Benevolence and the bottom line
Miles White is not given to introspection. But today the chief executive of Abbott Laboratories, one of the world's biggest drugs companies, is feeling less bullish than usual.
"If there is a lesson to relearn from all of this", he says, wearily, "it is that goodwill is fragile."
Abbott has spent the past several years trying to win the hearts and minds of HIV/ Aids sufferers. It sends cut-priced drugs to Africa, is building a state of the art clinic in Tanzania and funds projects aimed at lowering the rate of monther-to-child HIV infection.
Yet, on the day of my visit to the company's headquarters outside Chicago, HIV/ Aids doctors across the US are sporting "Boycott Abbott" badges on the lapels of their white coats.
The company's offence? A fivefold increase in the US price of Norvir, its longstanding protease inhibitor that is still widely prescribed in the treatment of HIV/ Aids.
Notwithstanding the company's efforts to justify the price increase - and soften the blow for patients whose health insurance will not foot the bill - the backlash has been intense. Lapel badges. Petitions. Protests. Hearings on Capitol Hill. Fragile or not, goodwill towards Abbott Labs has been trampled underfoot.
The most recent letter to the company from the American Association of HIV Medicine (AAHIVM), a collection of the foremost experts in the field, castigates Abbott for "egregiously compromising" HIV/Aids care and pledges that the association will "continue to press for a significant rollback in price".
Mr White is not an easy man to press. Big and confident in a crisp white shirt and silk tie, his office furnished with faux antique furniture, he is the CEO from central casting.
His resumé is equally impeccable: a degree in mechanical engineering, a Stanford MBA, a spell at McKinsey and then into industry. He took the top job at Abbott in 1999, at the age of 43.
Unlike many of his contemporaries, however, the man who spent his formative years at military school is refreshingly free of sanctimony. Questions about Aids, Africa and ethics are tackled head-on.
Wall Street analysts estimate that the Norvir price increase will bring in about $50m (￡26.9m) a year, against Abbott Labs' total annual revenue of about $20bn. So would it not it be easier, I ask, to back down in the interests of goodwill?
"If we were back here judging all of our decisions only by our ability to generate goodwill then it would be [easier to reverse the price increase]," he replies. "But we are not. We are balancing a lot of other things too."
One of Abbott's main arguments is that the additional $50m it earns will be used to accelerate the development of new drugs.
While the company no longer spends big money on HIV/Aids research, its $1.7bn annual R&D budget makes it a serious force in therapy areas such as oncology and diabetes.
Asks Mr White, rhetorically: "If that $50m could accelerate the development of another cancer drug, and a member of your family had cancer, what would you do?"
But if the prospects for drug development are so good, why not sacrifice profits for increased R&D spending? Surely, shareholders would be better off in the long run?
"We are back to all these other balances. I can tell shareholders that we are going to invest, invest, invest for the long term. But shareholders will ask: how long is long?"
Then why spend money sending HIV/Aids drugs to Africa and on corporate citizenship initiatives that deliver no obvious return to shareholders?
Most CEOs would answer the question with vague talk of moral responsibility. Mr White's response is typically direct:
"Why spend money on corporate citizenship? Frankly, because it is required. If I don't provide our products in Africa, governments will license our intellectual property to others who can. Governments will intervene. Make no mistake, they will do that."
Such is the realpolitik of the pharmaceuticals industry.
While corporate finance theory says that companies exist to make money for shareholders, the reality is more complex. What every chief executive knows - but few are willing to say in public - is that they cannot afford to ignore the wishes of governments, government agencies and, increasingly, non-governmental organisations.
Mr White reflects: "Companies exist in free markets by the grace of society. Society, by the way it makes laws, selects legislators, levies taxes, allows companies to exist. It is not right to think that a company exists in a vacuum where it can do anything it wants."
Boiled down to basics: if companies ignore the wishes of governments, governments will change the rules.
