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THE MORAL CORPORATION – MERCK EXPERIENCES

Merck and the pharmaceutical industry are headline news today. Contro-
versies 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 Corpora-
tion. He and Louis Galambos published Medicine, Science, and Merck
(Cambridge, 2004).

Louis Galambos is Professor of History at The Johns Hopkins Univer-

sity 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.

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THE MORAL CORPORATION –

MERCK EXPERIENCES

P. Roy Vagelos

Louis Galambos

iii
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-13 978-0-511-16845-1 eBook (EBL)

isbn-10 0-511-16845-4 eBook (EBL)

isbn-13 978-0-521-86455-8 hardback

isbn-10 0-521-86455-0 hardback

isbn-13 978-0-521-68383-8
isbn-10 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.
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Contents

Preface page vii

1 The Puzzle 1

2 The Professional Path 4

3 Turn Around 25

4 New Drugs and Public Safety 49

5 Corporate Grooming 75

6 Winning in Global Competition 93

7 Prices and the Public Interest 120

8 Moral Leadership 144

9 Afterwards 173

Index 181

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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 multi-
national, 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.

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Preface

Those controversies are not new, and they provide a back-

drop for this account of the business career of Roy Vagelos, who
was head of research and then CEO at Merck from the mid-
1970s through the mid-1990s. His experiences in this vital indus-
try 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 block-
buster 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 orga-
nization 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 thou-
sands 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 inter-
est in these pages. There is “trouble” as well as “hope” in this
account of two decades in the evolution of an innovative, science-
based 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, never-
theless, like to give a special thanks to Cambridge editor, Frank
Smith, who encouraged us to write a study focused tightly on Roy

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Preface

Vagelos’ career at Merck and the ethical questions the pharma-

ceutical industry is facing today. We hope this book will help our
readers untangle and debate all of those issues, using history as it
should be used, to deepen our understanding of the world in which
we live.

Roy Vagelos
Louis Galambos
November 2005

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chapter one

The Puzzle

I was the head of research and development at

Merck & Co., Inc., when two of the company’s scientists
dropped a puzzle in my lap. The puzzle had an important eth-
ical component, but that was not what concerned the scientists
who had come to see me. Bill Campbell was a parasitologist who
was involved in the discovery and development of ivermectin,
a remarkable substance that was active against the worms that
plague livestock as well as household pets. He and Mohammed
Aziz, an infectious disease specialist, weren’t concerned about cat-
tle or horses, however. They had a more intriguing problem in
mind. They wanted to spend some of the company’s money to see
if ivermectin could be used against the parasite that causes river
blindness in people.
Mohammed had a good, firsthand knowledge of the disease.
He had worked with the World Health Organization (WHO) in
Sub-Saharan Africa, where the black fly breeds in the continent’s
fast-flowing rivers – hence river blindness. The flies pick up a
tiny parasite (microfilariae) from infected humans and spread it to

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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 microfi-
lariae that crawl through the skin and produce intolerable itching.
Even worse, when they enter the eyes, they cause inflammation
and then scarring that leaves the victim blind. As Mohammed and
Bill explained, there was a good chance that ivermectin might be
the first effective treatment for this terrible disease. The drug, they
said, was working against a related parasite that attacks horses.
But there was a catch. At that time, it was estimated that 18 mil-
lion people were infected in Sub-Saharan Africa alone, and in some
West African villages 60 percent of the population over fifty-five
years old was already blind. According to WHO’s estimates, there
were over 100 million people living in areas of Africa and Latin
America where they were threatened by the disease.1 If ivermectin
worked, there was bound to be a tremendous demand for it. But
there was no way either the people at risk or their governments
could pay for the treatment.
That was the first part of the puzzle, and I found it relatively
easy to solve by saying “Yes.” There was a potential downside for
me personally. I hadn’t been on the job very long and I was still
learning how to promote new drug development in a corporate
setting. While we had some big innovations in our pipeline, I was
still an unproven rookie in the business world. I would be spend-
ing a considerable amount of company money in a field, tropical
medicine, that few of us other than Mohammed Aziz knew very
well.
Still, I had good reason to be confident of what we could
accomplish with ivermectin. Merck & Co., Inc., had an impressive

1
The scientific name of the parasite is Onchocerca volvulus, and thus
the disease is onchocerciasis (pronounced onco-sir-KI-isis).

