The moral corporation merck experiences

P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 This page intentionally left blank ii February 4, 2006 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION – MERCK EXPERIENCES Merck and the pharmaceutical industry are headline news today Controversies over public safety, prices, and the ability of the industry to develop the new drugs and vaccines that society needs have swirled over the United States, Europe, and the developing nations Roy Vagelos, who was head of research and then CEO at Merck from the mid-1970s through the early 1990s, addresses each of these issues in The Moral Corporation – Merck Experiences Vagelos highlights his efforts to turn around the Merck laboratories and introduce an entirely novel approach to new drug development Success with targeted research started Merck on a path that would lead to a series of blockbuster therapies that carried the firm to the top of the global industry in the 1980s and 1990s and Vagelos into the top position at the company Trained as a physician and scientist, he had to learn how to run a successful business while holding the organization and all of its employees to the highest principles of ethical behavior He was not always successful He and his co-author explain where and why he failed to achieve his goals and analyze those initiatives that succeeded P Roy Vagelos is retired Chairman of Merck & Co., Inc.; Chairman of Regeneron Pharmaceuticals Inc.; and Chairman of Theravance Corporation He and Louis Galambos published Medicine, Science, and Merck (Cambridge, 2004) Louis Galambos is Professor of History at The Johns Hopkins University and the editor of The Papers of Dwight David Eisenhower He is the coauthor of a book on vaccine development, Networks of Innovation (Cambridge, 1995), and Anytime, Anywhere (Cambridge, 2002), a study of the wireless industry i 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 ii February 4, 2006 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION – MERCK EXPERIENCES P Roy Vagelos Louis Galambos iii 15:6 cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge cb2 2ru, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521864558 © P Roy Vagelos and Louis Galambos 2006 This publication is in copyright Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press First published in print format 2006 isbn-13 isbn-10 978-0-511-16845-1 eBook (EBL) 0-511-16845-4 eBook (EBL) isbn-13 isbn-10 978-0-521-86455-8 hardback 0-521-86455-0 hardback isbn-13 isbn-10 978-0-521-68383-8 0-521-68383-1 Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 February 4, 2006 Contents Preface page vii The Puzzle The Professional Path Turn Around 25 New Drugs and Public Safety 49 Corporate Grooming 75 Winning in Global Competition 93 Prices and the Public Interest 120 Moral Leadership 144 Afterwards 173 Index 181 v 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 vi February 4, 2006 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 February 4, 2006 Preface “Man that is born of woman,” the Book of Job tells us, “is of few days and full of trouble.” Our experiences in business, in science, in government service, and in academic life give us plenty of reasons to affirm Job’s insight The evening news, the morning newspaper, and the Internet provide fresh evidence every day of a troubled world But we also find cause for hope in the everyday events that don’t make it into the media, events that inspire the kind of hope that runs through the New Testament and our study of the moral corporation Here is a story of life and leadership in an American multinational, one of the world’s leading pharmaceutical companies, Merck & Co., Inc Merck and the entire pharmaceutical industry are headline news today – mostly bad news Controversies over public safety, prices, and the ability of the industry to develop the new drugs and vaccines that society needs are swirling through the United States, Europe, and the developing nations vii 15:6 P1: JZZ 0521864550pre CB1050/Vagelos 521 86455 February 4, 2006 Preface Those controversies are not new, and they provide a backdrop for this account of the business career of Roy Vagelos, who was head of research and then CEO at Merck from the