For US drugs companies the implicit threats are (a) controls that would cap the price of prescription medi cines and (b) reforms that would weaken the patent protection enjoyed by discoverers of pharmaceutical compounds.
The first of these is very real at a time when US healthcare spending is spiralling upwards.
Pfizer, Abbott's larger rival, last week stole a march on the industry by announcing steep drug discounts for the 43m US citizens without health insurance.
Pfizer was not motivated by a sudden outbreak of corporate conscience. Rather, its motivation was the mounting threat by US legislators to impose price controls, or legislation that would allow US citizens to buy prescription medicines from Canada, where such controls are already in place.
Against this background, expect other big US pharma companies to follow suit.
But surely, looked at in purely economic terms, Africa is different. Abbott makes little or no profit on the continent. Why worry if African governments confiscate the company's intellectual property?
"It depends whether you think there is a slippery slope," replies Mr White, still in realpolitik mode. "If Africa does it, why not China? Why not India? Why not Latin America?"
A world flooded with cheap, generic versions of its HIV/Aids drugs would be very bad for business.
If such a scenario seems far-fetched, consider that China last week overturned Pfizer's patent on Viagra, its best-selling treatment for erectile dysfunction.
The move sent tremors through the industry and put trade diplomats into a spin. If the Chinese authorities press ahead, however, cheap generic Viagra is certain to find its way out on to the world market.
The lesson is that the pharma industry depends not only on the ability of its scientists to come up with new therapies but also the co-operation of governments to turn medicines into money. The costs of maintaining this co-operation are not trivial.
In Abbott Lab's case, every $20m spent on corporate citizenship knocks one cent from earings per share.
In April, Mr White told the company's shareholder meeting that in 2003 it spent $225m on cut-price medicines and other work in developing countries.
Why does Wall Street put up with this while at the same time punishing companies ruthlessly for missing earnings targets by a couple of pennies?
Because, in this industry, corporate citizenship is a cost of doing business, an overhead to be managed like any other.
None of this implies that Miles White is cold-hearted or calculating. He comes across as a normal - if abnormally ambitious - human being.
In 2001, he went to Tanzania to see for himself the human cost of Aids. This year he travelled to Romania to assess the situation. This experience informs his decisions about how Abbott should spend its citizenship dollars.
The mood among Abbott's 72,000 employees is another consideration.
Roy Vagelos, former chairman and chief executive of Merck, another drugs industry giant, argues that his decision in the 1980s to give away a drug that could cure river blindness in Africa had a positive impact on morale within the company.
"We could hire almost anybody we wanted for 10 years because of the feeling in the company", he said in a recent speech at Wharton Business School.
You don't need a Phd in social psychology to see that employees at any company - especially a company whose business is human health - like to see their employer behave well.
Yet against this background, you have to wonder why Miles White risked the ire of employees, doctors, patients, activists and legislators by quintupling the price of Norvir - all for a measly $50m, or 2.5 cents a share.
For the first time in our conversation, Mr White is reticent. He does not want to fan the flames. Yet his response, while vague, gets to the heart of the matter:
"Look, there are activists who argue that we have a moral obligation to provide products, if we have them, to anyone who needs them, regardless of ability to pay. I understand that point of view. The trouble is that I also have an obligation to satisfy the enterprise. So there will be parts of the world that do not pay, parts of the world that pay only a little, and parts of the world that pay a lot."