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THE PUZZLE

long-term track record in new drug development. The year I joined

the company (1975), it was spending over $120 million on research
and development out of total revenue of almost $1.5 billion. Rev-
enue had increased by 12 percent over the previous year, and Merck
was doing particularly well in overseas markets, which accounted
for 45 percent of the firm’s sales. But CEO Henry Gadsden had
become worried – with good cause – about Merck’s pipeline of
new products, and he had hired me to solve that problem. It was
as obvious to me as it was to Mohammed and Bill that even if
ivermectin was successful against river blindness, the drug wasn’t
going to pump up the firm’s revenue and make the stockholders
happy. So I was being asked to take on some risk for myself and
for the laboratories.
Nevertheless, I decided to crawl out on that limb. This decision
reflected the fact that I was so new to the business world that I still
thought of myself as a physician first, scientist second, and presi-
dent of an industrial laboratory third. So I didn’t hesitate and sent
Mohammed and a small group of Merck people to Dakar, Senegal,
to find out if ivermectin could indeed control river blindness.
The second part of the puzzle would be more expensive, more
risky, and more difficult to solve. But before I faced that problem,
Mohammed would have to find out if ivermectin worked against
river blindness and I would have to learn how to do an entirely
different job at Merck. I would have to become a business leader
and would have to rearrange my priorities: I would have to become
a corporate leader first, a medical scientist promoting innovation
second, and a physician concerned about healing third. Before
explaining how that happened, what kind of leader I became, and
what Merck decided to do with this new drug, I want to tell you
a bit more about myself and my background before I got into the
pharmaceutical business.

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chapter two

The Professional Path

M y life has in many ways been the classic

American dream: Poor immigrants come to the United
States and work very hard; their children receive an excellent edu-
cation and lead a better life. Like most such myths, the story has
some truth to it, as it certainly does in my case.
I was born just before the start of the Great Depression, in
October 1929, in Westfield, New Jersey, where my Greek father
and one of his brothers owned a shop that sold candy, ice cream,
and snacks. Times were hard for all of us, but I grew up in a fam-
ily that was extremely supportive, even in the harshest days of the
1930s.
I needed support because in elementary school I was a cutup
who entertained the other students – but not, of course, the teach-
ers. They were interested in teaching Pindaros Roy Vagelos (they
wouldn’t use my nickname, Pindo) to read and write in English,
goals that seemed formidable to a first grader who spoke only
Greek at home. I was a slow learner. I just wasn’t interested in
learning. Since my last name begins with a “V,” I sat in the back

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THE PROFESSIONAL PATH

of the class, where it was hard to hear. I got used to not paying
attention to the lessons, although I pretended to work when the
teacher was watching.
The year 1936, when I was in first grade, was an especially dif-
ficult one for my family. My father and his oldest brother owned
the Westfield Sweet Shoppe in the center of an affluent bedroom
community about an hour’s drive from New York City. Like many
other Greek immigrants, they had gravitated to the candy and
small restaurant business because startup costs were small and they
were largely uneducated. They could thrive with minimal English,
making up with hard work and warm personalities what they
lacked in education and capital.
But the hard times of the 1930s didn’t spare Westfield or our
family business. When the market collapsed, we lost our house.
We moved into an apartment above a drugstore about two miles
from Westfield, and I thought my life was coming unhinged. My
sister and I changed schools. I lost my room and had to sleep on a
sofa in the living room.
I remember it like it was yesterday. My parents, Herodotus and
Marianthi, never discussed their financial problems in front of
me. But I absorbed every sign of urgency in our family. My father
and his older brother tried to keep the Sweet Shoppe going by
cutting expenses and working longer hours. My mother, who had
stayed home before I entered school, took a job ironing clothes
in a laundry. After a full day there, she came home and made
elaborate evening dresses for the few women in that part of New
Jersey who could still afford them. As soon as we could work, we
all helped with the family business. I washed windows and swept
out the store. I think I learned more about life from these early
experiences in my family than I did in school, where I continued
to lag.

