SMITH: What’s surprised you most about being a CEO? KINDLER: The job is much more complicated and broad than I even imagined. The range of stakeholders in an enterprise like this is just extraordinary, whether it’s investors, customers, employees, government officials, patients or the public. And within each of those constituencies, there are multiple additional constituencies you have to think about. What’s surprised me is the extent to which I need to spend time with, and understand, the needs of and interests of all these different constituencies.
Is it hard for someone who’s not a physician or a scientist to run the biggest pharmaceutical company on the planet? It certainly presents challenges. I like to think my training and my background have taught me a couple of things that are useful in any job of this nature. One is to ensure that you have really talented and knowledgeable people running the different aspects of the business, including the science side of things. And the second is to ask intelligent questions, pursue ideas and encourage people to do their best.
You’ve announced plans to cut 10,000 jobs. How do you convince the remaining employees that Pfizer is a good place to be? It is the single most challenging and important thing that I focus on and worry about. It is very, very difficult to terminate people’s jobs and to ask them to leave the company, which in many cases they’ve served for years and years. The only good thing I can say is that I have discovered that most people in this company—including some of the people who are leaving—recognize that we’re doing the things we need to do. I hear from employees who say a lot of the changes that we’re making, as painful as they are, are overdue.
How much is your business, like Hollywood, a hit-driven business, built on blockbuster drugs like Viagra and Lipitor? There’s no question that’s true. Another analogy you could draw is oil wildcatting, where you drill a hole in the ground and nine out of 10 times it comes up dry. You hope the 10th time is a gusher that pays for the other nine. The pharmaceutical business has been highly dependent on blockbuster products and probably will be for the foreseeable future. On the other hand, I think that as medicine evolves, personalized medicine becomes a greater opportunity and we’re going to see medicines focused on populations that are smaller, but for whom we can be much more confident that the drug will be efficacious.
Has the industry done a good job of justifying the price of prescription medicines? No, the polling is very clear that the public doesn’t accept that proposition. The number of misconceptions about our industry is extraordinary. I’ve read surveys that something like 70 percent of the American public thinks drugs are actually discovered and developed by the government, or by universities, when in fact 90 percent are discovered by the pharmaceutical industry. So we need to do a better job of communicating. But we also have to recognize that there is a fundamental societal issue here—the affordability of medicine, both of individuals to afford medicine and of society to pay for its health-care system —that we in the pharmaceutical industry have to be a part of solving.
What’s your advice to young leaders in businesses dealing with government or regulators? You need to think of them as your customers. Now, that doesn’t mean you’re always going to agree with them … But you have to, as you would with any customer, try to understand what they’re trying to achieve. What’s driving them? … What are their problems? And see if you can find win-win solutions.
Has the industry done a good job of justifying its marketing costs? No. One thing that has not been helpful is the way we as an industry—and Pfizer, certainly, is no exception—have done TV commercials. When direct-to-consumer advertising was first permitted, there was a real seriousness about the ads, a real science orientation, a balance about the risks and the benefits. And over time we got a little bit away from that. We’re doing everything we can to rectify that. But I think one of the things that contributed to [the problem] was a view of the industry that we were more of a marketing operation than a science operation, and that we were spending so much money on marketing that we could reduce the prices of our drugs. That’s not economically factual, but I think we have, to some extent, ourselves to blame for that.
What are the most common mistakes that you see in young managers? One mistake or lost opportunity is to not look for ways of growing within your job. There’s a tendency, especially in a big hierarchical organization, to feel like you can only grow if you’re promoted. I don’t think there’s anything wrong with being ambitious in a healthy way, as long as you don’t hurt other people in doing it. But if your ambition is entirely focused on “I need to be promoted,” you’re going to upset people and you’re going to frustrate yourself over time, especially as organizations grow flatter and opportunities become fewer. So my strongest advice to people—and I frankly try to do this myself, it’s one of the reasons I ended up broadening beyond where I started from as a lawyer—is, look within your own job for ways in which you can expand your contribution. And there are always a million of them, because any company is looking for smart people to help solve problems.
title: “Medicine Man” ShowToc: true date: “2022-12-12” author: “Jim Graham”
Mattin credits his recovery to Jacques Mabit, a French physician who founded the Takiwasi clinic 10 years ago near the remote town of Tarapoto in Peru. Since then, he claims to have successfully treated scores of former addicts with ritual fasting, psychotherapy and hallucinogenic-drug trips. Nearly all his patients undergo a mystical or religious awakening.
The notion of using hallucinogenic drugs sounds like a relic of the 1960s, but recently scientists have taken a fresh look. Research on ecstasy, psilocybin and other drugs is ongoing in dozens of universities in the United States and Europe. Scientists believe that psychotropic drugs may yield therapeutic benefits for drug addicts and those suffering from chronic depression, and that studying their effects may yield insight into how personality is constructed in the brain. “There is tremendous potential there in terms of future research,” says Charles Grob, a psychiatrist at UCLA.
