American Medicine God: Starting by Inheriting a Pharmaceutical Company and Selling Medicine

Before Wall Street had even finished its champagne, snow had already fallen in Washington.

For Victor, the New Jersey office was too small, not even as tall as the skyscrapers of Manhattan. In this country, real power wasn't in the treasury, but in the place where the rules were set.

The Willard InterContinental Hotel. This hotel, known as "the President's residence," is only two blocks from the White House.

Victor, dressed in a tuxedo, stood in the center of the crowd.

"Senator, it's a pleasure to have you here." Victor smiled and shook hands with the silver-haired politician. "Regarding the healthcare reform proposal you mentioned last time, Water Pharmaceuticals is very interested. We believe that the efficiency of private capital in the field of public health is irreplaceable."

"Of course, of course." The senator patted Victor on the shoulder with a beaming smile. "We need visionary entrepreneurs like you."

Saul followed behind Victor, but his attention wasn't on the politicians; it was on the old man sitting alone in the corner, drinking. He was Robert Grant, the outgoing FDA commissioner.

It was this bureau chief who withstood enormous pressure from the media and Congress, insisting that "there is no conclusive scientific evidence to prove the dangers of blood products," thus securing a valuable buffer period for the pharmaceutical company—a crucial time for Water Pharmaceuticals to clear its inventory, transfer assets, and complete its legal separation.

More importantly, it was during his term that he vigorously promoted the implementation of the PDUFA (Prescription Drug User Fee Act). This "genius act," which allows pharmaceutical companies to directly bribe the FDA, completely changed the relationship between regulators and those being regulated.

Now, he is retiring.

Victor, carrying two glasses of wine, walked towards the corner.

"Director," Victor said, sitting down opposite the old man and pushing a glass of whiskey toward him. "Or should I call you Robert?"

Robert Grant looked up, his eyes weary and complicated. He gazed at the excessively young billionaire before him, his heart filled with mixed emotions.

"Victor," the old director sighed, "do you know what people outside say about me? They call me 'the watchdog of the pharmaceutical industry,' and say I have blood on my hands."

“They don’t understand,” Victor said casually. “The public is always emotional. They can’t see the data, they can’t see the industry logic. If it weren’t for your insistence on scientific rigor, the American pharmaceutical industry would have been destroyed by those purists long ago. Especially the PDUFA Act, which doubled the speed of new drug approval, benefiting countless patients.”

"PDUFA..." Robert gave a wry smile, picked up his glass, and took a sip. "Maybe. But I'm leaving that office next month. My retirement won't even be enough to buy a decent oceanfront house in Florida."

This is a signal. A blatant signal!

Civil servants are paid meager salaries, but the power they wield is priceless. This enormous disparity is the physical basis for the existence of the "revolving door."

Victor smiled. That was exactly what he was waiting for.

"Robert, your contributions to this country are immeasurable. But that doesn't mean your wisdom shouldn't be rewarded by the market."

Victor pulled a business card from his pocket. It had no title, only a handwritten phone number.

"The Waters Foundation is currently preparing to establish a 'Global Public Health Strategy Institute.' We are in dire need of a senior expert with a global perspective and a deep understanding of regulatory logic to serve as its chair."

Robert's finger trembled slightly: "Chairman? Is this a full-time job?"

“No, it’s an honorary position.” Victor lowered his voice. “You don’t need to be in the office. You just need to attend two board meetings a year and provide some… strategic advice. Especially advice on optimizing FDA internal processes and accelerating new drug approvals.”

"And the payment?"

"The Waters Foundation will provide a $300 million 'startup research grant.' In addition, as an independent director of Waters Pharmaceuticals, your annual salary is $50, plus stock options."

Robert's breathing became rapid.

$3 million plus a $500,000 annual salary. That's equivalent to his income over nearly 35 years at the FDA. This, of course, refers to his apparent disposable income.

"Is this...is this compliant with regulations?" The old director subconsciously glanced around.

“Completely compliant.” Victor leaned closer. “These are consulting fees, speaking fees, think tank expert stipends. Everyone in Washington does it. This is what you deserve, Robert. This is your reward for upholding ‘science and reason’ for so many years.”

