>> HELLO, EVERYONE, AND WELCOME TO "AMANPOUR & COMPANY.

"HERE'S WHAT'S COMING UP.

PUTIN IS A NO-SHOW AT PEACE TALKS, AS PRESIDENT ZELENSKYY DISMISSES THE RUSSIAN DELEGATION AS PHONY.

I ASK HIS FORMER FOREIGN MINISTER WHERE UKRAINE GOES NEXT.

>> THEN, PRESIDENT TRUMP SAYS NOTHING'S GOING TO HAPPEN UNTIL PUTIN AND I GET TOGETHER.

AND WITH THE WAR ON GAZA INTENSIFYING, HOW WILL TRUMP'S DIPLOMACY PLAY OUT?

WENDY SHERMAN JOINS ME.

I'LL ALSO ASK ABOUT HER FORMER BOSS, AND THE ALLEGED COVERUP OF PRESIDENT BIDEN'S DECLINE.

>> PLUS, RETHINKING MEDICATION.

WHY AMERICANS ARE PAYING TOO MUCH.

AND CAN THE PRESIDENT DO SOMETHING ABOUT IT?

>> "AMANPOUR & COMPANY" IS MADE POSSIBLE BY -- THE ANDERSON FAMILY ENDOWMENT.

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> >> WELCOME TO THE PROGRAM, EVERYONE, I'M CHRISTIANE AMANPOUR IN LONDON.

A WAITING GAME IN ISTANBUL.

UKRAINIAN AND RUSSIAN DELEGATIONS ARE DUE TO MEET THERE FOR PEACE TALKS, AS EXPECTED, VLADIMIR PUTIN DIDN'T SHOW UP.

SO, PRESIDENT ZELENSKYY JUST SENT HIS TEAM.

HAD THE TWO LEADERS MET, IT WOULD HAVE BEEN THE FIRST TIME SINCE 2019.

REMEMBER, IT WAS PUTIN HIMSELF THAT PROPOSED THESE TALKS.

ZELENSKYY SAID HE WON'T MEET WITH ANYONE OTHER THAN PUTIN HIMSELF.

AND DONALD TRUMP SAYS NOTHING WILL HAPPEN ON UKRAINE UNTIL HE MEETS WITH PUTIN.

SO, A LOT OF MOVING PERSONAL PARTS.

AND WHAT CAN UKRAINE REASONABLY EXPECT NOW?

HERE WITH ME TO DISCUSS IS DMYTRO KULEBA, THE COUNTRY'S FORMER FOREIGN MINISTER.

WELCOME TO THE PROGRAM.

>> GOOD TO BE BACK.

>> YOU KNOW A LOT ABOUT THESE MEETINGS.

DESCRIBE WHAT YOU THINK WENT --HAPPENED TODAY.

WAS IT EVER SERIOUS THAT PUTIN WAS GOING TO COME?

>> NO, ABSOLUTELY.

AND HE WAS ACTUALLY CLEAR, HE NEVER PROMISED TO COME.

HE SAID HE WOULD --HE WAS READY TO RESUME NEGOTIATIONS, AND THAT KIND OF THROWS EVERYTHING BACK TO THE SPRING OF 2022, WHEN UKRAINIAN AND RUSSIAN DELEGATIONS WERE SEEING EACH OTHER, BUT IT DIDN'T REALLY HAVE ANY IMPACT ON THE COURSE OF THE WAR, AND I'M AFRAID THAT STORY WILL REPEAT ITSELF AGAIN.

>> AND THAT WAS SHORTLY AFTER THE FULL-SCALE INVASION.

>> ABSOLUTELY.

>> DELEGATIONS MET, RIGHT?

WERE YOU THERE?

>> NO.

WE NEVER ACTUALLY CONSIDERED SENDING A FOREIGN MINISTER TO MEET AN UNDERREPRESENTED OFFICIAL OF THE RUSSIAN DELEGATION, AND SECOND, THIS WAS NOT LEGAL OFFICIAL TALKS.

FOR A LEGAL PERSPECTIVE, THESE WERE JUST TWO SIDES SEEING EACH OTHER WITHOUT FOLLOWING PROPER LEGAL PROCEDURES.

>> I DON'T KNOW WHETHER YOU'VE SEEN THE LIST OF NAMES OF THE RUSSIAN DELEGATION, BUT THEY SEEM TO BE MUCH LOWER LEVEL THAN PEOPLE EXPECTED.

NO FOREIGN MINISTER, TO CHIEF OF STAFF, OBVIOUSLY NO PUTIN.

AND --AND PRESIDENT ZELENSKYY CALLED IT A PHONY DELEGATION.

WHAT DO YOU THINK WOULD HAVE HAPPENED?

>> WELL, YOU KNOW, THERE ARE PHONY WARS THAT WE KNOW FROM HISTORY, AND NOW, WE HAVE A CASE OF PHONY DIPLOMACY.

YOU KNOW, THERE IS A SYMBOLISM IN THE DELEGATION THAT PRESIDENT PUTIN SENT TO ISTANBUL THIS TIME, BECAUSE THE HEAD OF THIS DELEGATION IS EXACTLY THE SAME PERSON WHO LED THE RUSSIAN DELEGATION THREE YEARS AGO.

AND IT DID NOT DELIVER THERE YEARS AGO.

I'M AFRAID IT WILL NOT DELIVER NOW.

BUT WHAT PUTIN TRIES TO ACHIEVE HERE IS TO ACTUALLY BRIDGE HIS OLD STORY THAT HE WAS CLOSE TO STRIKE A DEAL WITH UKRAINE, BUT UKRAINE REFUSED TO -- >> THAT'S WHAT HE SAYS.

>> EXACTLY, THAT'S HIS NARRATIVE, IT'S A FALSE NARRATIVE, BUT IT'S STILL HIS NARRATIVE.

SO, HE JUST REENFORCES HIS MESSAGE THAT HE'S WILLING TO NEGOTIATE.

BUT IF YOU'RE WILLING TO NEGOTIATE, WHY DID YOU ATTACK AT ALL?

>> YOU COULD SAY, HE WAS GOING TO GET ALL OF UKRAINE IN TWO TO THREE DAYS, IT DIDN'T HAPPEN -- >> HE STILL BELIEVES IN THIS.

>> NO, COME ON.

>> NO, I ASSURE YOU, HE DOES.

THE DIFFERENCE BETWEEN HIM AND PRESIDENT ZELENSKYY AND EUROPEAN LEADERS IS THAT THEY ARE BOUND BY ELECTORAL CYCLES, EVEN IF THEY ARE INTERRUPTED BY THE WAR, BUT PUTIN ISN'T, HE HAS A LONG ETERNITY AHEAD OF HIM.

>> SO, HE STILL EVENTUALLY BELIEVES IN GETTING UKRAINE?

>> ONE WAY OR ANOTHER, ABSOLUTELY.

>> SO, WHAT CAN, FOR INSTANCE, A NEW ADMINISTRATION SEEK TO CHANGE IN THIS DYNAMIC?

A NEW AMERICAN ADMINISTRATION?

>> PUTIN CAN PUT HIS PLAN ON HOLD.

I DON'T THINK HE WILL EVER BE ABLE TO ABANDON THE IDEA OF YOU UKRAINE, BECAUSE THAT'S HIS WHOLE MISSION.

AND APART FROM THAT, SINCE MIDDLE 17th CENTURY, EVERY RUSSIAN CZAR SUCCEEDED IN DOING THAT.

FOR HIM NOT TO SUCCEED IS JUST TO END UP IN THE WRONG BASKET OF LUGS RUSSIAN LEADERS, AND THAT'S NOT WHAT HE'S LOOKING FOR, BUT THERE ARE VERY SPECIFIC AND CLEAR INSTRUMENTS HOW TO MAKE HIM PUT HIS PLANS ON HOLD, DELAY THEM, AND BUY TIME.

FIRST AND FOREMOST, IT'S OIL.

I MEAN, HIS WAR MACHINE RUNS ON OIL, ON MONEY, ON OIL REVENUES.

AND THIS IS THE REAL NEEDLE THAT CAN MAKE HIM CHANGE HIS MIND.

>> SO, WE'RE SPEAKING LATER WITH WENDY SHERMAN AND SHE HAS A VIEW ON IMMEDIATELY IMPOSING SECONDARY SANCTIONS, AS HAS BEEN FLOATED BY SOME EUROPEANS.

PRESIDENT TRUMP HAS, YOU KNOW, ON AND OFF FLOATED THE IDEA OF SANCTIONS.

IS THAT WHAT YOU EXPECT PRESIDENT TRUMP TO DO?

HE HIMSELF SAID NOTHING IS GOING TO CHANGE ON THE BATTLEFIELD OR IN THE --AROUND THE NEGOTIATING TABLE, UNLESS HE MEETS WITH PUTIN.

>> IN DIPLOMACY, TO MAKE SOMEONE CHANGE HIS POSITION, YOU HAVE TO STRIKE THE RIGHT BALANCE BETWEEN STICKS AND CARROTS, RIGHT?

SO, THE CARROT HERE IS, LET'S --IS WHEN DONALD TRUMP SAYS, LET'S MEET, LET'S SEE WHAT WE CAN DO TOGETHER, AND THE CARROT - - AND THE STICK IS, IF YOU DO NOT END THE WAR, THEN THIS, THIS AND THEN, AND THAT BAD THING WILL HAPPEN TO YOU.

WHAT WE'VE SEEN SO FAR, WHERE ALL THE STICKS WERE GOING TO UKRAINE AND ALL THE CARROTS WERE GOING TO RUSSIA.

I MEAN, BY DEFINITION, BY THE VERY KIND OF FUNDAMENTALS OF DIPLOMACY, IT DOESN'T WORK.

SO TODAY, I PERSONALLY DOUBT THERE WILL BE A SERIOUS KIND OF SHOWER OF SANCTIONS THROWN ON --FALLING ON THE HEAD OF PUTIN.

IN THE NEAREST DAYS OR WEEKS.

