Facing the challenge of maintaining prosperity at the end of World War II, America introduced a new system to harness the power of science for the public good. The key idea was using public funds to perform “basic research” in the nation’s universities to create a steady stream of scientific advances for commercialization by private industry. This course explores how the system transformed drug development and the pharmaceutical industry and will grapple with the fundamental question: Does the pharmaceutical industry serve the common good? The US system has generated many amazing success stories for the development of effective medicines to improve public health. The role that drug development played in two global health crises - the emergence of the AIDS in the 1980s and the recent COVID-19 pandemic – will be considered. However, there are also conflicts built into the American model for scientific development that produce ethical issues related to prescription drug approval, access, and use. For example, how does the profit motive of private industry limit or undermine the public good? Recent examples include misleading marketing that encouraged large scale prescribing of opioid pain medication and industry encouragement of doctors to prescribe their medicines for uses that are not FDA approved (known as “off label” uses). There are also ethical issues that arise from relying on a market-based approach to deliver scientific advances in pharmaceutical chemistry to the public. On example is the existence of “orphan drugs” – effective medicines that treat rare diseases but are unavailable because the size of the patient pool cannot support a commercial drug production effort. The course will look at public and private efforts in the Commonwealth of Virginia to meet this challenge in drug access. The most important pragmatic question is: How should the system be changed to deliver increased benefits to society? Current ideas in public policy to improve the efficiency of translating scientific discovery into new medicines and to increase access to effective medicines on a global scale will be discussed.