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P T. 2010 June; 35(6): 306.
PMCID: PMC2888549


David B. Nash, MD, MBA

I had voted for him twice, but I had never seen him in person. He is just what you would expect—tall, totally in charge, gripping the podium purposely, and seemingly making eye contact with all 750 people in the room! I was mesmerized to be seated so close to where he stood, and I acquired a better appreciation of his telegenic charisma and his ability to work a room. I’m referring to former President William Jefferson Clinton.

Sitting just about 20 yards from the podium this past December, I had a chance to closely observe the 42nd President, and I listened carefully to his nearly hour-long, somewhat rambling presentation on the state of the world. As many of you know, he is the founder and director of the William J. Clinton Foundation, with headquarters in New York City. Former President Clinton is well know today for traversing the globe and tackling difficult issues such as the delivery of AIDS drugs to poor nations in Africa and for his peace-making efforts in the former war-torn nation of Rwanda.

But to me, the theme of interdependence among nations and within the global economy is a topic relevant for readers of P&T. Mr. Clinton highlighted the recent explosion in the growth of so-called nongovernmental organizations (NGOs) around the world as “one of the most hopeful developments of the early 21st century.”1 He noted that there are limits to what the private sector can produce and to what the government can provide. More than one million foundations and 355,000 religious institutions that do charitable work in the U.S. are stepping in to fill this gap, and half of these charities were started in the past decade.

It is this type of NGO that is increasingly working to address difficult international problems. Bill Clinton views this global interdependence through the lens of a pragmatist.

He asked: “How do you propose to turn your good intentions into real changes in other people’s lives?”1

This question must become the obsession of all those who work in NGOs. In assessing a particular project or initiative, the former President always asks himself the following question:

“Will this [project] contribute to building up the positive forces or reducing the negative forces of our interdependence? If it will, I’m for it. If it won’t, I’m against it.”1

Thus, his current philosophy is focused on the work of these NGOs and how they, and only they, can step into the void and acknowledge our interdependence, based on his formula of improving positive forces or reducing negative forces. How does this goal relate to the work of our readers in the pharmaceutical industry?

From a global perspective, the drug industry certainly relies on the efforts of many. Our bench scientists, working with other researchers, economists, and technical experts, have brought to the fore a pipeline of products unimagined even a decade ago; however, getting these products to the right people at a price that every society can afford remains elusive. Perhaps if we take two steps back and consider the interdependent nature of our work, a new model for distributing the products might emerge. A new lens with which to view these challenges might make the solutions clearer to all involved.

For example, instead of worrying about the price of drug reimportation from various countries outside of our own borders, maybe we should think about gaining a better understanding of the cost effectiveness of these products. Instead of spending tens of millions of dollars on lobbying our elected representatives to create legislation favorable to the drug industry, maybe we need a shift in our thinking. For example, international borders are porous, leaking brainpower, technology, software, and basic discoveries every day. With a more comprehensive outlook, we might realize that one way to fix the crisis in health care costs in the U.S. is to give away what we value the most.

When we give everyone respect, we get it back many times over. When we radiate personal integrity, people deal with us differently. When we recognize global interdependence, we are supporting comparative effectiveness research (CER) as a potential tool to rationalize the cost of drug development.

Maybe there is no direct relationship between interdependence and how we apply our knowledge of drug-related discoveries—and maybe global interdependence and the need for CER are not directly related to reimbursement levels. Finally, perhaps there is no readily apparent connection between the good work of NGOs and the work we do every day in our industry.

However, the world is shrinking. The sooner we appreciate that one legislative victory, such as resisting reimportation and limiting the power of CER, might work for today, the better off we will be, for we truly do depend on the cooperative efforts of other groups and nations. Whatever your personal opinion of President Clinton, I hope you will give some thought to how truly interdependent we are. I know I left the President’s speech thinking about it for days afterward.

As always, I’m interested in your views. My e-mail address is ude.nosreffej@hsan.divad. Please also visit my blog at


1. Hostein L. Clinton tackles interdependence among nations Jewish Exponent December172009. 1 Available at: Accessed May 4, 2010.

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