BUT WE HAVE TO UNDERSTAND CLEARLY THAT FIRST THING TO DO IS OIL PRICES OIL SANCTIONS.

SECOND THING IS TO KEEP SUPPORTING UKRAINE MILITARILY.

PUTIN THINKS THE WEST DOES NOT EXIST ANYMORE.

THE UNITED STATES WALKED AWAY.

THE MOMENT WILL COME WHEN UKRAINE WILL BEGIN TO BECOME WEAKER, AND THAT WILL BE HIS OPPORTUNITY.

>> CAN I ASK YOU, THOUGH, FROM PRESIDENT BIDEN'S ADMINISTRATION, YOU HAD PRETTY MUCH A LONG-TERM COMMITMENT FOR DIPLOMATIC AND MILITARY HELP.

THE SLOGAN WAS, FOR AS LONG AS IT TAKES, YOU REMEMBER THAT, BUT WHAT WAS THE END GAME?

THERE WAS NEVER AN END GAME.

THEY NEVER SAID, TO DEFEAT RUSSIA, OR TO THIS OR TO THAT, OR WHATEVER IT WAS.

IT WAS JUST AN OPEN-ENDED, FOR AS LONG AS IT TAKES.

THERE ARE SOME, INCLUDING, YOU KNOW, UKRAINIAN ALLIES WHO BELIEVE, THAT AT LEAST PRESIDENT TRUMP AND ALL THOSE WHO KIND OF DON'T SUPPORT SENDING ENDLESS WEAPONS TO UKRAINE IN THE NEW ADMINISTRATION, THAT AT LEAST THEY BROUGHT MATTERS TO A HEAD AND --AND KIND OF MOVED THE CONVERSATION AWAY FROM ENDLESS WAR TOWARDS FIGURING OUT HOW TO STOP IT.

NOW, I'M NOT --I DON'T KNOW, I MEAN, FIRST THERE HAS TO BE A CEASE-FIRE AND THEN A PROPER PEACE NEGOTIATION.

DO YOU THINK THAT'S CONSTRUCTIVE?

>> WELL, THEY NEED TO CHANGE ATTITUDE TOWARD THE STRATEGY WAS APPARENT, BUT OBVIOUS.

PRESIDENT TRUMP BROUGHT NEW DYNAMICS INTO THIS CONVERSATION, BUT AS I SAID, IN DIPLOMACY, IT'S ABOUT STICKS, CARROTS, AND A SENSE OF TIME.

AND YOU CANNOT ACHIEVE A RESULT IF YOU GIVE ALL THE STICKS TO UKRAINE THAT WAS ATTACKED, AND ALL THE CARROTS TO PUTIN, BECAUSE WHO ATTACKED?

>> DON'T YOU THINK IT'S CHANGING A LITTLE BIT, THAT PRESIDENT TRUMP IS LESS, YOU KNOW, STICKING IT TO -- >> IT IS CHANGING A LITTLE BIT, BUT I CAN TELL YOU THAT IN TERMS OF REACHING A CEASE-FIRE, TODAY WE'RE IN EXACTLY THE SAME MOMENT AS WE WERE FOUR MONTHS AGO IN JANUARY, OR SIX MONTHS AGO, OR EVEN EIGHT MONTHS AGO.

EVERYTHING WE'VE SEEN SO FAR, LET'S BE CLEAR ABOUT IT, THIS IS NOT NEGOTIATIONS ABOUT CEASE-FIRE.

THESE WERE MANEUVERS TO MAKE --TO KEEP PRESIDENT TRUMP ON HIS SIDE.

>> PUTIN'S MANEUVERS.

>> AND ZELENSKYY'S MANEUVERS, AS WELL.

HE WAS MANEUVERING TO AVOID TRUMP'S WRATH AND ANGER, AND MOVES WHICH WOULD PUT UKRAINE INTO AN EVEN WEAKER POSITION.

>> BUT ZELENSKYY DID GO FOR A CEASE-FIRE, WHICH IS WHAT THE U. S. WANTED, I MEAN, HE'S REALLY MET THE MOMENT AND THROWN THE BALL INTO THE RUSSIAN COURT.

>> YEAH, THAT WAS THE ONLY VIABLE STRATEGY FOR HIM, AND HE MADE THE RIGHT MOVE, KNOWING THAT PUTIN WOULD NOT RESPOND, BECAUSE, YOU KNOW, LISTEN, UKRAINIANS WAKE UP IN THE MORNING AND YOU READ, FIRST YOU READ THE NEWS FEED ABOUT WHAT HAPPENED OVERNIGHT IN THE UNITED STATES, WHO SAID WHAT, ALL THE NEGOTIATIONS, THERE'S A LOT OF NOISE ABOUT NEGOTIATIONS, THERE'S A LOT OF NOISE ABOUT CEASE- FIRE.

YOU REMEMBER, VICE PRESIDENT AND PRESIDENT SAYING, WE ARE ABOUT TO GET A DEAL, WE ARE AS CLOSE TO GETTING THE DEAL AS WE'VE EVER BEEN.

TODAY WE'RE CLOSER THAN YESTERDAY, BUT THEN UKRAINIANS OPEN ANOTHER NEWS FEED AND THAT NEWS FEED IS ABOUT DRONE AND MISSILE ATTACKS OVERNIGHT, AND FRONTLINE ENGAGEMENTS AND RUSSIAN ASSAULTS OVERNIGHT.

AND THEY DO NOT SEE THE CORRELATION.

THEY DO NOT SEE HOW THE VOLUME OF WORRIES ABOUT CEASE-FIRE TRANSFORMS INTO CEASE-FIRE.

NOTHING CHANGES.

WE STILL GET BOMBED, RUSSIAN ARMY IS STILL ON THE ATTACK.

SO, I MEAN, WE CAN CONTINUE LIKE THIS, I MEAN, STAKEHOLDERS CAN CONTINUE LIKE THIS, BUT IT JUST DOES NOT BRING US CLOSER TO PEACE.

>> SO, I WANT TO ASK YOU FIRST AND FOREMOST, BECAUSE ONE OF THE NARRATIVES, CERTAINLY, FROM RUSSIA, AND THEY BELIEVE THEY'RE WINNING, I ASSUME, OR AT LEAST THEY HAVE THE TIME, THE ENDLESS TIME AHEAD OF THEM WITH NO CONSTRAINTS TO WIN, THE AMERICAN ADMINISTRATION KEEPS SORT OF SUGGESTING THAT UKRAINE HAS NO CARDS AND COULD LOSE EVERYTHING.

LET ME JUST READ YOU THIS FROM THE INSTITUTE OF THE STUDY OF WAR.

SO, OVER THE PAST 16 MONTHS AS RUSSIAN FORCED SEIZED THE INITIATIVE, MOSCOW TOOK 1,827 SQUARE MILES OF UKRAINE, AN AREA SMALLER THAN DELAWARE.

THIS IS ACCORDING TO THEIR DAU THAT.

NOW, OVER THAT PERIOD, THE U. S. GOVERNMENT ESTIMATES RUSSIANS LOST 4,000 TROOPS, A HIGH COST FOR WRESTING CONTROL OF LESS THAN 1% OF UKRAINIAN TERRITORY.

SO, WHY DO YOU THINK THIS NARRATIVE OF RUSSIA HAVING THE UPPER HAND, OR DO YOU THINK IT HAS THE UPPER HAND.

>> WELL, STRATEGICALLY, IT DOESN'T.

IF YOU READ DAILY NEWS, 20 SQUARE KILOMETERS HERE, A VILLAGE THERE, A SMALL FARM THERE, AND ALL OF THIS ACHIEVEMENT IS CELEBRATED BY RUSSIAN PROPAGANDA AND SOMETIMES PRESIDENT PUTIN COMMENDS HIS ARMY FOR TAKING ANOTHER VILLAGE.

WHEN YOU ZOOM IN THAT DEEPLY, OF COURSE, IT LOOKS LIKE RUSSIA IS HAVING UPPER HAND.

THREE YEARS INTO THE WAR, UKRAINE IS STILL ON ITS FEET.

RUSSIA'S ADVANCE HAS SLOWED.

NO, HE DOESN'T BUT THERE ARE CERTAIN VOICES, ESPECIALLY IN THE UNITED STATES, IN THE TRUMP ADMINISTRATION, WHO MAKE THE POINT THAT RUSSIA IS WINNING ANYWAY.

RUSSIA IS NOT WINNING.

RUSSIA IS MOVING FORWARD IN CERTAIN POSITION, AND IT BELIEVES IT CAN WIN, BUT IT'S NOT WINNING STRATEGICALLY.

>> YOU'VE SAID, AND MOST PEOPLE BELIEVE, OBVIOUSLY, THAT YOU HAVE TO KEEP ARMING UKRAINE TO INFLICT ENOUGH PAIN ON THE ENEMY TO BRING THE ENEMY ACTUALLY TO THE TABLE.

IT'S PROBABLY UNLIKELY, I DON'T KNOW WHETHER YOU AGREE, THAT UKRAINE WILL WIN BACK ALL ITS TERRITORY UNDER THE CURRENT CIRCUMSTANCES, BUT AT LEAST TO HAVE A SHOT AT BRINGING THE ENEMY TO THE NEGOTIATING TABLE.

SO, NOW APPARENTLY, THAT'S GOING TO DEPEND ON EUROPE.

I DON'T KNOW, YOU MUST BE --YOU'RE IN TOWN, YOU MUST BE TALKING TO EUROPEANS, PEOPLE WHO YOU USED TO KNOW WHEN YOU WERE IN THE FOREIGN MINISTER POSITION.

IS THERE A STRUGGLE IN EUROPE, THE IDEA OF BEING --HAVING TO CHOOSE BETWEEN GIVING THEIR WEAPONS AND AMMUNITIONS TO UKRAINE, OR HAVING TO FILL THE MASSIVE GAP THAT THE TRUMP ADMINISTRATION HAS CREATED?

FOR THEIR OWN SECURITY.

DO YOU THINK THE EUROPEANS HAVE WHAT IT TAKES?

