Some health care firms have managed to work around the industry's well-documented growth constraints by pursuing a strategy of convergence--finding new combinations of formerly distinct market segments for pharmaceuticals, devices, and diagnostics. The authors, at Bain & Company, outline the considerations that drive the evaluation of and set the stage for convergence opportunities. Companies can use them to capitalize on an array of opportunities throughout the commercialization continuum and develop a response to potential threats from the outside.

Until now, most spine surgeons wouldn't even treat osteoporotic fractures of the spine, referring such patients to medical management. But using technology borrowed from balloon angioplasty, Kyphon has developed instrumentation that represents a new clinical approach to this serious problem. As with most device companies, regulatory issues and reimbursement have been a challenge, as have comparisons with another spinal procedure, vertebroplasty.

Recent news that long-term hormone-replacement therapy was doing more harm than good slashed Wyeth's valuation by 25%-$15 billion-overnight, even though the company maintains there was "nothing shocking" in the study. Hormones had been its top-selling product franchise. It's another hard knock for a company that only just settled a nationwide class-action suit, to the tune of $13.2 billion, over anti-obesity drugs fen-phen and Redux. Wyeth has also had well-publicized troubles with manufacturing. But Wyeth is stronger than it was just a few years ago, partly because acquisitions boosted research productivity but also because it learned from hardship. The company is quicker to face up to problems and deal with them. It's also more aware of the ramifications of developing biological drugs, especially in terms of production. Wyeth should be able to continue growing without resorting to M&A, if it can learn to be as active in prosperity as it has learned to be through adversity.

With Big Pharma still trying to figure out how to create productive businesses from their mega-mergers, most of the year's high-value M&A saw biotechs buying late-stage or marketed products. But these biotechs are also, with the risk of development failure ever clearer, actively in-licensing and acquiring products and product-creating technologies in order to diversify what are often single-product portfolios. Unlike many Big Pharmas, these companies have been willing to improve existing chemical entities, often exploiting drug delivery and other pharmaceutical sciences. Meanwhile, large companies focused on late-stage in-licensing, in part because they couldn't afford acquisitions--given the valuation disparities between large companies and small ones with valuable late-stage products. Nonetheless, while more affordable than acquisitions, the high price of these deals has transferred the majority of the regulatory and commercial risk to the licensee. As for the early-stage side of the biotech industry: platform companies have not been able to sell their discovery technologies at anything like the prices they expected; as a result, many of them have merged in an effort to create product-focused discovery operations.