their reach around the world, prompting the communications service industries to follow suit. In the face of such sweeping change, traditional advertising agencies morphed into multidisciplinary, centrally managed global networks—as detailed by Jed Beitler in "Going Global"—providing a seemingly ever- expanding menu of highly specialized communications services based on new behavioral science discoveries and new technologies. What follows is a close look at the environment within which medical communications firms have had to exist, survive, and prosper over the last two decades. Despite more budgetary and regulatory controls, and integration into a global environment, the industry has persisted in its primary function—bringing information to healthcare professionals and patients about the ever-growing treatment options available to them. Harry Sweeney 23
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