Watch The R&D Chiefs Of Pfizer, Merck, And Amgen Discuss The Drug Industry's Challenges

A big moment at the Forbes Healthcare Summit last month: I was on stage with the R&D chief of three of the biggest drug companies on the planet. Roger Perlmutter, formerly of Amgen but now head of research at Merck , talked about what it means to pare down R&D headcount – something his company had just done the week before.

“It was certainly never my goal to come into Merck research laboratories a place with an extraordinary legacy of accomplishment and just shrink it with the idea that just shrinking it will make it more productive. Because I don't think that's true,” Perlmutter said. “What I do think is true is that you have to scale the organization to meet the opportunities that exist and focus, focus, focus. One of the largest problems that we face in the research and development world is simply the breadth of activity that we undertake and it's absolutely critical that we eschew distraction.”

I asked Mikael Dolsten, of Pfizer , what scale means in R&D. He warned, “R&D in the industry embraces solving a problem by deploying more resources.” The problem with that is you can always throw good money after bad. What about the new genetic technologies? How are those enabling us match the right drug to the right patient? Sean Harper, from Amgen, argued that using genetic information from humans s way better than trying to figure out that how to make drugs using rodents. Dolsten pointed out that in cancer, new genetic information is speeding things up. “You see the time and the pace allow us to approach complex problems faster,” he said. And then Perlmutter warned that finding a genetic variant that protects against, to give one example, heart disease doesn't mean that you can make an effective drug; just because variants of the PCSK9 gene prevent people from getting heart attacks doesn't mean that drugs aginst PCSK9 (Amgen has one) will prevent heart attacks – though it might be a decent bet.

Then, 16 minutes and 40 seconds in, Susan Desmond-Hellmann, the chancellor at UCSF who ran development at Genentech during its glory days, asked the threesome how they would try to decrease the costs of clinical trials – one of the most expensive parts of drug development. That launched Perlmutter's best bon mot of the day: “We do 21st century biology in our laboratories and then do clinical trials that Hippocrates would have been quite comfortable with.” You can watch the whole panel below.