mid1970s through the mid-1990s His experiences in this vital industry include a long, sometimes painful, but ultimately successful attempt to introduce at the Merck laboratories a novel approach to new drug development Success with targeted research started Merck on a path that would lead the company to a series of blockbuster therapies and to the very top of the global industry Trained as a physician and scientist, Vagelos had to learn how to run a successful multinational business while holding the organization and all of its employees to the highest principles of ethical behavior He made mistakes and we explain in detail where and why he fell short of his own goals This is, then, a first-hand look at corporate leadership from the inside out, a book that offers a perspective on gender relations and affirmative action, as well as entrepreneurship Students in business schools, their professors, the tens of thousands of people who work in pharmaceuticals, and the millions who use their products, invest in their stocks, or are concerned today about healthcare in America should find something of interest in these pages There is “trouble” as well as “hope” in this account of two decades in the evolution of an innovative, sciencebased corporation We have drawn upon our earlier book, Medicine, Science, and Merck (Cambridge University Press, 2004), in drafting these pages and thus received help, directly or indirectly, from all those acknowledged in the preface to that volume We would, nevertheless, like to give a special thanks to Cambridge editor, Frank Smith, who encouraged us to write a study focused tightly on Roy viii 15:6 P1: KsF 0521864550c08 CB1050/Vagelos 521 86455 February 4, 2006 MORAL LEADERSHIP guiding philosophy in the 1970s, when the company was not yet big news We frequently reminded people inside and outside the firm what George W Merck, the founder’s son and company leader from 1925 until 1957, said about the Merck mission: “We try never to forget that medicine is for the people It is not for the profits The profits follow, and if we have remembered that, they have never failed to appear.” He and Merck faithfully followed those guidelines But most of what Merck did for many years wasn’t big news and wasn’t noticed, even though it was indeed moral behavior What we had at Merck in the 1980s and 1990s was a series of special opportunities – some related to medical science, some to economic performance, and some to what we might call social responsibility We vigorously and effectively took advantage of those opportunities and that attracted the attention of the media We were quick to respond to the unusual situations developing in the medical sciences, especially in enzymology and then in molecular genetics We implemented a business strategy appropriate to our changing markets and the national and global economies We were also vigorous and innovative about our social responsibilities But remember, we didn’t create the medical sciences, nor did we shape the national and international political economy in which Merck thrived Absent those two settings, few would have noticed that we were, indeed, a moral corporation Why am I so certain about that? Because I am now chairman of two small start-up firms I’m the same person I was before I retired from Merck in 1994 Both companies are focused on producing products needed by patients in the United States and around the world, and both have the same moral standards that George W Merck expressed so eloquently Neither company is front-page news – yet – nor many people know anything about them 171 16:26 P1: KsF 0521864550c08 CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION But both of these companies are, I believe, close to the norm in moral terms for American business Although our business system is far from perfect, it has long been the most successful in the world Headlines notwithstanding, our high moral standards have contributed to that success 172 16:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 chapter nine Afterwards When I retired in 1994, I left Merck with several major regrets One was completely personal Company policy required me to stop doing what I loved, and I found that very upsetting Love is the right