Segments - Operating Segments (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Total revenues	$ 224,344	$ 228,772	$ 226,368	$ 222,451	$ 221,852	$ 249,815	$ 263,685	$ 254,914	$ 901,935	$ 990,266	$ 966,006
Operating loss									(274,052)	(171,197)	(276,442)
Depreciation and amortization									93,807	97,344	102,093
Loss from investment in investees									(2,900)	(14,497)	(14,471)
Assets	2,309,272				2,451,072				2,309,272	2,451,072
Goodwill	671,940				700,193				671,940	700,193	717,099
U.S.
Segment Reporting Information [Line Items]
Total revenues									751,099	837,509	803,853
Ireland
Segment Reporting Information [Line Items]
Total revenues									81,170	78,102	80,905
Chile
Segment Reporting Information [Line Items]
Total revenues									33,642	41,216	44,286
Spain
Segment Reporting Information [Line Items]
Total revenues									18,747	18,195	18,285
Israel
Segment Reporting Information [Line Items]
Total revenues									8,769	9,479	13,951
Mexico
Segment Reporting Information [Line Items]
Total revenues									8,032	5,598	4,605
Other
Segment Reporting Information [Line Items]
Total revenues									476	167	121
Corporate, Non-Segment
Segment Reporting Information [Line Items]
Operating loss									(41,631)	(43,614)	(55,615)
Depreciation and amortization									59	91	138
Loss from investment in investees									0	0	0
Assets	99,521				52,413				99,521	52,413
Goodwill	0				0				0	0
Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Operating loss									(109,062)	(82,641)	(84,287)
Depreciation and amortization									30,073	28,007	27,513
Loss from investment in investees									(2,900)	(10,822)	(12,646)
Assets	1,174,639				1,236,499				1,174,639	1,236,499
Goodwill	237,131				247,407				237,131	247,407
Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Operating loss									(123,359)	(44,942)	(136,540)
Depreciation and amortization									63,675	69,246	74,442
Loss from investment in investees									0	(3,675)	(1,825)
Assets	1,035,112				1,162,160				1,035,112	1,162,160
Goodwill	$ 434,809				$ 452,786				434,809	452,786
Revenue from services
Segment Reporting Information [Line Items]
Total revenues									716,434	813,248	782,710
Revenue from services | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues									0	0
Revenue from services | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									0	0	0
Revenue from services | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									716,434	813,248	782,710
Product
Segment Reporting Information [Line Items]
Total revenues									112,184	107,112	107,759
Product | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues
Product | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									112,184	107,112	107,759
Product | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues
Revenue from transfer of intellectual property and other
Segment Reporting Information [Line Items]
Total revenues									73,317	69,906	75,537
Revenue from transfer of intellectual property and other | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues									0	0
Revenue from transfer of intellectual property and other | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									73,317	69,906	75,537
Revenue from transfer of intellectual property and other | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									$ 0	$ 0