Beginning in the 1970s, several scientific breakthroughs promised to transform the creation of new medicines. As investors sought to capitalize on these Nobel Prize-winning discoveries, the biotech industry grew to thousands of small companies around the world. Each sought to emulate what the major pharmaceutical companies had been doing for a century or more, but without the advantages of scale, scope, experience, and massive resources. Biotech companies have met the challenge by creating nearly 40% more of the most important treatments for previously unmet medical needs. Moreover, they have done so with much lower overall costs. focuses on both the companies themselves and the broader biotech ecosystem that supports them. It paints a portrait of the crucial roles played by academic research, venture capital, contract research organizations, the capital markets, and pharmaceutical companies, demonstrating how a supportive environment enabled the entrepreneurial biotech industry to create novel medicines with unprecedented efficiency. In doing so, it also offers insights for any industry seeking to innovate in uncertain and ambiguous conditions.