word in this case I loved the opportunity I had to play a role in building a successful pharmaceutical company, and I hated the thought of retirement After a brief interlude in which I was introduced to depression for one of the first times in my adult life, I found a number of new problems to solve and new opportunities to help improve our society.1 My second regret was that I was never completely satisfied with the level of innovation we had achieved in our marketing efforts Although Medco had made tremendous strides in lowering the costs of distribution, the old system of personal “reps” remained intact and continued to play a large role at Merck and throughout Readers who have an interest in these problems and opportunities should consult Chapter 12 of P Roy Vagelos and Louis Galambos, Medicine, Science, and Merck (Cambridge, 2004) 173 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION the rest of the industry We had introduced laptop computers and emphasized the role our reps played as sources of up-to-date information for physicians and other healthcare professionals We had the highest standards in the industry, I believe, for what we would say about our products and those of our competitors But the system was still fundamentally flawed We sent our well-trained reps to wait in physicians’ offices for hours hoping to spend a few precious minutes with the doctor When I was a practicing physician, many years ago, I never talked to reps because I didn’t want to waste my time So you can see how conflicted I was As CEO at Merck, I had for years presided over a system I knew was inefficient I also knew, however, that if a drug company didn’t market its products aggressively, using the traditional approach, it could not maximize sales At least not under existing market conditions We experimented with some new approaches, but we failed to find a successful alternative to the current, wasteful system Information technology, and in particular the Internet, may ultimately be the answer, but in recent years, all of the large firms – Merck included – have moved in the opposite direction They have ramped up their sales forces, sending out new cadres of reps to deliver samples, gifts, and pizzas in return for a few moments with the doctor Even more disappointing to me was the problem of developing my successor One of the most important responsibilities for any CEO is to prepare for an orderly succession, normally by grooming an heir apparent I had done just that at MRL And as CEO, I had begun identifying and developing potential successors long before others were thinking about and gossiping about my retirement All went well, and the Board of Directors and I were anticipating a smooth transition 174 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 AFTERWARDS But at a late moment in the process, my plan crashed when our lead candidate left Merck for personal reasons The Board launched a search that began by reviewing the firm’s top executives and continued with a survey of business leaders outside of Merck They selected Ray Gilmartin, who was then heading BectonDickinson, a medical equipment firm Although Ray had no experience in pharmaceuticals, he was a talented business strategist with a special ability to encourage a cooperative approach to any business activity Once Gilmartin had taken over and the transition was completed, I stepped aside I resigned from the Merck Board of Directors, although I was urged to stay on the Board and remain involved with the firm I didn’t want to sit on the Board, however, and suggest to the new CEO and others in the company that I was looking over their shoulders, being critical of what they were doing as new problems developed *** New problems abounded Not just for Merck, but for the entire industry One of the central issues was the declining rate of new drug development This had happened before and will happen again Merck recruited me in the 1970s to help the firm get out of a flat phase of innovation when medicinal chemistry, pharmacology, and traditional random techniques were no longer producing breakthrough drugs The flat phase was industrywide then, just as it is now Very few of the professionals who stay up with the science base of the