Increasing global regulation of drug prices and expenditures already affects the efficiency of pharmaceutical R&D and of health care delivery, with important implications for patient care now and in the future. The author examines the effect of existing foreign regulation - price controls, rate-of-return regulations, and industrial policies - on U.S. and other multinational producers of innovative drugs. She explores the growing threat to global revenues from the regulatory use of international price comparisons and the increasing threat from parallel trade.