Simon Clowes joined AstraZeneca as a college intern 20 years ago, back when it was mainly a chemical company. Today, he's the global product manager for Brilinta, the antiplatelet that may knock out Plavix as the standard of care for acute coronary syndrome and earn a fortune for the British firm. That makes Clowes something of a star at AZ—even if the development has consumed 12 years of his life.

As manager of a hard-driving cross-functional team, Clowes calls himself more of an "alignment agent" than a "change agent." One of the first things he did as head of this big-product cross-functional team was to lead everyone out into the real world of heart-attack patients and doctors in emergency situations. "Seeing a patient coming into a hospital in an ambulance really did help us all understand how the data that we were developing was really critical," he says. Clowes' fieldwork silenced those who said Brilinta's twice-daily dosage would be a commercial problem. "When you sit down with a cardiovascular patient, and they show you the seven or eight different medications they're on, adding a drug that could save their lives would not be a problem for them," he says.

"One of the really enjoyable parts of my job is to try and predict what will be happening in five or ten years time," he says. He follows daily medical news, the professional journals and meetings, and larger trends, from stent manufacturers to financial markets—and, of course, the competition. "When you design an 18,000-patient study that will take years to complete, you've got to anticipate where the world will be by the end of it to make sure it's still medically relevant."

Being open to criticism is no less important than being open to novelty, especially if your goal is to produce the best drug possible. "I like to include people with different views and I like to have ideas challenged," Clowes says. "When we were designing this study, I brought other AstraZeneca experts in and said, 'Throw stones at us and tell how the study can be improved.'"