>> THEY CERTAINLY HAVE THE INFRASTRUCTURE, THE MONEY, AND THE POTENTIAL, TO PUT ALL THESE PIECES TOGETHER.

AND TO SERIOUSLY ADDRESS THE ISSUE OF EUROPE'S DEFENSE, WHICH UKRAINE WILL ALSO BENEFIT FROM.

THERE ARE TWO RISKS THEY ARE FACING.

THE FIRST ONE IS THAT EVERY TIME THE SLIGHT --THE SLIGHTEST SOFTENING OF LANGUAGE COMING FROM WASHINGTON TO EUROPE IS REGISTERED BY EUROPEAN OFFICIALS, THERE'S ALWAYS SOMEONE WHO SAYS, OKAY, LET'S SLOW DOWN, LET'S NOT ESCALATE, LET'S PUT THESE THINGS ON HOLD, WE HAVE TO KEEP - -WE HAVE TO FOLLOW THE AMERICANS, WE HAVE TO STAY WITH THEM.

SO, THE EUROPEANS CLEARLY WOKE UP, THEY WERE SHOCKED AND STAGGERED AFTER THE JD VANCE SPEECH IN MUNICH IN FEBRUARY.

LESS THAN TWO MONTHS LATER, JD VANCE GAVE ANOTHER TALK AT THE MUNICH SECURITY CONFERENCE, FAR LESS CONFRONTATIONAL, AND YOU IMMEDIATELY SEE THIS VOICES IN EUROPE POPPING UP AND SAYING, YOU SEE, THE AMERICANS ARE NOT THAT RADICAL, THEY'RE STILL WITH US, WE DO NOT HAVE TO CON FRONT THEM, WE DON'T HAVE TO ESCALATE.

SO, THE RISK OF EUROPE MUST READING AMERICA --AMERICA'S STRATEGIC VIEWS, AND SLOWING DOWN ITS REARMAMENT AND DEFENSE IS ABSOLUTELY THERE.

AND IT'S A BIG, BIG ISSUE FOR THEM.

AND THE SECOND, EUROPE IS LOSING THE RACE AGAINST TIME.

BECAUSE EUROPEAN UNION WAS NOT DESIGNED TO BE FAST.

BY DEFINITION.

THE IDEA WAS ALWAYS THAT THE SLOWER YOU ARE, THE MORE BALANCED DECISIONS YOU WILL COME UP WITH.

SO, BUT NO ONE HAS TIME IN THIS GAME.

>> AND ACCORDING TO, YOU KNOW, MANY --MANY REPORTS, BY SUMMER, THE MILITARY AID APPROVED UNDER THE BIDEN ADMINISTRATION, WHICH APPARENTLY IS STILL IN THE PIPELINE, OR, AT LEAST, YOU HAVE IT, WILL BASICALLY RUN OUT.

>> WELL, EUROPEANS HAVE TO DO A VERY SIMILAR PAL MATH EXERCISE.

THEY HAVE TO CALL KYIV, SIT DOWN WITH THEM, AND DO A VERY SIMPLE MATH.

HERE IS THE AMOUNT, VOLUME OF WEAPONS UKRAINE IS SPENDING EVERY MONTH.

HERE IS THE VOLUME OF WEAPONS EUROPE IS CURRENTLY DELIVERING.

AND HERE IS THE VOLUME OF WEAPONS THAT WILL HAVE TO BE DELIVERED TO COMPENSATE THE ABSENCE OF AMERICAN DELIVERIES, WHICH I BELIEVE IT'S HIGHLY UNLIKELY THAT PRESIDENT TRUMP WILL COME OUT WITH HIS NEW PROGRAM OF NEW SUPPLIES TO UKRAINE.

AND THEN -- >> IT'S UNLIKELY.

>> IT'S UNLIKELY.

AND THEN YOU GET ALL THE NUMBERS IN FRONT OF YOU AND YOU SEE HOW MUCH TIME EUROPEAN UNION HAS TO RAMP UP ITS PRODUCTION OR TO CONTRACT THESE WEAPONS ABROAD AND DELIVER THEM TO UKRAINE.

BECAUSE THE MOMENT THERE IS A GAP BETWEEN WHAT UKRAINE HAS AND WHAT UKRAINE NEEDS TO FIGHT, THIS IS WHERE YOU WILL SEE THE SITUATION CHANGING.

THE SITUATION ON THE FRONT LINE.

>> WE SAW IT LAST SUMMER, WHEN THERE WAS A GAP, WHEN THEY STOPPED THE SUPPLEMENTAL AID TO UKRAINE.

I JUST WANT TO ASK YOU ONE LAST QUESTION.

EUROPE ALSO IS BASICALLY RAISING THE IDEA OF TARIFFS ON UKRAINE, ON UKRAINIAN IMPORTS WITHIN WEEKS.

YOU KNOW, APPARENTLY POLAND HAS BEEN, YOU KNOW, WELL, IT HAS, WE KNOW, BEEN --BEEN WANTING TO PROTECT ITS OWN FARMERS, AND UKRAINE ESTIMATES THAT A RETURN TO PRE-WAR TRADE CONDITIONS WOULD REDUCE ITS REVENUES BY ABOUT $3.

5 BILLION A YEAR.

I MEAN, WHAT WILL HAPPEN IF THAT HAPPENS?

>> UKRAINIAN ECONOMY WILL SUFFER.

BUT LISTEN, TO BE FAIR, UKRAINE IS HEADING TOWARDS WHAT I WOULD CALL STRATEGIC ENCIRCLEMENT.

THE LEADING CANDIDATE IN ELECTIONS IN ROMANIAN IS ANTI-ANTI-UKRAINIAN.

UNGARY HUNDRED GAUR HUNDRED GARY IS ANTI-ANTI- UKRAINIAN, POLAND IS LIKE 50/50.

SO WE HAVE AN ENEMY ON OUR EASTERN FRONT, WE HAVE AN ALLY OF OUR ENEMY IN THE NORTH.

WE HAVE GOVERNMENTS ACROSS OUR WESTERN BORDER WHO ARE NOT AS FRIENDLY TO SAY THE LEAST, AND THEY WILL TRY TO USE EU MECHANISMS TO INFLICT DAMAGE ON UKRAINE, AND WE HAVE TURKEY, WHO IS ALWAYS PLAYING ITS -- ITS OWN GAME GAME.

SO, WE --THERE WILL BE --WE WILL NEED TO SHOW, TO DEMONSTRATE A REAL ART OF DIPLOMACY AND EVEN STRONGER RESILIENCE TO DEFEND OUR INTEREST.

>> OKAY.

DOESN'T SOUND GOOD.

>> WELL, IN THE END, EVERYTHING WILL BE GOOD.

AND IF IT'S NOT GOOD, THEN THIS IS NOT THE END.

>> FOREIGN MINISTER DMYTRO KULEBA, THANK YOU VERY MUCH, INDEED.

> >> IT WAS ANOTHER BUSY DAY OF DEAL MAKING FOR THE U. S. PRESIDENT.

DONALD TRUMP HAS BEEN IN THE UAE FOR THE FINAL LEG OF HIS MIDDLE EAST TOUR, TOUFTING HIS NEW APPROACH TO THE REGION.

BUSINESS AS GEOPOLITICS.

HIS TRANSACTIONAL FOREIGN POLICY ON SHOW IN SOME OF THE WORLD'S RICHEST COUNTRIES, BUT HOW DOES THAT WORK WHEN YOU'RE TRYING TO BRING PEACE TO A COUNTRY THAT WAS ILLEGALLY INVADED?

AS WE'VE BEEN DISCUSSING, TRUMP BELIEVES HE'S THE KEY TO ENDING THE WAR IN UKRAINE.

BUT IS PUTIN JUST PLAYING GAMES WITH HIM?

AND WITH EVERYONE ELSE?

I ASK WENDY SHERMAN, DEPUTY SECRETARY OF STATE UNDER PRESIDENT BIDEN, AND SHE JOINED ME FROM WASHINGTON.

WENDY SHERMAN, WELCOME BACK TO THE PROGRAM.

>> GREAT TO BE WITH YOU.

>> SO, LET'S TALK ABOUT THE THING IN QUESTION RIGHT NOW, WHICH IS ATTEMPTING TO BROKER SOME KIND OF END TO THE RUSSIA/UKRAINE WAR.

THERE WAS A WHOLE LOAD OF, I DON'T KNOW WHETHER IT WAS ATMOSPHERICS OR CARROTS AND STICKS OR WHATEVER, THROWN INTO THE HOPPER, AND NONE OF IT HAS TRANSPIRED.

PUTIN HAS NOT GONE TO TURKEY, ZELENSKYY IS THERE.

PUTIN HAS SENT A RELATIVELY LOWER LEVEL DELEGATION THAN ONE MIGHT HOPEFUL, LOWER THAN THE U.S. WHOSE SECRETARY OF STATE IS THERE, AND PRESIDENT TRUMP ISN'T THERE.

WAS THIS ALL TOO MUCH TO EXPECT ANYWAY?

WAS ALL THIS STUFF ABOUT PUTIN JUST PUTIN?

>> I THINK A LOT OF IT WAS JUST PUTIN.

I THINK HE FEELS THAT HE CAN DO ANYTHING AND PLAY WHATEVER GAME HE CAN TO HOLD OFF ANY REAL PEACE AGREEMENT OR DEAL.

HE THINKS HE HAS THE ED ADVANTAGE ON THE BATTLEFIELD THAT HE CAN OUTLAST UKRAINE.

AND SO, WHEN BOTH PRESIDENT TRUMP AND THE EUROPEANS PROPOSED A 30-DAY CEASE- FIRE, HE THOUGHT IT WAS GETTING TO BE DIFFICULT FOR HIM, AND SO, HE SAID, OKAY, LET'S HAVE AN AGREEMENT TOLL MEET DELEGATIONS IN ISTANBUL, HOSTED BY TURKEY, HE THOUGHT THAT WOULD BUY HIM MORE TIME, IT ACTUALLY DID, THE EUROPEANS SAID THEY WOULD HOLD OFF FURTHER SANCTIONS UNTIL THAT MEETING HAPPENED.