industry believe that this will be a permanent condition The advances in molecular genetics, in virology, and in advanced research techniques have laid the foundation for another spurt in new drug development Our understanding of diseases and of the 175 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION means of disease prevention and cure forecast a positive future for mankind and for the pharmaceutical industry The special American combination of small-firm, biotech innovators and large firm producers and distributers will have a great deal to with that positive outcome Unfortunately, however, for the large pharmaceutical firms trying to get through the current flat phase in innovation, their industry has experienced one of the most remarkable declines in public favor in modern history Let me briefly chart my perception of this astonishing fall from grace It all began with success, not failure, in new drug development Crucial to the setting was the great HIV/AIDS pandemic, a public health crisis with no known solution.2 In the age of modern scientific medicine, this new plague seemed to have returned us to the epoch before sulfa drugs, penicillin, and the new viral vaccines had transformed medical practice Once again, physicians were helpless to prevent or cure a disease that in its final stages killed virtually every person who was infected The disease hit with devastating results in the 1980s, spread in the 1990s, and in 2004, when close to 40 million people were living with the virus, it was estimated to have caused over million deaths worldwide In 1986, Merck had embarked on a major HIV research effort This was risky because the virus had only been identified in 1983 Much basic research remained to be done But the HIV/AIDS pandemic was too threatening to wait for basic science to make its discoveries We moved ahead knowing that MRL would need to AIDS (acquired immunodeficiency syndrome) is a late stage in the development of an HIV (human immunodeficiency virus) infection The virus attacks the body’s immune system, ultimately weakening it to such an extent that the patient succumbs to secondary infections of various sorts 176 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 AFTERWARDS a significant amount of basic research as well as the normal applied research At Merck we were looking for either a vaccine to prevent infection or an antiviral drug that would effectively treat the infection Neither Merck nor the rest of the industry was able to discover a vaccine that would work, but Merck and other firms were able to develop a number of antivirals that inhibited the enzymes crucial to viral replication This work was well underway as I was retiring In brief, the new drugs enabled physicians to control the infection but not get rid of it For those with advanced AIDS, the new antivirals were literally their lifesavers The regimens were demanding and the drugs were expensive, but they worked Resistance was still a major problem But the new antivirals in the 1990s sharply reduced the mortality from HIV infections But this happened at first only in the developed nations where patients and their private or public insurers could afford the new drugs and the healthcare infrastructure could support the patients In many parts of Africa, Latin America, and Asia, neither patients nor their governments could afford the new drugs The result was a drumbeat of criticism of the greedy pharmaceutical companies that would not reduce their prices They valued their patents and profits, the critics said, more than they did the lives of those suffering from HIV/AIDS The major pharmaceutical companies – “big pharma” in the media – responded to the pandemic in the developing world As early as 2000, Merck was helping to launch a new public-private HIV/AIDS program in Botswana and working toward the establishment of lower prices for developing nations But the industry was moving too slowly and with too many missteps that provided ammunition to the industry’s critics Pressure mounted after a firm 177 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 THE MORAL CORPORATION in India began to sell generic versions of the HIV drugs in Africa at very low prices Merck’s public–private partnership