CAPALDI: There are two dimensions that we have to pay careful attention to. One is getting over the tendency of middle managers to
shoot the messenger. Middle managers think that they are going to be promoted by creating the impression that no emergency
situation ever arises. That's absurd. I think we have to judge middle managers not in terms of their denying that these things
arise, but how they handle them when they come up.
The larger suggestion is you have to develop some kind of internal honor code. If all the employees understand what the larger
objective of the organization is and how they fit into that, and if they're constantly judged by whether or not they're contributing
to the larger objective, then they have a responsibility, an incentive to point out when something goes wrong.
Right now people are afraid that if they blow the whistle, they will be fired. If you have an honor system, however, you will
get fired for not blowing the whistle.
CLINTON: At Novartis a few years back, when they looked at those clinical trials for Gleevec, they said, "This drug has got to be
through FDA tomorrow and has got to be manufactured the day after tomorrow. And it's got to be on the streets the day after
that." People worked incredible hours, doing things that most people can't do, just because they saw what a difference it
would make in the lives of the patients.
CAPALDI: Very often people at the top see that. But it's not a message that gets down to those working at the middle level, simply
because of the model used. The tendency is to use the industrial or technological model. Creative people can't be treated
like cogs in a wheel. You've got to explain everything to them. You've got to make sure that their private agenda is consistent
with the company agenda.
CLINTON: I'm a skeptic about training programs and evaluations, and the rest of it. For me, the easiest way is make sure you have
better products in the pipeline. If you've got enough products in the pipeline and they're good enough and they're innovative
enough—isn't that enough?
PEREA-HENZE: I don't think it's enough. I think you have to put it in the culture of the company. And the only way for that to happen
is for it to be a consistent message from the top. I don't rule my behavior on how I think about clinical trials because of
what's in the pipeline.
LOUIS: The sense of passion in the organization I work in is unbelievable, from the top down. Everybody had the same basic vision
and passion, the sense that we're doing something that no one else does—the sense that it makes not just incremental differences,
but life-saving differences to the patients. It's impossible for every pharmaceutical company to replicate that across every
product. But if you have a few products that make a huge difference, that helps a lot.