SO NOW, WE HAVE ZELENSKYY IN ANKARA, SEEING ERDOGAN, WE'VE GOT A VERY LOW-LEVEL DELEGATION IN ISTANBUL.

WE'LL SEE HOW THE DAY PLAYS OUT.

TRUMP HAD SAID, WELL, MAYBE I WILL GO, BUT OF COURSE, WITH NO PUTIN OR HIGH LEVEL DELEGATION, IT IS UNLIKELY THE RUSSIANS HAVE ANY AUTHORITY TO DO ANYTHING, AND ZELENSKYY HAS BROUGHT A VERY HIGH LEVEL DELEGATION, INCLUDING HIS, IN ESSENCE, NATIONAL SECURITY ADVISER, WITH HIM.

SO I THINK THIS IS ALL PUTIN'S EFFORT TO POSTPONE ANYTHING REAL, TO CONTINUE TO BOMBARD UKRAINE, AND HAVE THE ADVANTAGE.

SO, NOW, QUITE FRANKLY, PRESIDENT TRUMP HAS TO DECIDE WHETHER, IN FACT, HE'S GOING TO SANCTION PUTIN, WHETHER HE'S GOING TO GET TOUGH ON PUTIN, AND INCENTIVIZE HIM TO ACTUALLY COME TO THE TABLE.

UP UNTIL NOW, THERE HAS BEEN REALLY NO PRESSURE ON PRESIDENT PUTIN TO DO ANYTHING OTHER BUT CONTINUE THE WAR.

>> SO, WENDY SHERMAN, PRESIDENT TRUMP ALSO JUST SAID IN THE MIDDLE EAST THAT NOTHING WOULD GET DONE UNTIL HE EVENTUALLY MEETS PUTIN.

OKAY, LET'S TAKE THAT.

BUT YOU HAVE DEALT WITH THIS, YOU KNOW, WITH THIS DELEGATION, IN FACT, I THINK YOU MAY HAVE MET SOME OF THEM THE LAST TIME YOU WERE PART OF THIS U. S. EFFORT TO STOP THE WAR IN 2022, THE FULL-SCALE INVASION.

PUTIN HIMSELF, IT HAS BEEN SAID, BY BRITISH INTELLIGENCE, FORMER INTELLIGENCE IS REALLY THROWING AWAY HIS BEST LEVERAGE, WHICH IS HIS RELATIONSHIP WITH DONALD TRUMP.

I DON'T KNOW WHAT GAME HE THINKS HE'S PLAY, BUT HE APPEARS TO BE ESSENTIALLY DISSING WHAT TRUMP WANTS AND WHAT TRUMP ASKS OF HIM.

DO YOU THINK THAT'S A CORRECT ANALYSIS?

AND WHERE WILL THAT GET HIM?

>> I ACTUALLY THINK PUTIN IS DISSING EVERYONE, INCLUDING PRESIDENT TRUMP.

AS I SAID, I THINK HE BELIEVES HE HAS THE ADVANTAGE ON THE BATTLEFIELD, THAT HE CAN INSIST ON THE ELEMENTS THAT HE WANTS.

I DON'T THINK THAT UKRAINE CAN EVER AGREE TO WHAT PUTIN WANTS, BECAUSE HE WANTS TO ENSURE NOT ONLY THAT UKRAINE WILL NEVER GET INTO NATO, BUT THAT IT WILL HAVE CONSTRAINED MILITARY, THAT PUTIN WILL GET EVEN MORE TERRITORY THAN HE CURRENTLY HOLDS.

THAT, IN FACT, ALL NUCLEAR WEAPONS WILL BE REPOSITIONED IN EUROPE SO THAT PUTIN FEELS SECURE.

A LOT OF THE THINGS THAT HE INSISTED ON BEFORE THIS WAR BEGAN, WHICH WAS PUTIN'S ILLEGAL AND REALLY HORRIFYING ATTEMPT TO TAKE A SOVEREIGN COUNTRY.

SO, I ACTUALLY DO BELIEVE, CHRISTIANE, THE MOMENT HAS COME, WHERE DONALD TRUMP IS GOING TO HAVE TO DECIDE WHETHER HE WANTS TO PLAY TOUGH AND TRY TO GET A DEAL, PUT SOME SANCTIONS ON PUTIN.

IF HE IMPOSES SECONDARY SANCTIONS ON OIL, THAT MEANS CHINA AND INDIA ARE GOING TO HAVE A VERY DIFFICULT PROBLEM, WHICH CREATES PROBLEMS FOR US, OF COURSE.

BUT INDEED, THAT WOULD BE THE HEAVIEST SANCTION HE COULD IMPOSE, BECAUSE WE DON'T HAVE A LOT OF DIRECT TRADE WITH RUSSIA, WHEN IT COMES TO GOODS AND SERVICES, THIS REALLY COMES DOWN TO OIL.

THE PRICE OF OIL, WHICH IS QUITE LOW TODAY.

AND WOULD GET LOWER, IF THERE'S A DEAL WITH IRAN, BECAUSE IRAN COULD THEN PUMP AND REFINE AND SEND ITS OIL AROUND THE WORLD LEGALLY.

SO, A LOT GOING ON HERE, A LOT OF PUZZLE PIECES TO THE GEOPOLITICS OF THE WORLD, BUT EVERY DAY, UKRAINIANS CONTINUE TO BE POUNDED BY PUTIN.

>> AND EVERY DAY, PUTIN CONTINUES TO LOSE SOLDIERS.

THERE'S THIS NARRATIVE, AS YOU'VE JUST SAID, THAT HE THINKS HE'S WINNING, BUT MUCH ANALYSIS SAYS THAT HE'S NOT.

I MEAN, FOR THE AMOUNT OF EXPENDITURE OF PERSONNEL AND WEAPONRY, HE'S GAINED, I THINK, IN THE LAST, I THINK THEY SAID IN THE LAST YEAR OR SO, AN AMOUNT OF TERRITORY THE SIZE OF DELAWARE.

IN OTHER DS, NOT THAT MUCH.

AND YET, THAT FACT THAT HE KEEPS, YOU KNOW, PERPETRATING, SEEMS TO BE ONE THAT SOME AMERICANS ARE BELIEVING, THAT HE'S GOING TO WIN, AND THEREFORE, WE HAVE TO DO WHAT WE CAN TO ACCOMMODATE HIM.

BUT LET'S MOVE ON FOR A SECOND, BECAUSE PRESIDENT TRUMP IS IN THE GULF.

HE SEEMS TO BE REALLY, REALLY PLEASED, IN FACT, WHEN ASKED ABOUT THIS LOW LEVEL RUSSIAN DELEGATION, HE SAID TO A REPORTER, YOU'RE JUST OBSESSED WITH THE DELEGATION, WHY SHOULD I WITH DISAPPOINTED?

I'VE COME AWAY WITH $4 TRILLION WORTH IN DEALS.

NOW, WE'RE NOT SURE ABOUT THAT NUMBER, BUT WHAT DO YOU MAKE OF THIS BEING AN OVERTLY, YOU KNOW, BUSINESS DEAL TRIP, RATHER THAN A GEOPOLITICAL, DIPLOMATIC TRIP?

OR CAN THE TWO HAPPEN TOGETHER?

>> WELL, I THINK THERE, QUITE FRANKLY, WAS ONE VERY GOOD THING THAT'S COME OUT OF THIS TRIP, AND THAT IS THE PRESIDENT MEETING WITH THE NEW LEADER,AL AL SHARAA, OF SYRIA, AND SAYING THAT THE U. S. WOULD LIFT SANCTIONS AGAINST SYRIA, WHICH WOULD GIVE THEM A CHANCE TO PUT A COUNTRY TOGETHER AND TO HAVE A REAL FUTURE.

AND I THINK THAT BOTH DEMOCRATS AND REPUBLICANS THINK THAT THAT WAS A GOOD IDEA.

THE BROADER PLAY BY TRUMP TO CREATE THESE TRANSACTIONS WITH SAUDI ARABIA, QATAR, AND THE UNITED ARAB EMIRATES, IS ALL ABOUT HOW HE IS APPROACHING HIS PRESIDENCY.

IT IS NOT ONLY TRANSACTIONAL, IT IS NOT ONLY BUSINESS-FIRST, BUT IT'S BUSINESS FOR THE TRUMP FAMILY, AND I THINK IT'S QUITE DISTURBING, TO SAY THE LEAST, THAT JARED KUSHNER WAS THERE, WHO REALLY GOT HIS FUND STARTED WITH $2 BILLION FROM THE SAUDIS.

NOBODY GIVES $2 BILLION TO A BRAND NEW EQUITY FUND, I CAN'T THINK OF A KNO NOTHER INSTANCE WHERE THAT HAS OCCURRED.

SO, WHAT THE PRESIDENT IS REALLY DOING HERE IS PUTTING HIS OWN INTERESTS ABOVE THE INTERESTS OF THE UNITED STATES.

NOW, I WANT ALL OF THESE COUNTRIES TO PROSPER AND THE PEOPLE TO DO WELL, BUT THE FACT IS THAT THESE COUNTRIES REMAIN QUITE ATHOR TARN, THAT HUMAN RIGHTS ARE NOT ACKNOWLEDGED IN ANY WAY.

THAT THERE ARE PEOPLE THAT HAVE BEEN UNFAIRLY INED AND IMPRISONED, THERE ISN'T FREEDOM IN THE WAY WE UNDERSTAND IT.

THE PRESIDENT SAID THAT THE U. S. WILL NO LONGER INTERVENE, THEY WILL NO LONGER DO NATIONBUILDING, BUT WHAT HE REALLY MEANS IS, WE ARE HANDS-OFF.

DO WHATEVER YOU WANT, HOWEVER YOU WANT TO DO IT, AS LONG AS YOU MAKE DEALS WITH US AND HELP OUR ECONOMY GROW.

>> SO, LET ME, WENDY -- >> QUITE AN APPROACH.