with the government of Botswana and the Bill and Melinda Gates Foundation has been successful, but by the time these new policies and programs started to gain a secure place in the industry’s public image, the media campaign against big pharma was being translated in the United States into a political movement Prices were again a central issue An aging population, a large number of citizens without medical insurance, and an industry that was increasing prices faster than the rate of inflation combined to produce a forest fire of new criticism A few firms stoked the flames by charging outlandish prices for particular new drugs The attacks steadily mounted Mergers and acquisitions created ever larger targets for the opponents to assault, and the industry’s heavy investments in marketing and sales undercut the business argument that high returns were needed to fund advanced R&D Accounting scandals and the recent wave of concern about the safety of vaccines and prescription drugs left pharmaceutials vulnerable to political attacks at the state and federal levels of our government It has seemed of late as if the industry was writing a prescription for its own demise The major threat to its future in the United States comes from the advocates of price controls This is not a new issue It has come up before and will come up repeatedly in the future, making it difficult for the industry to defend a form of public–private partnership that has sustained the most innovative medical, scientific, and pharmaceutical establishments in the world’s history Inevitably, price controls will over the long term dampen innovation No careful student of the collapse of centrally controlled economies would, I believe, advocate price controls as a means of improving new drug development It is no accident that most 178 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 February 4, 2006 AFTERWARDS of the world’s most important new drugs have in recent decades come from the U.S industry Before we introduce price controls, I hope we will reflect on the fact that our vast complex of partnerships has enabled millions of people to improve the quality of their lives and saved the lives of many additional millions throughout the world Personally, I am grateful for the opportunities I have had – as a practicing physician, a research scientist, a university administrator, and a senior executive of one of the world’s leading pharmaceutical companies – to play a role in making that system work I believe it has a great future if everyone who cares about medical progress will study carefully the sources of our past success 179 15:26 P1: KsF 0521864550c09 CB1050/Vagelos 521 86455 180 February 4, 2006 15:26 P1: KsF 0521864550ind CB1050/Vagelos 521 86455 February 4, 2006 Index AB Astra, 112, 153 acyl carrier protein (ACP), 18 Africa, 1, 2, 100, 162, 168, 169, 177, 178 African Americans, 153, 154 AIDS research, 78, 128, 176 Alberts, Al, 16, 22, 23, 52, 53, 54, 60, 64 at U of Maryland, 16 first work with, 16 Rahway lab and, 31 research work, 16, 22, 49, 50 Washington University and, 19 Aldomet, 57 American Heart Association, 67 American Home Products, 94 angiotensin-converting enzyme (ACE), 69, 93 animal models, of human diseases, 27, 31 antibiotics research, 71 atherosclerosis, 22 Aziz, Mohammed, 3, 162, 163, 164, 165, 169 bacterial mutations, 71 Baltimore Aircoil Company, 26 Banse, Robert, 157 Banyu Pharmaceutical Company, 159 Barceloneta accident, 151 Bauer, Walter, 15 beta-blocker drugs, 31 Bilheimer, David, 63 biochemistry, 14, 15, 17, 23, 24 medical sciences and, 17 sequences in, 14 Birnbaum, Jerry, 130 Black, James, 45, 46, 109, 110 blind screening experiments, 27 blood pressure, 69 Bradley, Bill, 137 Bristol-Myers Squibb, 102 Burke, Jim, 111 Calgon Corporation, 26, 114 Calgon Vestal Laboratories, 114 Calgon Water Management, 114 Campbell, William C., 1, 2, 3, 162 cancer research, 78 cholesterol and, 67 genetics and, 78 Capoten, 69, 70 captopril, 69, 70 cardiovascular research, 49 181 15:40 P1: KsF 0521864550ind CB1050/Vagelos 521 86455 February 4, 2006 INDEX Carter, Jimmy, 167 Carter, Rosalyn, 167 Cary, Frank T., 87 Chen, Julie S., 51 Children’s Inn, 169 China, 131, 161 cholesterol, 22, 23, 26 arteries and, 22 biosynthesis