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THE MORAL CORPORATION

I learned a great deal from just being around my father. He

taught me something about community and interdependence.
Watching him help other members of the family come over from
Greece provided important lessons about our responsibilities to
others. I also learned something about endurance and optimism.
Even during the worst years of the Depression, my father consid-
ered himself fortunate to be in a place where people could build
new lives and had access to greater opportunities for themselves
and their children. If you work hard, my father said, you can
achieve anything here.
At first, it looked like this lesson was not going to take. I was
an able young musician, playing my violin in the school orchestra
and singing in the chorus. It encouraged me to think of myself
as an entertainer. My father remained gentle but firm. He kept
telling me about relatives whose sons had received scholarships to
college. He spoke of the advantages of working with a pen behind
a desk instead of working long hours on one’s feet in a store or a
factory.
Gradually, I began to get the picture and started to concentrate
more of my energy on schoolwork. Especially when I discovered
that mathematics came easily to me. Reading was still a problem.
Nevertheless, my academic performance improved steadily, and
to my surprise I found myself among the top group of students at
Roosevelt Junior High School.
When the economy was recovering in the early 1940s, my
father and mother were able to buy the Estelle Luncheonette from
another Greek family. So we moved from Westfield to Rahway, a
working-class town just five miles away. For me, this move was
providential. It threw me into the hands of Miss Brokaw, my high
school algebra teacher. Miss Brokaw was young, enthusiastic, and
interested in her students. She began to make me feel that I could

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THE PROFESSIONAL PATH

do something important in life. She constantly challenged me with

extra homework assignments, and I responded to that positive
pressure by doing exactly what she had in mind.
I also was able to upgrade my position in the family business:
Now I was a soda jerk. When I was working the fountain and help-
ing with the tables, I got to know our customers, especially the peo-
ple who worked for Merck & Co., Inc., which was Rahway’s lead-
ing business. Merck was only a few blocks from the luncheonette,
and many of its scientists and engineers regularly came over for
meals. They impressed me with their intelligence and ability to
talk about different ideas. The common language seemed to be
chemistry, and for the first time I saw people truly excited about
the intellectual aspects of their work. I started to see an interesting
path opening ahead of me, and it led directly to college, as Miss
Brokaw and my father had understood long before I did.
Academic accomplishment brought out a fiercely competitive
streak in my personality, something I can’t remember having dur-
ing my early years. I became an honor student on a fast track in
science and mathematics, both of which played to my newfound
ability in analysis. I was not a geek – the luncheonette prevented
that from happening – but I now had all of the energy and deter-
mination of a religious convert. My newfound zeal didn’t keep me
from being turned down when I applied to go to Johns Hopkins,
but I had better fortune with the University of Pennsylvania, which
became the next leg on my path to a profession.

***
I had never even seen the Penn campus before my parents drove me
and my single suitcase down to Philadelphia in September 1947
and dropped me at the gate on 37th Street and Woodland Avenue.
Beyond the gate were dormitories built around large quadrangles

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THE MORAL CORPORATION

of green lawn. The classrooms and laboratories that absorbed my

time over the next three years sprawled on both sides of Woodland
Avenue, which divided the campus.
At Penn I found exactly what I was looking for, including the
opportunity to set my own pace and to explore what intrigued me.
When I found difficult problems to solve in chemistry or physics,
problems that sustained my interest, I became even more ener-
gized. I learned how to concentrate, to stay focused for longer and
longer periods of time. Did the memory of my mother bent over
her sewing, my father’s long hours in the shop, have anything to
do with my drive? I believe they did. Studying late at night, I would
recall how hard both my parents worked and reflect on the differ-
ence between their lives and those of the professionals who ate at
our luncheonette.
The only significant break in my schedule was rowing. I rowed
my whole time at Penn with the lightweight crew. I discovered that
the discipline of rowing – the physical exertion and team coor-
dination – fit my personality. My teammates became my closest
friends. From rowing I learned the benefits of being in peak con-
dition, the importance of teamwork and team leadership, and the
positive impact physical fitness could have on my intense studies
in chemistry. After I rowed, my concentration was always better.
When I wasn’t rowing, I focused with great energy on my stud-
ies and was able to graduate in three years. Playing to the hilt
my role in the classic American immigrant story, I had become
the classic American high achiever. Then, rather suddenly, I had
to decide what I was going to achieve after I left Penn. The top
two contenders were graduate training in chemistry or medicine.
I loved chemistry. Organic chemistry in particular was incredibly
exciting to me, and I could see opportunities to make important
intellectual and practical contributions through a scientific career.

8
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