When companies working in the pharmaceutical sector choose to develop new products, they have a certain set of choices. They can decide not to develop anything new, they can choose to make incremental improvements to existing products or choose to create something entirely new. In the short term, firms are also under pressure by shareholders to provide value, which may discourage longer-term investments. This may lead to an affinity for incremental discoveries and pursuits that are more likely to succeed in the short-term, such as me-too drugs. Chapter 11 explores how financial considerations influence the rate and direction of drug development, using antibiotics as a primary case example. Additionally, the chapter explores why there is missing novelty in drug development and how we might stimulate more breakthroughs in the future.