Rolf Schmidt, the CEO of a major global pharmaceutical company, looks out of his office at the twinkling lights of a major European city that has been its home for more than a century. The current conglomerate that occupies these offices bears little relationship to the sleepy little chemical company that was founded in the historic offices where the chief executive now paces late into the night. The company now operates across a global patchwork of complex regulations governing its pricing, advertising, and drug development and approval. Its research and development organization is stretched across diverse centers in the United States, Europe, and Asia. Its marketing initiatives are a combination of resource-intensive global brands and increasingly tightly tailored local brands. Its global supply chains and financing create new risks and make the company susceptible to unexpected shocks as it gears up for the rapid production of new drugs that have an ever-narrower window of opportunity.