Act and Reflect on the Outcome

1. How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?

2.How did my decision turn out and what have i learned from this specific situation?


Headquartered in New Jersey, Merck & Co. is one of the largest pharmaceuticalcompanies in the world. In 1978, Merck was about to lose patent protection on its twobest-selling prescription drugs. These medications had provided a significant part ofMerck’s $2 billion in annual sales. Because of imminent loss, Merck decided to pourmillions into research to develop new medications. During just three years in the1970s, the company invested over $1 billion in research and was rewarded with thediscovery of four powerful medications. Profits, however, were never all that Merckcared about. In 1950, George W. Merck, then chairman of the company his fatherfounded, said, “We try never to forget that medicine is for people. It is not for theprofits. The profits follow, and if we have remembered that, they have never failed toappear. The better we have remembered that, the larger they have been.” Thisphilosophy was at the core of Merck & Co.’s value system.


The disease onchocerciasis, known as river blindness, is caused by parasitic worms thatlive in the small black flies that breed in and about fast-moving rivers in developingcountries in the Middle East, Africa, and Latin America. When a person is bitten by a fly(and some people are bitten thousands of times a day), the larvae of the worm can enterthe person’s body. The worms can grow to almost two feet long and can cause grotesquegrowths on an infected person. The real trouble comes, however, when the worms beginto reproduce and release millions of microscopic baby worms into a person’s system.The itching is so intense that some infected persons have committed suicide. As timepasses, the larvae continue to cause severe problems, including blindness.

In 1978, the World Health Organization estimated that more than 300,000 peoplewere blind because of the disease, and another 18 million were infected. In 1978, thedisease had no safe cure. Only two drugs could kill the parasite, but both had serious,even fatal, side effects. The only measure being taken to combat river blindness was thespraying of infected rivers with insecticides in the hope of killing the flies. However,even this wasn’t effective since the flies had built up immunity to the chemicals.


Since it takes $$200 million in research and $12 years to bring the average drug tomarket, the decision to pursue research is a complex one. Resources are finite, sodollars and time have to go to projects that hold the most promise in terms of makingmoney to ensure the company continues to exist as well as of alleviating humansuffering. This is an especially delicate issue when it comes to rare diseases, when adrug company’s investment could probably never be recouped because the number ofpeople who would buy the drug is so small. The problem with developing a drug tocombat river blindness was the flip side of the “orphan” drug dilemma. There were


certainly enough people suffering from the disease to justify the research, but since itwas a disease afflicting people in some of the poorest parts of the world, thosesuffering from the disease could not pay for the medication.

In 1978, Merck was testing ivermectin, a drug for animals, to see if it could effectivelykill parasites and worms. During this clinical testing, Merck discovered that the drug killeda parasite in horses that was very similar to the worm that caused river blindness in humans.This, therefore, was Merck’s dilemma: company scientists were encouraging the firm toinvest in further research to determine whether the drug could be adapted for safe use withhumans, but Merck knew it would likely never be a profitable product. 

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