Company Profile
Pfizer
— A diversified pharmaceutical company that acquires and integrates small molecules, ADCs, mRNA, and peptides
Fazer is responsible for search, approval and sales.Pharmaceutical CompanyComment The characteristics of DDStechniques and in multiple modalities, rather than betting on one technical foundationContact Us The acquisition of Seagen in December 2023 incorporates antibody drug complex (ADC) with peptides for obesity (GLP-1 receptor actuators and amylin analogues) in November 2025. mRNA vac。s are developed and sold jointly with BioNTech. In this article, the size of the company is concise,What to do with the modalities, and what to doFilter by
- 30 sec. fingerprints and DDS standing position
- About logo and company name
- Where is this company in the world of drug discovery and DDS?
- Company Size (Concise)
- Drug discovery and DDS resources
- Past Initiatives
- Future plans
- What is DDS?
- Collaboration mapping of drug discovery and DDS
- Technologies, Products and Services
- The risk of this company
- Glossary/Source/Ins ment and Source Response Table
1. 30 sec. fingerprints and DDS standing position
Multi-specific antibodyThree Pillars of Companies in the Cancer Area
PROTACBioNTech,etssera, Arvinas
Drug discovery and DDSPharmaceutical Company / Biotech / Contract Development Manufacturing (CDMO・CRO)3 types. FazerPharmaceutical CompanyIt is different from biotech that deepens the specific technology base FactsHome “Low s, ADCs, Multi-specific Immunoin Antibody”Three mechanisms of actionContact Us ADC acquired Seagen (December 2023), and the peptide of obesity was acquired byetssera (November 2025). The new modality for the fighter isNot only grow in-house, but also buy from outside and put on our development, manufacturing and sales networkComment If you press this "buy and bundle" structure, the following chapter will be easier to read.
2. Logo and company name
Fazer Japan Inc. is a trademark of the company. In this article, we do not reproduce the generated image,
Images obtained from the official websiteHome img/pfizer_logo.svg Contact Us
Note: Corporate name Pfizer Inc.In Japanese, it is written as "Fighter". Pfizer Co., Ltd. is a group company of the company. In addition, in-house contract development manufacturing division is Pfizer CentreOne(10-K stands for PC1). We are entrusted to develop and manufacture pharmaceutical products from external customers. This article is written as "PC1".
Official Site:https://www.pfizer.com/3. Where is this company in the world of drug discovery and DDS?
When aligned by modalities, the Pfizer's hand tags are: FactsHome CoreLow affinity and ADCs(Three pillars of the company itself in the cancer area) NowmRNACOVID-19 vaccine jointly with BioNTechPeptide(Metsera-derived injectables GLP-1 receptor agonists and amylin analogs), Targeted protein decomposition(PROTAC jointly developed with Arvinas) Each technical mechanism is handled by the technical commentary "Antibody and ADC", "Peptide and GLP-1", "mRNA" and "targeted protein decomposition".
4. Company Scope (Concise)
The scale of the entire company stays in one table FactsHome The amount is USD, and the year is December.
| Index (US$ million) | 2023 year | 2024 views | 2025 years | January to June 2026 |
|---|---|---|---|---|
| Total revenues | 59,553 | 63,627 | 62,579 | 29,484 |
| R&D expenses | 10,679 | 10,822 | 10,437 | 5,299 |
| Acquisition R&D expenses (t payment etc.) | 194 | 108 | 1,613 | 153 |
| Acquisition of tangible fixed assets | 3,907 | 2,909 | 2,629 | ― |
75,000 employees (December 31, 2025) Pfizer Global Supply 10-Q unaudited value from January to June 2026
The above numbersCompany OverviewFees are research and development feesNot disclosed by development phase or treatment area10-K FactsHome Therefore, we do not understand the research and development costs of modalities such as "how much to ADC" and "how much to mRNA" Undetermined / FutureHome How to apply power to modalities:Acquisition and introduction amount and sales by productread from.
