One of the most difficult issues i struggled with during my tenure as CEO involved the prices of our products. Pricing of pharmaceuticals will always be a thorny issue because drugs and vaccines are literally matters of life or death for many people. When a physician prescribes a particular medication, the patient seldom has a choice about which one to buy. The physician has already made that choice. Health insurance, a health maintenance organization, or Medicare is likely to pay the physician's bill but many of the plans did not pay for prescriptions, which were, and still are, relatively expensive. If patients are not covered by a plan that provides low-cost prescription drugs, the pain of payment is immediate and memorable.

As a physician who grew up during the Great Depression, I understood their distress, and as CEO at Merck I became very concerned about our pricing policy. At first, I didn't really understand the nitty-gritty of what was going on in the marketplace.

When things are going well, the CEO doesn't press the managers very much. He wants to give them freedom to do what they do.

But I was fretting about prices, and so I started a dialogue within the firm about this issue. In general, Merck priced according to the value that its products contributed. If our new drugs made a substantial difference in treatment of a disease compared with earlier products, our price was going to be higher. We knew that many of our medicines, even when they were expensive, kept people alive, reduced overall healthcare costs, and kept people on the job.