glasgow smithkline, $41 billion. it seems to have jumped over the last few years. what is your experience? dr. fugh-berman: we spend more money on drugs in the united states than in any other country. and we certainly use a lot of drugs. and yes, there are some of these businesses, they are extremely successful at the very high profit margin on drugs. there are a lot of companies large and small. there has been in small specialty companies with niche drugs. brian: what is the difference between a patented drug like lipitor and then the patent runs out and then you go to the generic? dr. fugh-berman: by the dominant drug comes on the market there are usually seven or 10 years of patent life left. but there are many techniques for extending patent life in some ways of doing that are for example putting out delayed release preparations. a company might do an immediate release and then they do a controlled release and then an extended release. that is a way of extending patent life. sometimes companies will rename drugs and get a new indication for them, sometimes one