5. Drug discovery and DDS resources
We will organize it in four steps: "Investment, acquisition, introduction, cooperation with universities and public institutions" as follows.
| Resource Types | ||
|---|---|---|
| People (Research Center) | A total of 7 million square feet of research and development in the U.S. Leasing research in UK, India and Belgium outside the United States. Research and development is managed by a single organization led by the Chief Science Officer | Facts |
| Number of people | About 75,000 people Number of people in R&D and number of people in different modalities | Not confirmed |
| Gold (R&D expenses) | US$ 10,437 million in 2025. In January to June 2026, the US$5,299 million increase by 13% year-on-year, the increase described as 'increase in cancer and obesity candidates' | Facts |
| Gold (Manufacturing Equipment) | Acquisition of tangible fixed assets of 2025 US$2,629 million. No investment amounts for different modalities | FactsNot confirmed） |
| Seagen(December 2023, ADC, US$44.2 billion),Metsera(November 2025, peptide of obesity, US$8.0 billion) | Facts | |
| License | 3SBio(PD-1×VEGF double-specific antibody, T) US$1.25 billion + Chinese option US$100 million),YaoPharma(low-) GLP-1 receptor actuator, temp. US$150 million),Innovent12 programs of ADC and multi-specific antibody, US$650 millionSciwind(Peptide GLP-1 receptor agonist in China) | Facts |
| US$100 million share investment to 3SBio (2025) | Facts | |
| External funding for research and development | Agreement to jointly cover the development costs of specific items from A worth (up to US$200 million in September 2025 and up to US$300 million in June 2026) | Facts |
| Collaboration with universities and research institutions | 10-K is generally referred to as “a joint research, tie-up and license agreement with universities, biotech companies, etc.”, and does not include specific university names and public funds related to drug discovery and DDS. | Not confirmed |
Fizer disclosureAlthough the amount of acquisition and introduction is fine, it is hardly written in-house research system (voluntary roles and university cooperation)It is a form FactsHome In 2025, the acquisition of R&D costs US$1,613 million are approximately 15 times more than the previous year, and the majority of them are paid to 3SBio (US$1.35 billion) and YaoPharma (US$150 million). It is expressed in the number that the specific gravity of buying candidates from outside was raised in 2025. The calculation of this paper。
6. Past Initiatives
| Time | Home | The meaning of drug discovery and DDS |
|---|---|---|
| July 2021 | Partnered with Arvinas to co-develop and joint sales of oral PROTAC (ER decomposition) vepdegestrant | Participating in a new modality called target protein decomposition |
| December 14, 2023 | Acquisition of Seagen(US$229, US$44.2 billion) )ed four approved drugs and candidates (10-K) | ADC Technology, Manufacturing and Sales |
| July 2025 | 3SBioSSd PD-1×VEGF double-specific antibody SSGJ-antibody (PF-08634404) from China. Invested in 3SBio | Secondary candidates for multi-specific antibodies obtained from the outside |
| August 2025 | Approve vepdegestrant in the United States (FDA acceptance date) | PROTAC at the stage of approval screening |
| November 13, 2025 | Acquisition of Metsera(US$65.60 + CVR max. US$20.65 per share, US$8.0 billion per share) | Acquisition of obesity peptide for injection once a month |
| November 2025 | Padcev and Pembrolizumab are approved in the United States for periodic treatment of cisplatin-inappropriate muscle invasion b、der cancer | Expansion of ADC adaptation |
| December 2025 | YaoPharmaIntroduction of low oral GLP-1 receptor agonist YP05002 (Phase 1) | In addition to injectable peptides, it also secures oral low s |
| February 2026 | Sciwind BiosciencesGLP-1 receptor agonist ecnoglutide acquires exclusive right in mainland China | Sales only. Sciwind |
| May 1, 2026 | Veppanu (vepdegestrant) approved by the U.S. FDAHome ESR1 mutated ER-positive/HER2-negative advanced milk cancer First FDA approval as PROTAC | Targeted protein decomposition reached approval for the first time |
| May 2026 | Agreement with Arvinas to derive vepdegestrant’s right to sale to Rigel Pharmaceuticals | New modalities that have been approved are not sold in-house |