Depending on your point of view, Mabit is either at the forefront of this research or he’s careering dangerously ahead of it. Research on psychotropic drugs is many years from clinical trials, but Mabit isn’t waiting for the tests: he’s already using hallucinogens on live patients. The practice is controversial, to say the least. Critics contend that he’s endangering the lives of his patients without any good science to back up his claims. Back in France, where Mabit gets many of his referrals, he’s been suspected of being involved in a “sect.” Mabit says he’s simply picking up where conventional medicine has failed. Is he a visionary who’s anticipating where medical science is headed? Or is he, as critics charge, a danger to the desperate and vulnerable young adults he lures to his treatment center in the jungle?
Mabit, a portly 47-year-old who speaks reassuringly like a country doctor, first went to Peru in the 1980s with the French group Doctors Without Borders. Native healers told him about how they used plants to cure rheumatism and mental illness. They would talk about how the plants “taught” them how to heal, or “told” them what a particular patient needed. “They told me that if I really wanted to understand how the plants worked, I would have to try them,” says Mabit. During several months, Mabit underwent several ayahuasca sessions with local ayahuasceros, or healers. During one session, he saw himself treating drug addicts with the plants. “It was the last thing I wanted to do,” Mabit says. “I knew that working with addicts was supposed to be very frustrating. They were always falling back into abuse.” But he took the vision to heart.
Since opening Takiwasi in 1992, about 500 patients–three quarters of them from Peru and the rest from Europe, the United States and elsewhere–have gone through the program, most referred by sympathetic doctors. Mabit typically admits 15 to 20 patients at a time, and puts them through periods of fasting and psychotherapy in addition to the drug ceremonies. Addiction, Mabit believes, requires a kind of spiritual healing that comes from deep introspection–for which ayahuasca acts as a catalyst.
The ayahuasca that Mabit gives out to his patients is actually a brew that includes two active ingredients. The bark of Banisteriopsis ca-api, the ayahuasca plant, contains the chemical harmine, which acts like an antidepressant drug, increasing levels of the neurotransmitter serotonin in the brain. The jungle plant Psychotria viridis contains DMT, a common hallucinogen. When taken with harmine, DMT lasts longer than usual in the body, yielding the kind of sustained visions that Mabit says are compatible with spiritual awakenings. When patients are properly guided through the experience, they have direct and visceral access to their unconscious thoughts. It’s as though they were having intense dreams while still awake, but unlike conventional dream analysis, the patients experience the images while fully conscious and can discuss them afterward in therapy sessions. “You can free yourself of your anger, or actually see your father and forgive him,” says Mabit. “That’s healing.”
Mabit’s ideas have generated some interest among specialists in mental illness and drug addiction, but few outside a small coterie of scientists are convinced. When a lawyer in the French town of Pau heard that a psychotherapist had persuaded his daughter to attend Takiwasi, he called the cops and accused Mabit of running a “sect,” a criminal offense in France. In June, the police detained the psychotherapist and a psychiatrist, both of whom have referred patients to Mabit. Police also searched the offices of an association that represents Takiwasi in France. The investigation is ongoing.
Even scientists who conduct research on hallucinogens express concern over Mabit’s treatments. Safety is a big issue: hallucinogens can induce psychosis. Mabit says he is careful to screen prospective patients for signs of schizophrenia, which the plants would exacerbate, and he lays down elaborate rules designed to avoid bad side effects. Scientists also question whether the treatment works over the long term. “It’s one thing to go down to the jungle,” says Grob. “It’s quite another thing to go back to your home community and keep it up.” Says Benny Shannon, a cognitive psychologist at Hebrew University in Jerusalem, and author of the first book on ayahuasca from a psychological perspective: “To think ayahuasca is a one-time solution to drug addiction is both naive and dangerous.”
In 10 years of data collecting, Mabit has failed to build an airtight case. In a typical drug-addiction program, only about 30 percent of patients manage to kick the habit entirely; the other 70 percent suffer relapses. Mabit claims that only a third of his patients go back to taking drugs. On the other hand, he admits that only a third manage to stay completely clean. The remainder show “significant improvement”–they may continue to abuse drugs, but not as egregiously as before. In which category belong those who, like Mattin, keep going back to Takiwasi for more ayahuasca? “I come back here every chance I get,” Mattin says. “But I’m not addicted to the plants. I know what addiction is. I come here to get in touch with nature, because that’s what keeps me healthy; that’s why I don’t need drugs anymore.” The data wouldn’t show whether Mabit’s program helps those who couldn’t be helped any other way. And that, in the end, may be the true virtue of the ayahuasca cure.