雅培制药：要善心还是要利润
迈尔斯?怀特(Miles White)素来不是深藏不露之人，平常总是精力充沛，口若悬河。不过今天，他似乎不在状态。怀特先生是全球最大的制药企业、雅培制药(Abbott Laboratories)的首席执行官。
“如果经过这些事情，我们需要得到点什么教训的话，”他不无疲惫地说，“那就是，信誉这东西很脆弱。”
过去几年来，雅培制药力求赢得“人类免疫缺陷病毒/艾滋病”（HIV/Aids)患者的喜爱和信任。它向非洲送出了大量折价药物，在坦桑尼亚建立了设备一流的症所。它还赞助了一些项目，旨在降低人类免疫缺陷病毒母婴感染率。
但是，就在我前往该公司位于芝加哥外的总部进行采访那天，全美国的医生都在白大褂的翻领上别着“抵制雅培”字样的徽章。
这家公司究竟何错之有？错就错在它出产的爱治威（Norvir）在美国的售价提高了5倍。爱治威一种蛋白酶抑制剂，是雅培传统产品之一，现在医生还普遍用它来治疗人类免疫缺陷病毒/艾滋病。
该公司尽力为其涨价开脱，并力图缓解保险公司不买单所带来的冲击，但是公司遭到的冲击还是非常大。扣在翻领上的抵制徽标。请愿。抗议。国会听证。不管脆弱与否，过去大家对雅培的信誉已经被一脚踩到地上了。
美国艾滋病药品协会（AA人类免疫缺陷病毒M）是一家汇聚着抗艾滋病领域顶尖专家的组织。在最近一封写给雅培的来信中，该组织谴责雅培“过度损害”艾滋病医治，并誓言“继续施加压力，使药价得到大幅度下调。”
向迈尔斯先生施加压力并不是件容易的事。他身材高大，信心十足。他穿一身白衬衫，打着丝绸领带。他的办公室用的古董家具。他是个天生当首席执行官的材料。
他的个人简历也同样无懈可击：他拥有机械工程学位，获得过斯坦福(Stanford)MBA，后来又成为麦肯锡（McKinsey）的杰出咨询顾问，最后进入工业界。1999年他开始担任雅培的最高职位，时年43岁。
怀特先生成年时期在军校度过，和很多同龄人不同，他能够正视救援、非洲和伦理等问题，并加以解决。
据华尔街的分析，爱治威的涨价能为公司带来5000万美元的收益，而雅培制药的总年收益为200亿。因此，我问，如果做出些让步，换取公众的信誉，岂不是更容易一些？
“如果我们在这里只以是否产生信誉为标准来作决策，那么确实（把价格降回去更容易一些），”他回答说，“但是我们并不是这样。我们还有其它很多方面的问题需要平衡。”
雅培的一个主要论点是将多挣的5000万用来加速新药开发。
该公司不再耗费巨资研制“人类免疫缺陷病毒/艾滋病”药，但它每年扔投资17亿进行研发。它是肿瘤病和糖尿病研究领域的一支重要生力军。
怀特先生反问道：“如果5000万可促进新型抗癌药的开发，而你家里有人得癌，你会怎么做呢？”
既然新药研制有这么好的前景，那为什么不牺牲利润，来增加研发开支呢？当然，从长远来看，还是股东得利。
“这又回到我说的其它平衡问题。我可以告诉股东，说我们要投资，投资，再投资，要投资很长时间。但股东就会问：很长是多长？”
那么为什么又花钱送药到非洲，挂“企业公民”之名做一些对股东没有直接好处的事呢？
面对这样的问题，大部分首席执行官会用道德责任这种话来搪塞。而怀特先生的回答却直截了当：
“为什么花钱从事‘企业公民’活动？坦白说，这是不得已而为之。如果我们不送药去非洲，政府就会将专利许可证发给别的能送药的人。政府会干预。毫无疑问，它们一定会干预。”
这就是制药业的现实政治。
根据公司财务理论，企业存在的目的就是为股东赚钱，但现实却更为复杂。每个首席执行官都清楚（但是很少公开说），他们无法忽略政府、政府机构还有越来越重要的非政府组织的影响。