>> YES, YES, IT IS PRESIDENT TRUMP, THOUGH, HE'S ALWAYS BEEN TRANSACTIONAL, AND HAS NEVER PUT HUMAN RIGHTS, I DON'T THINK, AT THE CENTER OF HIS POLICY, BUT LET ME PLAY WHAT HE SAID THAT YOU JUST REFERRED TO.

>> IN THE END, THE SO-CALLED NATIONBUILDERS WRECKED FAR MORE NATIONS THAN THEY BUILT AND THE INTERVENTIONALISTS WERE ING IN COMPLEX SOCIETIES THAT THEY DID NOT EVEN UNDERSTAND THEMSELVES.

THEY TOLD YOU HOW TO DO IT, BUT THEY HAD NO IDEA HOW TO DO IT THEMSELVES.

PEACE, PROSPERITY, AND PROGRESS ULTIMATELY CAME NOT FROM A RADICAL REJECTION OF YOUR HERITAGE, BUT RATHER, FROM EMBRACING YOUR NATIONAL TRADITIONS AND EMBRACING THAT SAME HERITAGE THAT YOU LOVE SO DEARLY.

>> SO, IT'S REALLY INTERESTING, BECAUSE HE IS REALLY DISSING MUCH OF U. S. FOREIGN POLICY, YOU KNOW, BIPARTISAN, IN FACT, SINCE 9/11.

ALL THIS WARS OF INTERVENTION, ALL THIS NATIONBUILDING, WHICH COLLAPSED IN A HEAP OF PROBLEMS IN IRAQ AND AFGHANISTAN.

DO YOU AGREE WITH WHAT HE'S SAYING?

>> WELL, I THINK THERE IS SOME TRUTH, AND WE HEARD THIS FROM PRESIDENT BIDEN, THAT WE SHOULDN'T BE ABOUT INTERVENTION.

WE SHOULDN'T BE ABOUT ANY KIND OF WHAT PEOPLE MIGHT CALL NEOCOLONIALISM, THAT WE HAVE NOT DONE A GOOD JOB WHEN WE'VE TRIED TO DO NATIONBUILDING.

IRAQ, AFTER THE INITIAL SHOCK AND AWE, WAS QUITE A DISASTER.

AND AFGHANISTAN, PRESIDENT TRUMP ACTUALLY IS THE ONE IN HIS FIRST TERM, WHO CREATED A DEAL WITH THE TALIBAN, WHICH ULTIMATELY TOOK OVER THE COUNTRY.

SO, NONE OF THIS ACTUALLY HAS CREATED POSITIVITY.

AND I DON'T THINK THAT PEOPLE ARE TALKING ABOUT HUMAN RIGHTS BEING AT THE CENTER OF NATIONAL SECURITY AND FOREIGN POLICY, BUT FOR PRESIDENT TRUMP, IT'S NOWHERE ON THE AGENDA.

HE TOUTS HOW HE HAS BROUGHT UNFAIRLY DETAINED AMERICANS OUT OF COUNTRIES THAT HAVE BEEN REPRESSIVE AND HAVE UNJUSTLY DETAINED PEOPLE, BUT HE NEVER TALKS ABOUT WHAT HAPPENS TO THE CITIZENS OF A COUNTRY WHO ARE UNJUSTLY DETAINED, AND HE IS NOT, OBVIOUSLY, RIGHT NOW TALKING ABOUT THE HORRIFYING SITUATION IN GAZA, THERE ARE TALKS GOING ON FOR A CEASE-FIRE AND TRY TO BRING THE REST OF THE HOSTAGES DEAD OR ALIVE OUT OF GAZA, BUT THERE'S BEEN A LOT OF ACTION BY ISRAEL TO DO JUST THE OPPOSITE UNDER THE LEADERSHIP OF PRIME MINISTER NETANYAHU, SO, HE PICKS AND CHOOSES.

>> WELL, YOU KNOW WHAT, HE SEEMS TO HAVE --I DON'T KNOW WHAT THE RIGHT WORD IS, BUT HAS HE BOY COTTED NETANYAHU?

HE'S NOT GONE TO ISRAEL, COMPLETELY DIFFERENT THAN THE LAST TIME.

AND AT THE SAME TIME, THEY APPEAR TO BE PUTTING SOME KIND OF VERBAL PRESSURE, AS YOU SAID, HE MADE A DEAL ON HIS OWN TO GET THE AMERICAN ISRAELI HOSTAGE OUT, EDAN ALEXANDER, WITHOUT THE ISRAELI --YOU KNOW, INVOLVEMENT.

AND IT SEEMS THAT PUBLIC DISCOURSE BY PEOPLE LIKE YOURSELF, BY PEOPLE, YOU KNOW, AT THE UNITED NATIONS, IS BEGINNING TO SHIFT AGAINST THIS ONGOING ISRAELI BRUTALITY AGAINST THE CIVILIANS IN GAZA.

LISTEN TO THE EMERGENCY RELIEF COORDINATOR TOM FLETCHER FROM THE U. N. BRIEFING THE SECURITY COUNCIL.

I WAS STRUCK BY HIS LANGUAGE.

>> SO, FOR THOSE KILLED AND THOSE WHOSE VOICES ARE SILENCED, WHAT MORE EVIDENCE DO YOU NEED NOW?

WILL YOU ACT DECISIVELY TO PREVENT GENOCIDE AND TO ENSURE RESPECT FOR INTERNATIONAL HUMANITARIAN LAW?

OR WILL YOU SAY, INSTEAD, THAT WE DID ALL WE COULD?

>> I MEAN, WENDY SHERMAN, THAT IS THE FIRST TIME I'VE HEARD THAT WORD COME FROM THAT POSITION, THE GENOCIDE WORD.

AND I COULD PUT THAT QUESTION TO YOU AND THE BIDEN ADMINISTRATION, AS WELL.

DID YOU REALLY DO WHAT HAD TO BE DONE, OR DO YOU JUST SAY, WE DID THE BEST WE COULD, AND ALL WE COULD?

>> I DON'T THINK ANY OF US HAVE DONE ALL THAT WE COULD OR SHOULD, WHEN IT COMES TO GAZA.

ISRAEL CERTAINLY HAD THE RIGHT TO DEFEND ITSELF AFTER THE HORRIFYING ATTACK BY HAMAS.

BUT WHAT HAS HAPPENED SINCE IS WE HAVE LED THE PALESTINIANS IN GAZA TO THE POINT OF STARVATION.

WE HAVE TAKEN AWAY ANY POSSIBILITY, RIGHT NOW, AND I MEAN THIS NOT JUST WE AS THE UNITED STATES, BUT THE WORLD, HAS REALLY TURNED AWAY FROM PROVIDING THE HELP AND ING A PATHWAY OF DIGNITY.

IT'S INTERESTING TO ME THAT SAUDI ARABIA BASICALLY SAID TO PRESIDENT TRUMP, NO, WE CANNOT RECOGNIZE ISRAEL UNTIL THERE IS A PATHWAY FOR THE PALESTINIANS TO A POLITICAL FUTURE WITH DIGNITY AND PEACE.

I THINK THAT IS A LONG WAY IN COMING RIGHT NOW.

THE PRESIDENT REITERATED HIS VIEW THAT MAYBE THE U. S. SHOULD TAKE GAZA AND TURN IT INTO A BEAUTIFUL BEACHFRONT OF CONDOMINIUMS, WHICH IS A RIDICULOUS NOTION, GIVEN WHERE THINGS STAND TODAY AND THE DESTRUCTION IN GAZA.

SO, I THINK THE WORLD, INCLUDING THE UNITED STATES, HAS FAILED TO UNDERSTAND WHAT IS HAPPENING HERE, AND TO DO ANYTHING TO ENSURE THAT AID REACHES GAZANS.

>> GIVEN THAT THIS WAR, AND THE ATTACK, THE SAVAGERY OF OCTOBER 7th, AND THE SUBSEQUENT 19-MONTH WAR, COINCIDED WITH THE LAST TWO YEARS OF THE BIDEN PRESIDENCY AND THE REPORTS NOW THAT ARE BEING ALLEGED OF, AS YOU KNOW, YOU ARE PROBABLY AWARE, OF HIS COGNITIVE DECLINE AND OF EFFORTS BY HIS INNER CIRCLE TO INSULATE HIM FROM SCRUTINY.

BASED ON YOUR EXPERIENCE WORKING WITH PRESIDENT BIDEN, WERE YOU CONCERNED THAT THIS WAS HAPPENING?

AND THAT POTENTIALLY, YOU KNOW, THINGS WERE NOT BEING MANAGED FROM THE TOP?

>> SO, I WASN'T IN THE INNER CIRCLE IN THE WHITE HOUSE, SO, I CAN'T SPEAK TO SOME OF WHAT HAS BEEN WRITTEN.

MY OWN EXPERIENCE IS THAT THERE WAS NO PRESIDENTIAL DECISION THAT APPEARED TO ME TO BE PART OF ANY KIND OF COGNITIVE DECLINE.

THE PRESIDENT WAS VERY PRESENT FOR ANY DISCUSSION THAT I WAS PART OF.

AND THE DECISIONS THAT WERE MADE WERE MADE THROUGH A VERY INTRICATE AND COMPLEX PROCESS OF DECISION-MAKING, ALL THE WAY UP TO THE PRESIDENT, AND HE MADE THOSE FINAL DECISIONS.

SO, MY OWN EXPERIENCE WAS A POSITIVE ONE.

I DIDN'T STAY UNTIL THE END OF THE ADMINISTRATION, BUT UP UNTIL THE TIME THAT I LEFT IN 2023, I DID NOT SEE ANY IMPAIRMENT WHEN IT CAME TO THE TOUGH DECISIONS THAT HAD TO BE MADE.

>> I WONDER IF YOU'RE SURPRISED THAT THIS BOOK QUOTES ESSENTIALLY YOUR BOSS AT THE TIME, SECRETARY OF STATE ANTONY BLINKEN, APPARENTLY REPORTEDLY ASKED JOE BIDEN SEVERAL TIMES IF HE WAS, QUOTE, PREPARED FOR A RE-ELECTION CAMPAIGN.

