After publicly declaring that they would not enter the contract research organization (CRO) business in 2017, Thermo Fisher purchased Pharmaceutical Product Development (PPD), one of the biggest players in the CRO space, in 2021. Much had changed in the intervening years, but questions still remained concerning the strategic about-face. Thermo Fisher, often referred to as the 800lb gorilla in the room, was already nearly a one-stop-shop for biotech and pharma companies. Now, with the acquisition complete, Thermo Fisher and its customers faced a bit of a reckoning, with many potential paths forward. What would the right path for Thermo Fisher and its customers be?