| May 28, 2026 | InnoventPartnership with ADC and the Initial 12 Program of Multiple-Specific Antibody (completed on July 10, 2026) | Reinforces the next generation payload from outside |
| June 2026 | ADC's Sigvot phase 3 (SigVie-002) does not show statistically significant improvements to docetaxel during the entire survival period of the key evaluation items | ADC fails |
Clinical trial example: VERITAC-2 of vepdegestrant
Veppanu's test based on approvalVERITAC-2(NCT05654623, phase 3, randomized, non-comparative) Targets are patients with ER-positive/HER2-negative advanced breast cancer, compared with full-best treatment, The main evaluation item is by a blind-independent central judgmentUnexpected survival (PFS)Home FactsIn the presentation of Arvinas, patients with ESR1 mutations (n=270), the median PFS was 5 months for vepdegestrant and 2.1 months for full-best treatment (0.57 hazard ratio). This is the result of PFS analysis, and the overall survival period at the same time is 'unmature'. FactsHome This document does not constitute the superiority of the drug with this。al value.
7. Future plans
Research and DevelopmentTwo of the four priorities of 10-K
| Candidates | Development stage | |
|---|---|---|
| MET-097i/PF-08653944 (peptide, GLP-1 receptor agonist) | Post-term development by weight management (in the post-term development table of 10-K). “Phase 3 Starts” | Undetermined / Future |
| MET-097i+MET-233i | Phase 1. Phase 3 Start One of CVR Payment Terms | Undetermined / Future |
| PF-08634404 | Primary treatment of primary colorectal cancer, primary treatment of non-small cell lung cancer | Undetermined / Future |
| disitamab vedotin (joint with ADC, RemeGen) | First treatment of HER2 expression metastatic urinary tract carcinoma | Undetermined / Future |
| PF-08046054 | Secondary development after non-small cell lung cancer treatment (modalities are not listed in 10-K) | Undetermined / Future |
| Padcev（ADC） | Apply to the EU with a mus invasion b der suitable for cisplatin (March 2026), development in the latter half with b der warmth | Undetermined / Future |
| Comirnaty(mRNA)2026-2027 | Approve in the EU (July 2026) and apply in the US (June 2026) | Facts (USA)Undetermined / Future） |
10-K・10-Q Undetermined / Future。
Research and development costs for modalities/ADC and peptidesProduction capacityMET-097iApplication PeriodInnovent 12'sTarget and CandidateNumber of items in the entire product line (10-K) No media-based sales forecast or approval time.
8. What is this company aiming for drug discovery and DDS?
This includes parts that the company does not directly state.Calculation in the range that can be read from primary informationand write with the basis.
| Read | Primary Information | |
|---|---|---|
| Cancer areaTwo new pillars of ADC and multispecific antibodyHome | The company has three pillars of “low s, ADCs, and multi-specific antibodies”, and the acquisition of Seagen, 3SBio, and Innovent affiliation are concentrated to two later parties. | |
| ObesityDirections to reduce injection frequencyto differentiate | Both Metsera’s MET-097i and MET-233i are “one month” and the description of the acquisition highlights “less injections” | |
| In obesityBoth injection peptide and oral lowto have | In addition to the etssera product of injections, we have oral candidates for oral low-GLP-1 receptor agonists (YaoPharma) and etssera | |
| New modalitiesYou can select each item. | PROTAC’s vepdegestrant led sales right to Rigel after approval | Facts |
| ADCersification of Payload (Drug)externally | Innovent partner description is "ADC with new differentiated payload" |
VeppanuDrugs approved by the FDA for the first time as PROTACArvinas It is a great achievement in research and development to have the 'No.1' of modalities, but the fighters and Arvinas were approved in September 2025.Policy to Pass Sales Rights to Third PartiesContact Us In May 2026, we agreed to invest in Rigel Pharmaceuticals. FactsHome At the same time, ADC takes 12 programs with a temporary US$650 million to Innovent. This article is written by the Pfizer.Diseases and market scale that our sales network is effective from the novelties of modalitiesRead if you choose your investment Undetermined / FutureHome The narrowness of the target of ESR1 mutations is considered one of the reasons why we saw our sales, but the company does not disclose the reason.