of, 22, 49 cancer and, 67 diet and, 22 heart disease and, 22, 23, 49, 52, 63, 65 HMG-CoA reductase and, 49 mortality, 67 Churchill, Winston, 123 cigarettes, 67 Clinton, Bill, 131, 135, 136, 138, 139 drug industry and, 133, 135 Merck and, 133 Vagelos and, 134, 135, 136, 138 Clinton, Hillary, 136, 139, 140 compactin, 51, 54, 58, 60 computer model, 158 Connor, John, 82, 87 Cori, Carl, 19, 20 corporate donations, 170 crystallography, 108 Danforth, Bill, 20 diabetes, 94, 95, 96 diagnosis, and treatment, 12 Dingle, John, 137 DuPont, 112 elephantiasis, 169 enalapril, 70, 106 Endo, Akira, 51 environmental problems, 145, 149 Environmental Protection Agency, 147 enzymes, 17, 18, 23, 26 ACE, 69 biochemical sequences, 14 cells and, 23 drug research and, 28 inhibition of, 23, 50 molecular genetics, 77 Stadtman on, 14, 50 targeted research, 27 Fair balance program, 84, 85, 97, 141 fatty acids, 16, 18 biosynthesis of, 16 synthesis of, 16 FDA approval process, 36, 37, 38, 66 Fidelman, Stan, 54, 83 Fortune magazine, 170 Frazier, Ken, 152, 153 Gadsden, Henry, 3, 28, 29, 82 generic products, 141, 142 Genest, Jacques, 87 Gilmartin, Ray, 175 Great Depression, 4, 80, 120 Grundy, Scott, 63 Hall, Ben, 130, 131 halofenate, 26, 28, 52 Harvard University, 11, 15 heart disease, 52, 63, 65, 67 hepatitis B vaccine, 77, 78, 115, 122, 127, 128, 129, 130, 160, 162 Heptavax-B, 129 high blood pressure, 31, 53, 70 Hilleman, Maurice, 30, 78, 127 HIV See AIDS research Horan, John, 29, 60, 62, 80, 82, 87, 92, 128, 152 Huck, John, 86 Hydro Diuril, 116 ICI chemical company, 93, 94, 95, 96, 97, 110 Illingworth, Roger, 63 imipenem, 72 Indocin, 57 inflation, 57, 105, 108, 121, 178 ivermectin, 1, 2, 3, 46, 47, 162, 163 Jacobus, David, 23 Jaffe, Marvin, 58, 59 Japan, 54, 57, 58, 61, 64, 82, 90, 148, 159 Johns Hopkins University, Johnson & Johnson, 111 journal club, 15 Kelco, 114 Kennedy, Ted, 137 182 15:40 P1: KsF 0521864550ind CB1050/Vagelos 521 86455 February 4, 2006 INDEX Latin America, 2, 82, 100, 105, 148, 177 Lautenberg, Frank, 137 Leighton, Charlie, 58, 59 Lewent, Judy, 158, 159 licensing, 46 lipid research, 31 lisinopril, 93, 94, 95, 96 livestock, 47 Loeb, Robert F., 10 lovastatin, 53, 65 Majerus, Phil, 18, 19 managed care, 88, 100 Management by Objectives Program, 32 Massachusetts General Hospital, 11, 169 Maxalt, 115 McDonald, Mary, 157, 158 McKinley, John K., 87 Mectizan, 132, 170 Medco Containment Services, 102 Mefoxin, 72 Merck & Co., Inc., 1, 2, 3, 7, 9, 23, 24, 25, 26, 118, 119, 165, 170, 171 Annual Report, 62 awards, 155, 170 Board of Directors, 87, 167 business strategy, 171 centralization in, 100, 107 corporate philosophy, 169 Dakar, Senegal, environmental policies, 146, 147, 148 Europe and, 99 foreign nationals, 163 founders of, 81 gender and, 154, 159 generic products and, 141 globalization and, 107 healthcare reform, 131 history of, 81 inflation and, 57 internship at, Japanese industry and, 57 labor relations, 88, 89 managed care, 100 Management Council, 155 marketing, 67, 83, 97, 99 MBO Program, 32 Medicaid and, 140 Merck-Medco plan, 103 mergers and, 111 minorities and, 151 MRL projects, 23, 25, 29, 50, 53 new products, Operating Review Committee, 155, 157 outsourcing, 46 physicians and, 84 pricing, 82, 120, 121, 122, 125 quality control, 150 R&D costs, 141 Rahway lab, 23 recruitment, 34, 35, 91 regulatory affairs, 36 rep system, 85, 104, 173 research budget, 29, 114 restarting clinical tests, 64 revenue, safety programs, 150 sales, 117 Seaview meetings, 41, 55–56 social responsibility, 156 stock options, 119 strategic plan, 116, 141 U.S facilities, 91 unions and, 88, 89 West Point, 29 women employees, 151, 152 work stoppages, 88 World War II, 50 Merck Company Foundation, 169 Merck Human Health Division, 100 Merck, Al, 87 Merck, George W., 81, 171 Merck-Medco, 103 Mettler, Ruben F., 87 Mevacor, 67–70, 75, 105, 108, 115, 122 microbial research, 17, 46, 53 Mitchell, George, 137 molecular biology, 117 Monod, Jacques, 16, 17, 18 cell biology and, 17 genetics and, 16, 17 Nobel Prize, 18 polio and, 17 183 15:40 P1: KsF 0521864550ind CB1050/Vagelos 521 86455 February 4, 2006 INDEX National Heart Institute (NHI), 14, 17 National Institutes of Health (NIH), 15, 18, 19, 43, 65, 67, 169 military service at, 13 