怀特先生反思说：“在自由市场，企业的存在是社会的恩赐。社会通过法律，选择立法者，征税，掌握企业的生杀予夺大权。不要以为企业生活在真空里，想怎样就能怎样。“
说穿了，如果企业忽视政府的意愿，政府就会变更它的规则。
美国制药企业面临的潜在威胁有： 1) 各种控制机制，它限制处方药价格；2) 改革措施，它们会削弱新药发明者的专利保护。
这第一个威胁现在非常实际，因为美国的医疗开支正扶摇直上。
辉瑞（Pfizer）是雅培最大的竞争对手。它上周宣布，将为没有医疗保险的4300万美国人大幅度降低药价，此举一下子拉开了辉瑞和竞争对手的距离。
辉瑞之所以这么做，并非突然间良心发现。相反，这是因为来自美国立法者的威胁逐渐增加。他们要施加价格控制，或者通过立法，允许美国公民购买加拿大的药。加拿大已经实行了价格控制。
在此背景之下，很多美国大制药公司也会如法效仿。
但是，单从经济角度看，非洲的情形非常不同。雅培在非洲大陆获利甚微，甚至毫无利润。那么为什么还担心非洲政府会收回公司的知识产权呢？
“这要看你有没有考虑到连锁反应的问题，”怀特先生仍然沉浸在现实政治的思绪之中。“如果开了非洲这个头，中国就不会照做？印度不会照做？拉美不会照做？”
如果全世界到处都是廉价的非独家生产的抗“人类免疫缺陷病毒/艾滋病”药物，对生意的影响将非常之坏。
如果这种情景显得牵强，不妨想一想上周发生的一件事：中国宣布辉瑞公司治疗阳萎的畅销药伟哥专利失效。
此举在业界激起轩然大波，让负责贸易的外交人士忙得团团转。但是如果中国政府坚持下去，不久，就会有大量便宜而且非独家生产的伟哥涌入全球市场。
这件事的教训，就是制药业不能光靠科学家研制新的疗效药，也要依靠政府之间的相互合作，这样药才能够卖钱。保持这种合作的成本真是不能小瞧。
雅培花了2000万做企业公民的善事，让每股收益下降了一美分。
四月，怀特先生告诉股东大会说，2003年公司在减价药和其它发展中国家事务上，一共投入了2.25亿美元。
为什么华尔街对此能够宽容，却无情惩罚收益仅有毫厘之差的企业呢？
因为，在这个行业，企业公民行为乃业务成本，和其它需要管理的一般经营成本一样。
这都不能说明迈尔斯?怀特此人冷血无情，也不能说明他阴谋诡诈。他只是个常人，或许只是野心大了些。
2001年，他还去坦桑尼亚，亲自去考察救援工作的人员代价。今年他还前往罗马尼亚去评估当地局势。这些经验都影响他的企业公民款项分配。
雅培7.2万员工的情绪是另外一大考虑。
罗伊?瓦格洛斯（Roy Vagelos）就说，1980年代，他坚持发放对抗非洲河盲症的一种新药，结果就对公司士气产生了积极影响。罗伊?瓦格洛斯是另一家大型制药企业默克的前任董事长兼首席执行官。
“由于公司上下情绪好，我们要聘请任何人都畅通无阻，”他最近在沃顿商学院的一次演讲中说。
即便不是社会心理学博士，你也一样知道，任何企业的员工（尤其是以人类健康为主业的企业）都希望看到雇主有良好行为。
但是在此背景下，你或许会问，为什么迈尔斯?怀特为了区区5000万利润，或者每股2.5美分，竟然不顾员工、医生、病人、社会活动人士和立法者的愤怒，非要将爱治威价格提高5倍？
在我们的对话中，怀特先生第一次陷入了沉默。他不想火上加油。但是等他回答起来，虽然语焉不详，却一语中的：
“瞧，社会活动人士说我们如果有了产品，就有道义责任把它们拿出来，给需要的人，不管他们有没有能力买。我能理解这种观点。问题是我也有义务让企业满意。因此，世界上有些地方不付款，有些地方付一点款，还有些地方要付很多款。”