9. Collaboration mapping of drug discovery and DDS
10. Technologies, Products and Services
Main products related to drug discovery and DDS are indicated with sales of 2025 by modalities FactsHome 10-K Note 17C US$ million.
| Products | Home | Main target (company description) | 2025 sales | January to June 2026 |
|---|---|---|---|---|
| Padcev | ADC（Nectin-4） | Urinary tract epithelial cancer, myocardial invasive b der cancer | 1,940 | 1,258 |
| Adcetris | ADC | Some lymphomas such as hodgkin lymphoma | 907 | 386 |
| Tivdak | ADC | Recurrent and metastatic cervical cancer | 147 | 67 |
| Elrexfio | Double specific antibodies | Recurrence and Intractable Multiple Myeloma | 304 | 169 |
| Comirnaty | mRNA (joint with BioNTech) | Prevention of COVID-19 | 4,367 | 493 |
| Veppanu | PROTAC | ESR1 mutations ER-positive/HER2 negative advanced milk cancer | US approval in May 2026 | ― |
| PC1 | Contract development and manufacturing | For other companies | 1,338 | ― |
ADC The total sales of 3 items in 2025 is US$2,994 million, and the total sales is 4.8%.
10-Q of the 20 year ending June 2026 has a patent litigation for Comirnaty. Arbutus・Genevant(Comirnaty and its manufacturing claim to infringe five U.S. patents),GSK8 US patents and 3 European patentsModernaHome Prosecuted in July 2026Translate Bio・Sanofi8 U.S. patents FactsHome The active component of mRNA vac、 is mRNA itself, but to deliver it to cellsLipid nanoparticles (LNP)Arbutus・Genevant is a company that specializes in the technology of lipid nanoparticles. Right to the material and process such as the composition of ionized lipids and how to make particlesshow. However, any claims in each litigation cannot be read from 10-Q. Undetermined / Future。
Similarly, ADC connects antibodies and drugsLinker Chemicaland treat toxic payloadsE tion manufacturingis the core of technology. Innovent’s ADC partnership is “new differentiated payload” than antibodyDrug part and how to connectRead the statement and the article that the space of different has changed Undetermined / Future。
11. Risks that this company has
| Risks | ||
|---|---|---|
| Reduced sales due to patent failure | In 2026 to 2030, the company expects significant loss of sales due to the expiration of the patent and exclusive period. | Facts |
| Loss of acquired assets | US$3.9 billion in loss of intangible assets in 2025 If the candidates acquired fail, the company itself indicates that the same loss may occur | Facts |
| Focus on competitive areas | 10-K stated, “The acquisition ofetssera and Seagen is a major investment in highly competitive areas of obesity and cancer.” | Facts |
| ADC late test failure | Phase 3 of sigvot failed to achieve key evaluation items in June 2026 | Facts |
| Patent Disputes for mRNA and LNP | Comirnaty claims patent infringement. A lot of damages are unidentified | Facts |
| COVID-19 | Comirnaty sales decreased from US$ 11,220 million to US$ 4,367 million in 2025 | Facts |
| Increased external dependencies | The more you rely on the acquisition and introduction of candidates, the more you pay for temporary and decreasing, the more you can shake your performance | |
| Dependency on Candidates from China | 3SBio, YaoPharma, Innovent, Sciwind are both Chinese companies. Changes in regulations and geopolitics may affect development plans |
12. Glossary
- Home
- Types and forms of medicine. Low。, antibody, ADC, peptide, nucleic acid, mRNA, cell and gene therapy, etc.
