There are many people whose argument is not against a particular drug or a kind of selling, but against drugs overall. They believe that Americans are massively overprescribed.

I don't know that they're massively overprescribed. If you look at specific categories, you may find that's true, but overall Americans don't get a large number of drugs compared to the French or the Germans or the Japanese. I think American culture has a different set of values and expectations around healthcare and drug use than other parts of the world. People here believe that if they're sick or their kids are sick, everything possible should be done. In other parts of the world, people become accepting of the fact that they just can't afford that.

The rationing that goes on—I mean a real denial of care that would be considered standard in this country—is an ingrained part of many of the government-controlled healthcare systems around the world. It's not talked about much here, but if you go to Canada or the United Kingdom or other parts of the world, if you are of a certain age and have a certain condition, nothing will be done for you. In the United States, it would be considered morally wrong not to try to provide some kind of care.

You studied to be a historian. I'd be interested in hearing a historian's perspective on the industry at this moment.

It's a tough time. Given all the marvels in the last couple of decades that really have changed healthcare in a very positive way, why haven't we been more successful in building a strong reputation? I think one of the causes is that maybe the industry, in terms of how it's positioned itself to the public, has gotten maybe a little too big for its britches. Listen to the wonderful public service ads that talk about how we cured cancer. I have a lot of friends who are physicians, and you listen to how they view that. It's like the tool maker claiming the benefit for the use of the tool. The way the industry's positioned itself as the hero in healthcare has caused a real backlash.

When I joined the industry, companies were more or less invisible. Other than a few names, people didn't know companies. Practically nobody knew the names of drugs unless they were taking them. I think the success of the industry, and our consciousness of that success, has caused some of the backlash. I think we need to tone it down a bit. We need to recognize that we are tool makers. We make potentially lifesaving tools, but it's the doctors' and the healthcare system's skill in using it—selecting the right patient, using our tools well—that are the reasons for these outcomes.

We need to step back and look at ourselves through others' eyes. Some of the pride of people who really believe in what they're doing may have exacerbated the problem.I think we need to remember who we are, and where we fit into the healthcare industry.