The drug industry has accepted the need to outsource R&D--now, with sales productivity down, and the rising cost and risk of owning too much commercial infrastructure, why not outsource more of the sales effort, too? Big and small pharmas resist the idea but will eventually have to accept it--junior partners in licensing deals are insisting on roles in selling their own products, and Big Pharma must investigate cost-saving solutions.

Mid-sized European companies attempting to compete with Big Pharma's increasingly dominant sales forces in the European primary care arena might consider following Altana Pharma and Solvay Healthcare's lead. A novel cross-promotional agreement comprising a detail-time swap in the UK in theory allows each company to boost its share of voice in its target indication-at practically no extra cost.

The Lilly Icos joint venture for the erectile dysfunction drug Cialis has the markings of a complementary alliance. Though too soon to gauge its commercial efficacy, so far the deal is working because both parties view it as a vehicle to build value of the sort important to them.