- ADC
- A drug that connects a strong drug (payload) through a linker to antibodies that bind to the mark of cancer cells.
- Double specific antibodies
- Antibodies that bind two different targets in one. Multi-specific antibodies for three or more.
- PROTAC
- Low s that approach proteins that mark target proteins and decompose, and decompose targets in cells. A type of target protein decomposition derivative.
- GLP-1 receptor agonist
- Drugs that stimulate receptors of hormone GLP-1 insulin content and appetite. peptides and low s.
- Amylin analogues
- A peptide similar to the hormone “amirin” that comes from the panc . It is said to be involved in the feeling of fullness.
- LNP
- Dozens to hundreds of nm lipid particles that encapsulate nucleic acids such as mRNA to deliver to cells.
- CVR
- The right to promise additional payments in with future development and approval at the time of acquisition.
- Acquisition R&D expenses
- Exp s such as temporary money when in and obtaining candidates during development.
- Form 10-K／10-Q
- Annual and quarterly reports submitted by U.S. listed companies to SEC.
Concept diagram of AI generation13. Source
- Pfizer Inc. Form 10K for the) year ended December 31, 2025 Business structure, R&D system and base, sales, R&D cost, sales by product, number of employees, number of manufacturing plants, acquisition of Seagen・Metsera, introduction of 3SBio・YaoPharma, contract with A。worth, late development items, risk factors. https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm
- Pfizer Inc. Form 10-Q for the quarterly period ended June 28, 2026 2026 year-end sales, research and development costs, product sales, Sciwind/Innovent tie-up, Veppanu approval and gelding to Rigel, Phase 3 of sigvot。g vedotin patent litigation of Comirnaty. https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm
- Pfizer Inc. Portfolio Metsera candidates (MET-097i, MET-233i, oral candidates) and development stage. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-acquire-metsera-and-its-next-generation-obesity
- Pfizer Inc. Pfizer Completes Acquisition of Metsera Completed acquisition and acquired candidates. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-completes-acquisition-metsera
- Pfizer Inc.／Innovent Biologics Pfizer and Innovent Biologics Enter Global Collaboration to Accelerate Development of Innovative Oncology Medicines 12 programs of ADC and multi-specific antibody, three pillars of the cancer area. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-innovent-biologics-enter-global-strategic
- Arvinas, Inc. Arvinas Announces FDA Approval of VEPPANU (vepdegestrant) FDA approval, first approval as PROTAC, result of VERITAC-2. https://www.sec.gov/Archives/edgar/data/1655759/000162828026029210/fdaapprovalpressrelease_.htm
- ClinicalTrials.gov NCT05654623(VERITAC-2) Test design, phase and key evaluation items. https://clinicaltrials.gov/study/NCT05654623
- Pfizer Inc. Official website (for confirmation of the company profile) https://www.pfizer.com/
14. Response table of claims and sources
| Content | ||
|---|---|---|
| Official name, established year, head office location, listed market | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Sales, R&D, acquisition R&D, capital investment, approximately 75,000 employees, 36 manufacturing plants | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Sales and R&D costs from January to June 2026 and reasons for its increase | Facts | Source 2 https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| Research and development costs are not disclosed by stage and treatment area, and the scale of research bases | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Three pillars of the cancer area (low s, ADCs, multispecific antibodies) | Facts | Source 5 https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-innovent-biologics-enter-global-strategic |
| Acquisition of Seagen (December 14, 2023, US$229, US$44.2 billion, ADC technology) | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Acquisition of Metsera (November 13, 2025, US$65.60+CVR, US$8.0 billion) | Facts | Source 1・4 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Metsera's MET-097i (GLP-1 receptor agonist for injection once a week and once a month) and MET-233i (one amylin analogue per month), oral candidate | Facts | Source 3・4 https://www.pfizer.com/news/press-release/press-release-detail/pfizer-acquire-metsera-and-its-next-generation-obesity |
