The pharmaceutical industry is governed by several rules and requirements defined by Health Authorities across the world: the goal is to develop efficacious and safe medicines, to treat and protect patients. However, more than in the past, pharma industries should take care of changes imposed by cultural and social behaviors. Special attention should be paid on gender-medicine, personalized and individualized drugs/treatments, rare diseases, and development of so called “orphan drugs” and activities designed to support patients and families in need (donation of drugs, patient journey, patient support programs etc.…). But also, initiatives finalized to avoid the waste of good drugs and prescription of the right amount of medicine—this because there is the urgent need to protect the environment, reduce the waste and addressing the requests coming from the new generation of patients. The question is: how the companies can embrace these bottom-up requests in compliance with requirements and rules? How should the companies interact with Health Authorities to spread the voice of the real-world? The industry should be aware that the voice is not only the voice of patients in needs but also the one of healthy citizens that could be patients in the future.