The last 60 years have been characterised by an increase in life expectancy and an improvement in the quality of patients' lives. Such advances, to a significant extent, can be attributed - up to 40% of the total - to the results of pharmaceutical research. However, many treatment needs remain unsatisfied: tumoral pathologies, AIDS, neurodegenerative diseases, psychiatric pathologies and rare diseases are only a few of the challenges facing research in its attempt to make new and effective therapies available. The knowledge necessary before a new medicinal product can be made available is becoming increasingly complex, in line with the rising costs of clinical development. In such a scenario success is the result of the commitment made by large groups, aided by the innovative capacity of the SMEs and the active role played by public centres of excellence. A fundamental passage represented by this new model is the part played by clinical studies, which while maintaining the highest standards of efficacy and safety are in a position to identify genetic characteristics and processes before initiating large-scale patient trials. In any case, therapeutic progress is closely dependent upon the choices made to fund research and, therefore, raises the twin question of rationalising expenditure and the sustainability of the NHS. In this framework, where any kind of wasteful spending harms the right to health, every health management inefficiency is intolerable and administrative optimisation undeferrable.