| 3SBio introduced (US$1.25 billion, US$100 million, US$100 million) | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| YaoPharma (December 2025, YP05002, T) US$150 million) | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Co-payment agreement with Abingworth (September 2025, June 2026) | Facts | Source 1・2 https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| Sciwind (February 2026), Innovent (May 2026, T) US$650 million, July 10) | Facts | Source 2・5 https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| In partnership with Arvinas (July 2021), Veppanu’s U.S. approval (May 2026) and PROTAC approved for the first time and led to Rigel | Facts | Source 2・6 https://www.sec.gov/Archives/edgar/data/1655759/000162828026029210/fdaapprovalpressrelease_.htm |
| VERITAC-2 | Facts | Source 7 https://clinicaltrials.gov/study/NCT05654623 |
| 5 months to 2.1 months of PFS median in ESR1 variant population of VERITAC-2 (at full-best、 contrast, at PFS analysis) | Facts | Source 6 https://www.sec.gov/Archives/edgar/data/1655759/000162828026029210/fdaapprovalpressrelease_.htm |
| Sales by Padcev・Adcetris・Tivdak・Elrexfio・Comirnaty, Sales by PC1 | Facts | Source 1・2 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| MET-097i, PF-08634404, disitamab vedotin, PF-08046054 etc. | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Phase 3 of sigvot g vedotin did not achieve key evaluation items | Facts | Source 2 https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| Patent Litigation for Comirnaty (Arbutus・Genevant、GSK、Moderna、Translate Bio・Sanofi etc.) | Facts | Source 2 https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| 4 priority of 2026, expected sales loss of 2026-2030 due to patent failure, loss | Facts | Source 1 https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Classification of three types of drug discovery and DDS companies | The calculation of this paper | The company name is an example from the target company in this series. |
| ADC Total sales of three items: US$2,994 million, total sales ratio of 4.8%, PC1 sales ratio of 2.1%, acquisition acquisition R&D costs about 15 times in the previous year | The calculation of this paper | This document is calculated from the number of source 1 |
| Research and development costs and manufacturing capacity by modalities, MET-097i, individual candidates for Innovent partners, total number of pipelines | Undetermined / Future | Not listed in Source 1 and 2. Media-based numbers are not adopted https://www.sec.gov/Archives/edgar/data/78003/000007800326000095/pfe-20260628.htm |
| Specific cooperation with universities and public funds related to drug discovery and DDS | Undetermined / Future | No specific description in Source 1. This article does not break even if it is not present https://www.sec.gov/Archives/edgar/data/78003/000007800326000026/pfe-20251231.htm |
| Reading ADC and Multi-specific Antibody to a New Pillar | Interpret this paper from the description and acquisition of the three pillars and introduction | |
| Reads to reduce injection frequency with obesity and aim for both injection and oral | Interpret this article from the properties of candidates for Metsera and YaoPharma | |
| ADC's payload notification is externally sought, and the area of different is transferred to the drug section. | Interpret this document from the description of Innovent partner | |
| Read that new modalities have chosen investments in the disease and market scale that the sales network is effective | Interpre of this paper from the findings of vepdegestrant and the contrast of Innovent partners | |
| Read that LNP’s IP is placed on the material and process side | Interpre of this paper from the description of the litigation of source 2 (including manufacturing) | |
| Risk of increasing external dependency and dependency on candidates from China | Interpre of this document from the composition of acquisition and introduction |
Last Updated:September 26, 2026/Troy Technical
All figures in this article are based on the legal disclosure document submitted by the Pfizer to the US Securities and Exchange Commission (SEC), the official announcement of the Company and its partners, and the information provided by ClinicalTrials.gov. We do not use estimates and media-based numbers of survey companies. The "、ulation" section is an interpretation that the article reads from the primary information and is not an announcement of the company. This paper is not recommended for use of certain medicines, but please consult your doctor or pharmacist for medical decisions.