[PDF] Triggers for this shift include high profile campaigns over access to medicines in the developing world, serious violations of marketing and competition law, growing concerns from the medical profession over the role of 'big pharma' in medical research...a number of companies are demonstrating leadership in key areas...notably GSK, Novartis and Novo Nordisk in Europe, along with Bristol Myers Squibb and Johnson & Johnson in the USA...We also identified a second tier of companies...such as Aventis, AstraZeneca, Sanofi-Sythelabo and Schering...[also refers to Roche]