Most of Big Pharma have been trying to reinvent themselves as nimble Biotechs, at least in the eyes of Wall Street, in order to be perceived as being innovative R&D-driven companies. Despite the restructurings, Big Pharma is struggling with that transition. Since corporate change has to start from the top, a lack of biotech-savvy corporate governance may be at the heart of the issue: the reality is there are few if any biotech voices in Big Pharma boardrooms.