Neuroscience Research Centre, 115 New Drug Application (NDA), 37 Nobel Prizes, 18, 22 not-invented-here syndrome, 46 Oil, Chemical, and AtomicWorkers Union, 88 onchocerciasis, 2, 162, 163 organic chemistry, 24 parasites, 1, 2, 47, 163, 168 See also river blindness Pasteur Institute, 17 Pasteur M´erieux S´erums & Vaccins, 112 Patchett, Arthur, 36, 49, 50, 51, 53, 69 patents, 37 Peltier, Bert, 58 penicillin, 23, 50, 176 Pepcid, 46, 112, 115, 142 peptic ulcers, 44, 45, 46, 110, 112 Pfizer, 111 pharmaceutical industry, 23, 27 pharmacy benefit management organizations (PBMs), 101 physicians, and Merck, 84 preventive medicine, 126, 128 Prilosec, 116 Primaxin, 116 Prinivil, 116 proteins, 77 Puerto Rico, 151 radioactive isotopes, 150 Reagan administration, 89, 132 receptor molecules, 31 recombinant technology, 108, 129 Recombivax HB, 108, 115, 130, 131, 160, 161 regulatory filings, 37 river blindness, 1, 3, 132, 162, 167, 168, 170 Ross, Richard S., 87 Rostenkowski, Dan, 137 Rubin, Bob, 138 Rutter, Bill, 129, 130, 131 safety assessment, 150 Salk vaccine, 12 Sankyo, 51, 52, 54, 57, 58, 59, 60 Scolnick, Ed, 77, 78, 108, 114, 115, 130 Seaview conferences, 41, 42, 55, 56 Shalala, Donna, 136 Sharp & Dohme, 29, 103 Sheares, Brad, 152, 153 side effects, tests for, 27, 66 Sigma Tau, 112 simvastatin, 65, 67 Singulair, 115 sleeplessness, 68 Smith, Bob, 65 SmithKline, 45, 109 smoking, 149 soil microorganisms, 27, 50 Spiegel, Frank, 80, 82, 90, 158 Squibb, 69 Stadtman, Earl, 14, 15, 16, 18, 19, 50 biochemical sequences, 14 biochemistry laboratory, 15 enzymes and, 14, 50 journal club and, 15 laboratory of, 15 microbial experiments, 14 Steere, Bill, 111 streptomycin, 23, 50 strokes, 68 sulfa drugs, 176 Tagamet, 45, 110, 112 targeted research, 27, 76 tennis, 54, 55, 56, 156 Textbook of Medicine, 10 thienamycin, 72 Timoptic, 38 Tishler, Max, 104 triglycerides, 28, 65 U.S Public Health Service, 14 University of Pennsylvania, 7, 169 Vaccines for Children program, 138 vaccines, 120, 122, 129, 131, 134, 139, 143 Vagelos, Andrew, 25 Vagelos, Cynthia, 16 184 15:40 P1: KsF 0521864550ind CB1050/Vagelos 521 86455 February 4, 2006 INDEX Vagelos, Diana, 13, 16, 17, 19, 25, 74, 75, 79, 89, 167 Vagelos, Ellen, 25 Vagelos, Herodotus, Vagelos, Marianthi, 5, 6, Vagelos, Randall, 16 Vagelos, Roy, 4, 10, 31, 52, 53, 79, 83, 86, 145, 153, 154, 167, 169 as CEO, 92 as mentor, 20 at Columbia, 10 at Mass General, 11, 12 at NIH, 14, 15, 16, 17 at U Penn, birth of, brothers of, 4, business executive, 79 chemistry and, 8, clinical medicine, 10, 15 Diana and See Vagelos, Diana, 13 early schooling, family business, 6, 23, 88 family of, 5, 8, 9, 16 fatty acid studies, 18 first contact Merck, ICI agreement and, 95 in France, 17 Pasteur Institute, 17 in pharmaceutical innovation, 47 internship, 11, 12 Loeb program, 11 medical school, medicine and, 9, 15 Miss Brokaw, 6, 7, 14 molecular genetics, 17, 77 Monod and, 17 on hope, 13 on medical innovation, 13 on price controls, 178 organic chemistry and, research methods, 49 retirement, 158, 171, 173, 174 Roosevelt Junior High School, sister of, 5, 151 sports and, St Louis and, 19, 20 successor to, 76, 174 targeted research, 27 Washington University, 19 See Washington University, 19 Vaseretic, 116 Vasotec, 69, 70, 71, 75, 93, 94, 95, 96, 105, 106, 115, 116, 142 Vioxx, 115 viral vaccines, 176 Washington University, 19, 20 Al Alberts and, 19, 31 department chairs, 19 graduate program, 20, 21 minority recruitment, 20 renovation of, 21 undergraduate program, 20, 21 Westfield Sweet Shoppe, Woodruff, Boyd, 57, 60 World Health Organization, Wygod, Marty, 102 Zantac, 112 Zestril, 96 Zocor, 68, 116, 142 185 15:40 ... 2006 THE MORAL CORPORATION – MERCK EXPERIENCES Merck and the pharmaceutical industry are headline news today Controversies over public safety, prices, and the ability of the industry to develop the. .. started Merck on a path that would lead to a series of blockbuster therapies that carried the firm to the top of the global industry in the 1980s and 1990s and Vagelos into the top position at the. .. 2006 THE MORAL CORPORATION others In the victim’s skin, the parasites develop into adult worms that can reach two feet in length They produce millions of microfilariae that crawl through the skin