The unintended consequence of the OIG's crackdown may be to curtail the influence groups like ATAC have in helping prioritize the complex reality of patient needs in drug company's decision-making. For now, the pharma-activist alliance still has friends in high places. "FDA has said that they support the community meeting with industry, even though the OIG may oppose it," Camp says. "They really believe that getting drugs approved quickly and introducing innovations into drug development are very important." But it remains to be seen whether this special relationship based on mutual influence and interests will escape the changing political weather inside the Beltway.

On the day in June 2006 when he got word from FDA that his first drug had been waved through, Glenn Mattes says, "after the obligatory internal discussions and media contacts, I made calls to all the activists and community members to thank them for their support. And I said, 'Let's really use this day to springboard our working relationship forward.'" He was surprised to learn that it was the first time in 20 years that the president of a drug company had made such a call to activists.

"In HIV, I'm closer to the actual patient than I have ever been before, even in cancer," Mattes says. Many AIDS advocates, of course, have HIV, and many physicians are AIDS advocates, and on it goes. "That makes it very special," he says. "The community spirit, the personal commitment and passion, either that captures you or it doesn't." He pauses and laughs in spite of himself. "And I can certainly say it captured me."