It's a year of shifting allegiances for the pharmaceutical industry, which has leaned Republican in recent years.
The presumptive GOP candidate, John McCain, views the drug industry as "big bad boys" and vows to curb their influence.
And the candidate with the most pharma contributions at the moment is Democrat Hillary Rodham Clinton, a lightning rod for criticism during her husband's health-reform effort of the 1990s.
"It's quite clear the industry bets on candidates like they bet on horses," said Uwe Reinhardt, a health-economics professor at Princeton University. "They never bet their ideology as much as they bet who is going to be in the White House. I would view these [contributions] as betting odds. It's as cold as that."
The prospect of an unfriendly president puts another burden on an already beleaguered industry, which is cutting jobs and working to restore its new-drug pipeline. "They're between two innovation curves," Reinhardt said. "The old model is declining, and the new one is not there yet, and it's very expensive. It's not an industry [whose stock] I want to own."
When it comes to courting Democrats, the drug industry is not unusual. Nearly all firms that deal with the federal government are giving more to the Democrats since the party took control of Congress in 2006, said Larry Sabato, a political science professor at the University of Virginia. "They're going where the power is," he said.
While all three leading presidential candidates have taken the drug industry's money, each has also criticized pharmaceutical companies to varying degrees. That raises the likelihood that the government, no matter who wins, will allow the importation of cheap drugs from Canada and will give Medicare the ability to negotiate lower drug prices for the elderly and disabled - moves the industry has succeeded to block so far.
The drug industry is fighting back by changing its giving patterns, starting with the presidency.
Clinton, whose current proposals are far more moderate, received about $408,000 in industry PAC and individual contributions through mid-February, just ahead of Republican Mitt Romney's $400,000 and fellow Democrat Barack Obama ($396,000), according to the nonprofit Center for Responsive Politics, which tracks political contributions.
McCain ranks fifth ($112,000), though that is likely to rise since he is now the party's presumptive nominee.
A similar shift is apparent in Congress, where the drug industry has long favored Republicans. The industry is now giving about equally to both parties, with the Democrats' receiving a slight edge, according to the Center for Responsive Politics.
For the 2008 elections, the industry is giving 51 percent to Democrats ($4.65 million) and 49 percent to Republicans ($4.46 million), according to the center.
"That's a sea change," acknowledged Billy Tauzin, CEO of the industry lobbying group PhRMA (Pharmaceutical Research and Manufacturers of America) and a former Republican congressman who headed the House committee overseeing the drug industry.
In 2006, by contrast, Republicans took 67 percent of the industry's contributions ($13.2 million) when they were last in control of Congress, compared with 31 percent for the Democrats ($6.1 million). A similar pattern favoring the GOP dates back to when Republicans won control of the House in the mid-1990s.
The industry's shift can be seen in the personal contributions of Merck & Co. Inc. chief executive officer Richard T. Clark, a registered Republican who lives in Doylestown. In 2006, he gave $20,000 to Senate and House Republican committees, $2,000 to former U.S. Sen. Rick Santorum (R., Pa.), and $2,100 to Michael Fitzpatrick, the unsuccessful GOP congressional candidate in Bucks County. Clark gave nothing that year to Democrats at the federal level, according to the Center for Responsive Politics.
In 2007, Clark continued supporting the GOP, giving $15,000 to the National Republican Senatorial Committee and $5,000 to the Mike PAC, a political-action committee associated with U.S. Rep. Mike Ferguson (R., N.J.), whose district includes Merck's corporate headquarters in Whitehouse Station, N.J. But Clark also gave $5,000 to the New Millennium PAC linked to U.S. Sen. Robert Menendez (D., N.J.).
In a statement, Clark said he respected legislators on both sides, "and my personal giving reflects my support for their leadership on issues important to me."
No matter who is elected, that person will come under extreme pressure to cut health costs, including drug prices, said Patricia M. Danzon, a Wharton health-care professor.
The fiscal pressures will be greater on Obama or Clinton, said Danzon, because they have promised to expand health insurance to many of the estimated 47 million uninsured.
Clinton's plan is the most ambitious, offering public and private choices, while requiring every American to have coverage. Obama's plan requires only children to be insured and proposes fewer requirements on businesses.
McCain, by contrast, favors tax cuts for the uninsured, which will have limited impact, and he proposes undoing the employer write-off for health insurance.
McCain's views on pharmaceuticals stand out because they are uncommon on the GOP side.
During a New Hampshire debate, when Romney prodded McCain not to turn drug companies into "the big bad boys," McCain responded, "Well, they are."
In a town hall meeting last month in Warren, Mich., McCain first praised drug firms for their research, then said: "They're too powerful in Washington. They have too great an influence."
He told listeners that attorneys general in Iowa and South Carolina were suing drug firms, "alleging that they ripped off millions of dollars because of overcharges of Medicaid payments. That's a complex way to do it, but they did it.
"Why is it that these people in this audience can't go to Canada to buy the drugs they want?" McCain added. "Because of the power of the drug companies. I saw the Medicare Part D plan pass, and it inhibits, inhibits competition among pharmaceutical companies to pay for prescription drugs for Medicare patients. That's wrong. That's wrong."
Few in the industry appear willing to take on McCain publicly at this point. "As a company, we steer completely clear of being involved in any presidential politics," said a lobbyist for a major drug firm, who spoke on condition of anonymity. "We've worked with all administrations."
Of McCain's criticism, Tauzin said: "We take that with a grain of salt.
"He doesn't like lobbyists. Everyone who campaigns for president doesn't like lobbyists," Tauzin said, "but every citizen eventually lobbies.
"You can't really hurt this industry without hurting patients."