It is now normal to call biotech and small pharma the innovation engines for the pharmaceutical industry. IPO and ICOs abound, as dollars from venture capital truly flood the ecosystem. In 2018, biopharma investment is having a moment. Any big fluctuation, even a positive one, makes stakeholders nervous. Some of the investors might be tourists—Amazon, Google, Apple, IBM, JP Morgan, Berkshire Hathaway and a half dozen others are new entrants, whose long term goals remain unclear. Particularly disturbing are the health insurance and supply chain changes that make headlines, such as this one.