The European Medicines Agency (EMA) marked its coming of age on March 18 with a conference entitled “Patients at the heart of future innovation.” Guido Rasi, principal adviser in charge of strategy at EMA, welcomed regulators, advisers, drug developers, investors and policymakers from across the globe, including Margaret Hamburg of the US Food and Drug Administration (FDA); Elias Zerhouni, president of global R&D at Sanofi; and Mark Walport, chief scientific adviser to the UK government. Zerhouni credited the EMA for leading the way in clinical-trials transparency initiatives and the FDA for pioneering pathways to accelerate approvals for breakthrough drugs. But Zerhouni also remarked that the ultimate goal should not be to boost the number of drugs approved but to ensure drugs that affect great swathes of the population reach primary care, noting the trend toward approvals for rare disease therapies. The former NIH director also noted that regulatory convergence between agencies is sorely lacking. Despite efforts by the EMA and the FDA to collaborate, there is still a 22% discrepancy between the agencies' decisions to approve or reject drugs. Harmonization should become a priority, he urged. After all, drug development is a global business. Imagine international air travel if every country had its own airspace rules, Zerhouni prompted: who would board that plane?