WHAT DO YOU THINK PROMPTED BLINKEN TO RAISE THAT QUESTION?

DID YOU KNOW ABOUT, EVEN THOUGH YOU MIGHT NOT HAVE BEEN INSIDE THE INNER CIRCLE, DID YOU KNOW ABOUT ANY EFFORT TO PERSUADE PRESIDENT BIDEN THAT HE SHOULDN'T RUN AGAIN?

>> I KNOW WHAT HAS BEEN REPORTED IN THE PRESS.

SECRETARY BLINKEN HAS KNOWN AND WORKED WITH PRESIDENT BIDEN FOR MANY, MANY YEARS, AND HE WOULD, OF COURSE, ASK QUESTIONS OF HIM IN PERFECT CONFIDENCE TO SAY, YOU KNOW, YOU CAME IN SAYING YOU WERE GOING TO BE A TRANSITION PRESIDENT, ONE TERM, YOU'RE NOW CONSIDERING TO CONTINUE TO PRESS ON, ARE YOU SURE THIS IS WHAT YOU WANT TO DO?

HE'S BEEN A LONGTIME ADVISER AND COUNSELOR TO THE PRESIDENT, SO, THAT DOES NOT SURPRISE ME.

I WOULD EXPECT HIM TO DO THAT UNDER ANY CIRCUMSTANCES.

YOU KNOW, I THINK WE ALL HAVE TO LOOK FORWARD.

WHAT HAPPENED HAPPENED.

SOME PEOPLE BELIEVE AND I PROBABLY AM ONE OF THEM, THAT IT WAS VERY DIFFICULT FOR ANY DEMOCRAT TO HAVE WON THE ELECTION.

THE PRESIDENT --THE PEOPLE OF THE UNITED STATES CLEARLY WANTED A CHANGE, THEY CERTAINLY HAVE GOTTEN A PROFOUND CHANGE, ONE THAT I THINK WILL LEAVE A LINE OF DESTRUCTION IN REBUILDING OUR DEMOCRACY INTO THE FUTURE, AND I THINK WE ALL HAVE TO BE FOCUSED ON WHERE WE ARE NOW, WHAT PRESIDENT TRUMP IS DOING TO OUR DEMOCRACY, AND MAKE SURE WE DO EVERYTHING WE CAN TO SAVE IT, AND TO REBUILD IT.

>> WENDY SHERMAN, THANK YOU VERY MUCH, INDEED, FOR JOINING US.

>> THANK YOU, CHRISTIANE.

> >> NOW, JUST BEFORE HIS TRIP TO THE MIDDLE EAST, PRESIDENT TRUMP ISSUED AN EXECUTIVE ORDER TO REDUCE THE COST OF PRESCRIPTION DRUGS FOR AMERICANS.

HE SAYS HE'S TAKING ACTION TO STOP BIG PHARMA CHARGING PEOPLE HIGH PRICES.

>> SOME PRESCRIPTION DRUG AND PHARMACEUTICAL PRICES WILL BE REDUCED ALMOST IMMEDIATELY, BY 50% TO 80% TO 90%.

BIG PHARMA WILL EITHER ABIDE BY THIS PRINCIPLE VOLUNTARILY, OR WE'LL USE THE POWER OF THE FEDERAL GOVERNMENT TO ENSURE THAT WE ARE PAYING THE SAME PRICES OTHER COUNTRIES.

>> BUT HOW WILL HE DO THAT AND CAN HE?

DR. JERRY AVORN FROM THE HARVARD MEDICAL SCHOOL JOINS HARI TO DISCUSS WHY THE COST OF MEDICATION IN AMERICA IS SO HIGH, AND WHAT CAN BE DONE TO FIX IT?

>> CHRISTIANE, THANK YOU.

DR. JERRY AVORN, THANK YOU FOR JOINING US.

JUST THIS PAST WEEK, THE PRESIDENT SIGNED AN EXECUTIVE ORDER, TITLED DELIVERING MOST FAVORED NATION PRESCRIPTION DRUG PRICING TO AMERICAN PATIENTS.

WHAT DID THE ORDER DIRECT?

>> WELL, THE ORDER WAS KIND OF ASPIRATIONAL IN THAT THE PRESIDENT, I THINK, DID US A FAVOR BY REMINDING EVERYONE THAT AMERICANS PAY TRICE PER CAPITA WHAT PEOPLE IN OTHER WEALTHY COUNTRIES PAY FOR THE VERY SAME DRUGS, OFTEN MADE BY THE SAME COMPANY IN THE SAME FACTORY.

BUT HIS SOLUTION WAS REALLY MORE ABOUT THINGS THAT HE HOPES COULD HAPPEN IN THE FUTURE, BUT THERE WAS NO CLEAR ROAD MAP TO EXACTLY HOW HE WAS GOING TO BE ABLE TO ACCOMPLISH THAT.

>> BACKING UP A STEP, FOR OUR AUDIENCE, WHY DO AMERICANS PAY MORE FOR THE SAME DRUG FROM THE SAME COMPANY THAN OTHER COUNTRIES?

>> THAT'S A GREAT QUESTION.

REALLY, ALONE AMONG THE WEALTHY COUNTRIES, THE UNITED STATES ALLOWS DRUG COMPANIES TO SET A PRICE AT ANY LEVEL THEY WANT, AND THEN WE ARE, AS CONSUMERS OR AS HEALTH CARE SYSTEMS OR AS PATIENTS, WE ARE OBLIGED TO PAY THAT.

VIRTUALLY EVERY OTHER WEALTHY COUNTRY IN THE WORLD HAS A PROCESS THROUGH WHICH THEY FIGURE OUT, HOW GOOD IS THIS NEW DRUG, IS IT BETTER THAN WHAT WE HAVE?

DOES IT HAVE SOIM ED ME ADVANTAGE IN EFFECTIVENESS OR SAFETY?

AND THEY DETERMINE A PRICE AS A START OF A NEGOTIATION WITH THE DRUG COMPANY AND SAY, WE THINK THIS DRUG OUGHT TO BE WORTH THAT, AND THE COMPANY COMES BACK, SAYS, IT SHOULD BE HIGHER, AND THERE'S A CONVERSATION THAT OCCURS BETWEEN THE HEALTH CARE SYSTEM AND THE MANUFACTURER, AND THAT DETERMINES WHAT THEY PAY FOR THE DRUG.

HERE, IT'S WHATEVER THE COMPANY WANTS TO CHARGE, PRETTY MUCH.

>> SO, LOOK, PART OF THIS ALMOST GETS INTO A PHILOSOPHICAL QUESTION, RIGHT?

I MEAN, IS THIS THE ROLE OF THE FREE MARKET TO SET THE PRICE?

AND THE COMPANIES WILL SAY, LOOK, I APPLIED MILLIONS OF DOLLARS INTO RESEARCH AND DEVELOPMENT, FOR EVERY DRUG THAT YOU SEE ON THE SHELF, THERE'S 15 THAT DIDN'T MAKE IT THROUGH THE TRIALS, AND THAT'S ALL SUNK COST, AND I HAVE TO GET IT BACK WITH ONE OF THESE BLOCKBUSTER DRUGS THAT MAKE IT.

WHAT'S WRONG WITH THAT THINKING?

>> WELL, THE TERM FREE MARKET IS THROWN AROUND A LOT IN THE CONTEXT OF DRUG PRICES, BUT IN FACT, IF WE REALLY DID HAVE A FREE MARKET, IT WOULD LOOK LIKE EVERY OTHER FREE MARKET THAT WE HAVE FOR ANYTHING ELSE, WHERE THERE'S A BUYER AND A SELLER, AND THE BUYER DETERMINES WHAT THEY'RE WILLING TO PAY, AND THE SELLER DETERMINES WHAT THEY'RE WILLING --WHAT THEY'RE INTERESTED IN CHARGING, AND THE TWO PARTIES KIND OF COME TOGETHER WITH A SOLUTION.

WE DO NOT HAVE A FREE MARKET IN DRUGS.

THE --IT'S NOT A FREE MARKET IF THE PERSON SELLING IT CAN DECIDE WHAT THE PRICE IS AND THE PERSON BUYING IT DOES NOT GET TO HAVE ANY SECOND THOUGHTS ABOUT THAT.

SO, YEAH, I WOULD KIND OF LIKE FOR THERE TO BE MORE OF A MARKETPLACE ENCOUNTER, NOT WHERE ONE SIDE GETS TO SAY WHAT SOMETHING COSTS AND THEN EVERYBODY HAS TO MEET THAT PRICE OR NOT GET THE DRUG.

>> THE PRESIDENT RECENTLY SAID THAT HE EXPECTS, BECAUSE OF THIS EXECUTIVE ORDER, THAT THE PRICES OF DRUGS SHOULD GO DOWN ANYWHERE FROM 50% TO 90%.

IS THAT POSSIBLE?

>> NO.

IT WOULD BE NICE IF THERE WAS A MASSIVE REDUCTION, I THINK 90% MIGHT BE UNREASONABLE.

BUT I THINK THESE ARE STATEMENTS OF GOALS.

BUT WITHOUT SOME MECHANISM FOR HOW YOU GET FROM A TO B TO C, THEY REALLY ARE JUST ASPIRATIONAL STATEMENTS RATHER THAN ANYTHING THAT LOOKS LIKE A REAL GOVERNMENTAL PLAN.

>> DOCTOR, PHARMACEUTICAL COMPANY STOCKS ACTUALLY WENT UP, AND I DON'T KNOW IF IT'S CONNECTED TO THE NEWS ABOUT THE EXECUTIVE ORDER ON DRUG PRICING, OR THE POSSIBILITY THAT TRADE RELATIONS WITH CHINA MIGHT IMPROVE, AS THESE TALKS PROGRESS, BUT A HUGE CHUNK OF OUR MEDICINES ACTUALLY COME FROM CHINA.

EXPLAIN THIS KIND OF RELATIONSHIP.

