Patients who take a close look at medical science in search of treatments are often appalled by what they discover. On the one hand, there's academic research, a self-contained and self-absorbed universe of its own where data may be internally consistent (on a good day) and robustly reproducible, yet often has little relevance to real-world clinical conditions.

Without profound changes in the scientific and regulatory environment, things will remain very tough for the agile disruptor -- relatively good news for established giants, presumably less good news for patients and for progress.

Drug makers aren't chasing blockbusters like Lipitor anymore, or uncovering compounds the same way.

What if Muslim clerics were held to the same standards as Pfizer?

Improving healthcare will require increased focus on the gap between the clinical practice of medicine and health as it's experienced in real life.

Successfully translating scientific discoveries requires a sense of urgency, which some disease foundations seem to have, and many big pharmas appear to need. Patients waiting expectantly for medical research to produce important new cures are finding bad news almost everywhere they turn.

"Phake: The Deadly World of Falsified and Substandard Medicines" explores the underground trade in illegal medicines that kills over 100,000 people per year and supplants billions of dollars of real products.

In patent politics there is more at stake than money.