Robert looked at the liquid in his glass; the amber color seemed to have turned into gold.

He thought of the angry parents, and the dead children. But soon, those images were replaced by the Florida sun, beaches, and yachts.

Conscience? Can you buy a yacht with a conscience?

"Alright." Robert raised his glass and lightly clinked it against Victor's. "For the sake of public health."

"For the sake of public health," Victor repeated with a smile.

The clinking of glasses was barely audible in the noisy banquet hall. But in that instant, a door opened.

Ah, the revolving door, spinning and turning, the stories here are truly...

Regulators who give companies preferential treatment while in office can then take high-paying jobs at those companies after retirement. This isn't corruption; it's "legal option cashing."

Not far away, David Rossi leaned against a marble pillar, watching the scene with a cold expression.

He is now the deputy director of the FDA's Center for Drug Evaluation and Research.

Victor took his drink and left, sitting down in an empty spot.

"Excellent." David Rossi strode over to Victor and whispered, "You just bought a former director. This investment is going to be very profitable."

"This is just the beginning, David." Victor looked at Robert, who was chatting and laughing with the senator. "Robert's gone, and that position will be vacant."

David Rossi's heart skipped a beat.

You mean...

"Why not?" Victor turned to look at the middle-aged man who had already tasted the sweetness of power. "You're younger than Robert, you understand us better, and you understand the rules of this era better. Besides, after the PDUFA Act was passed, your department is now the richest and most powerful department in the FDA."

"However, the nomination needs to be approved by the Senate..."

"Senator Mitchell will handle it. His daughter is now our foundation's legal director. Katie will help maintain relations with Congress." Victor patted David on the shoulder. "Get ready for your inaugural address, Director."

David Rossi took a deep breath. He looked at Victor, his eyes filled with naked ambition.

"I'll get ready, Victor," David Rossi raised his glass, "for faster approval."

"Approval is just the beginning, David." Victor didn't clink glasses, but gently swirled the liquor. "We've won that battle. Now, my sights are set on something much higher."

"Further?" David Rossi asked, somewhat puzzled.

"Do you know who the real bloodsuckers of the healthcare system are right now?"

"It's not us, and it's not the hospitals. It's those in the middle—Pharmaceutical Benefit Management (PBMs) and those huge insurance giants."

"They control the 'reimbursement catalog,' they decide what medicine patients can take, and they extract up to 30% or more of the profit from every prescription, yet they don't produce a single pill."

A cold glint flashed in Victor's eyes: "They are the new kings. And I don't like kings who are not under my control."

"You want to touch PBMs?" David Rossi gasped. "That's a trillion-dollar market, and their lobbying power is no less than ours. Moreover, this would shake the very foundation of the entire US healthcare system."

"That's why I need you." Victor stared into David's eyes. "I don't need you to just stamp and approve a few new drugs. That's a small matter; any department head could handle it."

He leaned closer to David, his tone leaving no room for argument:

"I want you to turn the FDA into a 'one-man show'."

"Purge away those rigid idealists and marginalize those dissidents still agonizing over 'public interest.' I want the FDA to become a bastion with only one voice—your voice. And your voice must resonate absolutely with mine."

"When I wage war against PBMs, when I prepare to integrate pharmaceutical companies, insurance companies, and healthcare services into a closed loop, I need regulators to be the sword in my hand, not a stumbling block."

David Rossi looked at Victor and felt a chill run down his spine. He had initially thought Victor just wanted to win more chips within the existing rules of the game, but now he understood.

Victor didn't want to win the game; he wanted to flip the table and make up the rules himself.

"You want to turn the pharmaceutical company into...an insurance company?" David asked tentatively.

"It's not just insurance companies."

"It's an ecosystem. From diagnosis to prescription, from payment to treatment, every link must belong to Walter. That's the ultimate monopoly."

He raised his glass and gently touched the stiff glass in David's hand.

"Get ready, Chief. Lead your troops. The war is about to escalate."

"This is going to be a bloodbath, boss."

"No, David," Victor downed his drink in one gulp, "this is a glorious evolution. Join this glorious evolution, David!"