>> FOR ME, THE MOST TELLING THING WAS, AS YOU JUST SAID, BEFORE THE EXECUTIVE ORDER ABOUT DRUG PRICING, THE STOCKS OF DRUG COMPANIES WERE REALLY PRETTY LOW, AND AS SOON AS PEOPLE IN THE PHARMACEUTICAL INDUSTRY AND THEIR INVESTORS GOT TO READ WHAT THE ECUTIVE ORDER SAID, THE STOCKS SHOT UP BEYOND WHAT MOST OTHER COMPANIES DID THAT DAY.

AND I THINK WHAT THAT TELLS ME AND MOST OTHER OBSERVERS IS THAT WHEN THE RUBBER MET THE ROAD, THE INDUSTRY SAID, WHEW, THIS ACTUALLY IS SO VAGUE AND NONACTIONABLE THAT WE'RE NOT WORRIED, OUR PROFITS ARE GOING TO CONTINUE, AND THIS IS PROBABLY NOT GOING TO HAVE MUCH OF AN IMPACT.

AND, YOU KNOW, THAT'S THE VIEW OF MILLIONS OF PEOPLE WHO INVEST IN THE DRUG COMPANIES, AND WHO ARE RUNNING THE DRUG COMPANIES, BREATHING A LOUD SIGH OF RELIEF, WHICH CONFIRMS THE SENSE OF, THIS IS PROBABLY NOT GOING TO BRING ABOUT WHAT THE PRESIDENT HAD SAID IT WOULD.

>> THE CEO OF THE LOBBYING GROUP FOR THE PHARMACEUTICAL INDUSTRY SAID, AT IMPORTING FOREIGN PRICES FROM SOCIALIST COUNTRIES WOULD BE A BAD DEAL FOR AMERICAN PATIENTS AND WORKERS.

IT WOULD MEAN LESS TREATMENTS AND CURES AND WOULD JEOPARDIZE THE HUNDREDS OF MILLIONS OUR MEMBER COMPANIES ARE PLANNING TO INVEST IN AMERICA.

WHAT'S YOUR TAKE ON THAT?

>> WELL, THIS IS A VERY STANDARD TALKING POINT FROM THE INDUSTRY TRADE GROUP.

CERTAINLY DRUG COMPANIES, WHEN THEY MAKE AN IMPORTANT INNOVATION, DESERVE TO BE REWARDED REWARD ED THAN SOME HANDSOMELY FOR IT.

AND THAT IS THE CASE.

HOWEVER, AND IT'S A BIG HOWEVER, AN AWFUL LOT OF THE DEVELOPMENT OF DRUGS IS FUNDED BY THE U. S. TAXPAYER.

THE NIH, AT LEAST UNTIL RECENT MONTHS, LAYS ENORMOUSLY IMPORTANT GROUNDWORK ON THE BASIC SCIENCE RESEARCH THAT A COMPANY CAN THEN TAKE AN TRANSFORM INTO A DRUG.

AND THAT COSTS THEM, AND THEY DO A LOT OF IMPORTANT WORK TO GET THERE, BUT IT IS NOT QUITE TRUE THAT THE STORY WE HEAR FROM THE INDUSTRY TRADE GROUP AND HAVE BEEN HEARING FOR YEARS, IS ALL NEW DRUGS ARE THE PRODUCT OF INVESTMENT BY PHARMACEUTICAL COMPANIES, AND IF WE EVER DARE TO HARM THEIR PROFITS, THEY WILL STOP INVESTING AND WE'RE NOT GOING TO HAVE ANY NEW DRUGS.

THAT IS SIMPLY NOT THE CASE, AND MY COLLEAGUES AND I HAVE LOOKED AND, WHERE DO A LOT OF NEW DRUGS COME FROM?

AND WHEN YOU TRACE BACK THE PATENTS AND THE GRANTS AND IS THE PAPERS, IT DOES TURN OUT THAT AN AWFUL LOT OF THEM HAVE THEIR MOST IMPORTANT HIGH RISK ORIGINS IN PUBLIC FUNDING THROUGH THE NIH, WHICH THE COMPANIES ARE THEN FREE TO BUILD TO THE NEXT STEP, WHICH IS NOT NOTHING, BUT IT'S ALSO NOT SPENDING BILLIONS OF DOLLARS OF THEIR OWN MONEY STARTING FROM SCRATCH, BECAUSE THAT'S OFTEN, OR USUALLY, NOT THE CASE.

>> YOU WROTE A BOOK ON THIS TOPIC, IT'S PART OF WHY WE'RE HAVING THIS CONVERSATION, IT'S RETITLED "RETHINKING MEDICATIONS. "

YOU ALSO BUILT A LEADING RESEARCH CENTER AT HARVARD TO STUDY MEDICATION USE, OUTCOMES, COSTS, SO, YOU ARE EMINENTLY QUALIFIED TO DISCUSS THIS.

ONE OF THE THINGS YOU WRITE ABOUT IN THE BOOK IS, WHEN YOU THINK ABOUT THE FACT THAT THAT RISK HAS BEEN PUSHED ONTO THE PUBLIC, AND THEN THE PROFITS HAVE BEEN PUSHED OBJECT THE PRIVATE SECTOR.

EXPLAIN WHAT HAPPENS.

>> YEAH, WE HAD A POLICY FOR MANY YEARS, WHICH IS IN MANY WAYS A GOOD POLICY, THAT THE PUBLIC WOULD, THROUGH THE NIH AND OTHER KINDS OF PUBLIC PHILANTHROPY, DO MOST OF THE HIGH RISK EARLY STAGE INVESTMENT IN DEVELOPING NEW CONCEPTS FOR DRUGS.

AND, IN FACT, IT WAS INTENTIONALLY DESCRIBED AS DERISKING THE DEVELOPMENT PROCESS FOR THE DRUG COMPANIES.

AND IN NEARLY EVERY OTHER SECTOR OF THE ECONOMY, IF AN INVESTOR COMES IN EARLY FOR ANY PRODUCT, WHEN IT IS JUST A GLEAM IN SOMEONE'S EYE OR IT HAS NO CLEAR MARKET, AND THEY PUT MONEY INTO A NEW COMPANY TO GET IT OFF THE GROUND, THOSE PEOPLE ARE REWARDED HANDSOMELY IN TERMS OF SHARES OF THE COMPANY AND THE PROFITS DOWN THE ROAD.

WE HAVE EXACTLY THE OPPOSITE WITH DRUG DEVELOPMENT, WHERE THE PUBLIC HAS FOR DECADES PUT IN A LOT OF MONEY, MANY TENS OF BILLIONS OF DOLLARS A YEAR, TO DO THE HIGH RISK SO-CALLED PRECOMPETITIVE RESEARCH THAT IS REQUIRED TO DISCOVER NEW DRUGS, AND THEN AS SOON AS THERE IS SOMETHING THAT LOOKS MARKETABLE, WE SET UP A SERIES OF LAWS THAT ENABLE A COMPANY TO BUY ALL THE RIGHTS TO THESE PUBLICLY DEVELOPED PRODUCTS AND THEN OWN THEM OUTRIGHT, AND THEN BECAUSE OF OUR STRANGE WAY THAT A COMPANY CAN DETERMINE JUST WHAT IT WANTS TO CHARGE WITH NO PUSH-BACK TO SPEAK OF, THEY THEN GET TO PROFIT FROM THAT AND, IN A SENSE, THE PUBLIC GETS TO PAY TWICE.

ONCE, WHEN WE AS TAXPAYERS ARE FUNDING THE NIH, AND THEN, THE OTHER IS WHEN WE HAVE A DRUG DEVELOPED WITH THAT KIND OF FUNDING, THAT IS CHARGED TO US AS AMERICANS AT A RATE THAT IS 2 TO 4 TO 6 TIMES WHAT THE SAME COMPANY CHARGES FOR THAT SAME DRUG IN OTHER COUNTRIES.

>> SO, YOU'RE SAYING THAT --LET'S SAY THE PRIMARY RESEARCH MIGHT BE HAPPENING AT A LABORATORY THAT --AT A STATE UNIVERSITY, SAY UNIVERSITY OF INDIANA, AND THEY COME UP WITH SOME AMAZING COMBINATION OF CHEMICALS THAT MAKE SENSE, AND COULD BE A BLOCKBUSTER DRUG.

WHAT CAN THE DRUG COMPANY DO WITH, I MEAN, DOES THE PATENT SIT IN THE UNIVERSITY'S LAB?

DO THEY JUST BUY THE LAB OUT, DO THEY BUY THE RESEARCHERS?

WHAT HAPPENS?

>> THEY BUY THE LICENSE TO MAKE THE DRUG.

AND AN ACT IN 1980 MADE IT POSSIBLE AND EVEN ENCOURAGED UNIVERSITIES TO SELL OFF THE RIGHTS TO PRODUCTS, PARTICULARLY IN THIS CASE, DRUGS, THAT WERE DEVELOPED WITH PUBLIC FUNDING, AND THEN SELL IT TO THE HIGHEST BIDDER, WHO THEN OWN EXCLUSIVE RIGHTS TO PRODUCE THE DRUG.

AND IN RETHINKING MEDICATIONS, I TALK ABOUT A FANTASTIC DRUG FOR PROSTATE CANCER, IT WAS DEVELOPED 100% ON THE BASIS OF FEDERAL FUNDING TO RESEARCHERS AT UCLA, WHO DID BRILLIANT WORK, AND CAME UP WITH A WAY OF TREATING THIS CONDITION WE DIDN'T HAVE BEFORE, AND THEN THE UNIVERSITY WAS ABLE TO SELL THE RIGHTS TO MAKE THAT DRUG EXCLUSIVELY TO A SERIES OF INTERMEDIARIES FOR OVER A BILLION DOLLARS, AND NOW THOSE INTERMEDIARIES HAVE SOLD IT OFF TO PFIZER AND ANOTHER COMPANY CALLED ASTELLUS, WHICH IS A JAPANESE COMPANY, AND NOW THEY OWN THE RIGHTS TO MAKE THE DRUG, EVEN THOUGH IT WAS DISCOVERED IN A PUBLIC UNIVERSITY WITH NIH FUNDING.

