Remains of the Day

What else does Vasella have to prove?

Any fire he may have felt about acquiring cross-town rival Roche and creating Pharma Suisse has likely flickered out. After laying out $2.1 billion in 2002 to increase Novartis' stake to 33 percent, and reportedly mounting a failed charm offensive on the secretive Hoffmann-La Roche family, which owns slightly more than 50 percent of the shares, the final nail in the coffin materialized last month. A shareholder pact, which was to have expired at year's end, preserves the controlling voting rights among the family. "Nobody really believed Novartis would be able to take over Roche," said Allianz Global Investors' Joerg De Vries-Hippen in the Financial Times.

Vasella also has to solve the conundrum of his biggest-ever deal: a two-step acquisition worth up to $28.2 billion (with a locked-in share price), in which Novartis is aiming to grab a majority stake in Nestle's Alcon, the vision-care behemoth that makes a strategic fit with Novartis' Ciba—and would help ease the upcoming patent cliff with OTC cash. But Alcon's stock value has plummeted, analysts are frowning, and Vasella is likely to face shareholder fury if he proceeds with the deal.

The gee-whiz! factor, encoded in Novartis DNA, looks to be sending the healthcare giant into the orbit information technology. Two modest examples from the past few months: The first-ever genetic test to ID patients most at risk for side effects associated with cox-2 inhibitor Prexige, which FDA shot down because of evidence of liver toxicity. And, a little dicier, computer chips implanted in humans to improve drug compliance.

"Novartis would be the first pharma there—GE, Phillips, and Siemens are the main competitors," says Cliff Kalb. The timing is right. On the one hand, the Obama administration has dropped billions for healthcare records. On the other, Pfizer, Merck, and Roche are currently distracted by megamergers.

And money?

In 2008, Vasella made $15.1 million, ranking him seventh among pharma CEO packages. But Vasella's views on money are typically iconoclastic. In a 2002 Fortune interview, after criticizing the tyranny of quarterly earnings and the danger of CEOs believing their own good press, Vasella offered an anecdote from his own career: "The strange part is, the more [money] I made, the more I got preoccupied with money. When suddenly I didn't have to think about money as much, I found myself starting to think increasingly about it. Money corrupts the mind. ... One day the glitter will be gone anyway," he said. "Only once you are unencumbered by that will you become free to do the right things as leader of your company."

Yes, yes—money corrupts, glory is fleeting, and only through losing your attachment to the things of this world can you find your authentic self. But we rarely hear such truths—or truisms—from the mouth of the world's leading healthcare conglomerate, who makes $15 million a year and whose daily schedule is booked solid well into the next decade. Credit four years of psychoanalysis or what you will, but Vasella is one of a kind. He may take himself very seriously, but he definitely doesn't believe his own good press.