AND FOR OUR --FOR OUR TROUBLE, WE GET TO PAY 2 TO 4 4 TIMES WHAT OTHER PEOPLE IN OTHER COUNTRIES PAY FOR THE SAME DRUG.

>> WHEN WE TALK ABOUT THIS PRIMARY RESEARCH THAT'S HAPPENING AT UNIVERSITIES, I'D BE REMISS IN NOT ASKING, WHAT IS THE IMPACT OF THE CUTS THAT ARE HAPPENING ACROSS THE HEALTH SECTOR THAT WE'VE SEEN OVER THE PAST FEW WEEKS?

WE HAVE HEARD UNIVERSITY LABORATORIES HAVING TO STOP SOME OF THEIR WORK, EVEN AT SCHOOLS SUCH AS YOURS AT HARVARD.

I'M ASSUMING THAT THIS ISN'T JUST HARVARD, THIS IS OTHER SCHOOLS, IF IT'S NIH FUNDING, IF IT'S FDA-RELATED FUNDING.

>> IT IS A MASSIVE DISASTER THAT IS UNFOLDING BEFORE OUR EYES.

AND HARVARD, AS YOU KNOW, HAS BEEN HIT PARTICULARLY HARD, BUT IT'S HAPPENING AT MANY RESEARCH UNIVERSITIES ALL ACROSS THE COUNTRY.

AND THE PUBLIC IS NOT GOING TO NOTICE THE EFFECTS OF THIS IN THE NEXT COUPLE OF MONTHS.

YOU KNOW, IF THERE'S CUT- BACKS AT THE FEDERAL AVIATION AGENCY AND PLANES HIT EACH OTHER, THEN THEY MAY NOTICE THAT RATHER QUICKLY.

BUT CUT-BACKS IN BIO MEDICAL RESEARCH, BECAUSE IT TAKES YEARS FOR THESE TO TURN INTO MEDICATIONS, ARE GOING TO BE NOTICED BY THE PUBLIC FOR THE FIRST TIME IN A YEAR, TWO YEARS, THREE YEARS, BECAUSE RESEARCH PROJECTS ARE LITERALLY BEING STOPPED DEAD IN THEIR TRACKS AT HARVARD MEDICAL SCHOOL.

WE'VE GOTTEN STOP WORK ORDERS.

AND THESE ARE PROJECTS ABOUT CANCER, ABOUT MENTAL ILLNESS, ABOUT ALZHEIMER'S DISEASE.

THAT HAVE NOTHING WHATEVER TO DO WITH ANYTHING THAT THE ADMINISTRATION IS CONCERNED ABOUT IN RELATION TO WHAT HAPPENED LAST YEAR, FIVE MILES AWAY, ON OUR UNDERGRAD AND GRAD CAMPUS.

THE MEDICAL SCHOOL IS IN A DIFFERENT CITY, THESE FOLKS HAVE HAD HARDLY ANYTHING TO DO WITH THE PROTESTS.

MANY OF US BELIEVE THIS IS REALLY NOT AT ALL ABOUT ANTI-SEMITISM, AND IT IS DEVASTATING A LOT OF RESEARCH, WHICH WILL NEVER COME BACK THE WAY IT WOULD HAVE BEFORE.

YOU DON'T JUST STOP A CLINICAL TRIAL OR AN ANIMAL STUDY OR A TISSUE CULTURE EXPERIMENT, AND LEAVE IT GO FOR A NUMBER OF WEEKS OR MONTHS OR MORE AND THEN JUST COME BACK AT SOME POINT IN THE INDEFINITE FUTURE AND PICK UP WHERE YOU LEFT OFF.

A LOT OF THAT WORK IS GOING TO BE LOST FOREVER.

>> IN YOUR BOOK, YOU TALK ABOUT A PHRASE, THE MEDICAL INDUSTRIAL COMPLEX.

THIS IS KIND OF HARKENING BACK TO EISENHOWER'S FAMOUS LAST SPEECH ABOUT THE MILITARY INDUSTRIAL COMPLEX.

FOR OUR AUDIENCE, EXPLAIN WHAT THIS IS, WHAT'S WRONG WITH IT?

>> SURE.

THE MEDICAL INDUSTRIAL COMPLEX WAS A TERM INVENTED BY MY LATE COLLEAGUE BUD RELMAN, THE EDITOR OF "THE NEW ENGLAND JOURNAL OF MEDICINE. "

AND HE POINTED OUT THAT JUST AS EISENHOWER WARNED US THAT WITH THE GROWTH OF THE DEFENSE INDUSTRY, THOSE PEOPLE MAY TEND TO SHAPE OUR FOREIGN POLICY IN WAYS THAT MAKE SENSE FOR THEIR OWN BENEFIT, AND THEIR COMPANY'S BENEFIT.

SIMILARLY, WE HAVE DEVELOPED OVER THE DECADES A VERY POWERFUL MEDICAL INDUSTRY, NOT JUST DRUG COMPANIES, BUT ALSO PRIVATE EQUITY FIRMS THAT ARE GETTING INTO THE BUSINESS, HOSPITALS, AND EVEN NONPROFIT HOSPITALS HAVE ENORMOUS POWER AND WEALTH AND CLOUT, AND THAT TENDS TO SHAPE OUR HEALTH POLICY, MUCH AS THE DEFENSE INDUSTRY HAS COME AND STILL, IN MY VIEW, DOES SHAPE OUR FOREIGN POLICY.

AND DR. RELMAN WARNED, AND THIS GOES BACK 20-PLUS YEARS, WARNED US ABOUT THE FACT THAT WE NEED TO HAVE POLICIES IN MEDICINE THAT ARE DRIVEN ONLY BY SCIENCE AND BY THE NEEDS OF PATIENTS, NOT BY THE NEEDS OF DRUG COMPANIES.

AGAIN, DRUG COMPANIES OR HOSPITAL COMPANIES OR MEDICAL CENTERS THAT MAY EVEN FLY UNDER THE NONPROFIT BANNER, THE BUSINESSES ARE SO IMPORTANT AND LUCRATIVE AND ENORMOUS THAT THEY TEND TO SHAPE HOW WE THINK ABOUT DELIVERING HEALTH CARE WAY MORE THAN THEY SHOULD.

>> YOU ALSO POINT OUT THAT THE REGULATOR THAT MOST AMERICANS THINK IS THEIR KIND OF LINE OF DEFENSE, THE FDA, HAS BEEN STRUCTURALLY CHANGED OVER TIME, AND MOST PEOPLE DON'T KNOW THAT THE PHARMACEUTICAL INDUSTRY IS PART OF, WELL, THE SALARY OF THE FDA INSPECTORS, THE FEW THAT ARE LEFT.

>> EXACTLY RIGHT.

I THINK A LOT OF PATIENTS AND MOST DOCTORS BELIEVE THAT THE FDA TESTS DRUGS AND IT DOES SO IN AN UNBIASED WAY AND IT'S IMPORTANT, I THINK, FOR VIEWERS TO UNDERSTAND, THE FDA DOESN'T REALLY TEST DRUGS TO SEE IF THEY WORK.

THOSE STUDIES ARE PRIMARILY DONE BY THE COMPANIES THAT MAKE THEM, AND OFTEN THEY WILL STRUCTURE THOSE STUDIES IN A WAY TO KIND OF WIN APPROVAL, YOU KNOW, THEY'RE ALLOWED TO TEST THEIR DRUG AGAINST A PLACEBO, AND MEASURE A LAB TEST OUTCOME INSTEAD OF A PATIENT BENEFIT OUTCOME, AND IF THEY'RE BETTER THAN NOTHING AT CHANGING A LAB TEST, THEN THEY GOT THEMSELVES AN FDA APPROVAL.

AND FDA HAS NOT REALLY BEEN AS ASTUTE IN FOLLOWING UP ON A LOT OF THOSE APPROVALS TO ASK THE QUESTION THAT THEY'RE LEGALLY MANDATED TO ASK, WHICH IS, IT'S NICE THAT YOU CHANGED THAT LAB TEST SLIGHTLY, BUT DID YOUR DRUG HELP THE PATIENTS?

AND WE'VE GOT EXAMPLES THAT I REFER TO IN THE BOOK, FROM MUSCULAR DISFREE IF I TO ALZHEIMER'S DDZ, WHERE COMPANIES HAVE MANAGED TO KIND OF USE THAT TECHNICALITY AND SAY, LOOK, WE MADE A LAB TEST BETTER, AND FAILED TO SHOW THAT THEY MADE THE PATIENTS BETTER.

THEY THEN NOT COME BACK AND DONE THE FOLLOWUP STUDIES THAT THEY ARE SUPPOSED TO BE REQUIRED TO DO, AND AS A RESULT, THE DRUGS ARE ON THE MARKET, CHARGING FULL FREIGHT, SOMETIMES HUNDREDS OF THOUSANDS OF DOLLARS A YEAR, IN THE CASE OF SOME OF THE MUSCULAR DYSTROPHY DRUGS THAT I WRITE ABOUT, AND THERE'S REALLY NO ACCOUNTABILITY.

AND WE NEED TO GET BETTER AT FIXING THAT.

>> SO, IN THE BOOK, YOU ALSO LAY OUT KIND OF PRESCRIPTIONS FOR SYSTEMIC OVERHAUL.

WHAT WOULD YOU BOIL THOSE DOWN TO?

>> YEAH, I TRIED NOT TO BE ALL CRITICISM AND DOOM AND GLOOM.

I THINK THERE ARE SOME VERY ACTIONABLE THINGS THAT I TRIED TO RELATE THAT WE CAN DO BOTH IN TERMS OF POLICY, BUT ALSO THAT PATIENTS CAN DO THEMSELVES WHEN THEY'RE WITH THEIR DOCTOR.

YOU KNOW, WHAT IS THIS DRUG FOR, WHY ARE WE USING IT, IS THERE A GENERIC?

WILL I BE ABLE TO AFFORD IT?

HOW DO I TAKE IT?

YOU KNOW, THINGS WHICH YOU CAN KIND OF TAKE WITH YOU TO THE DOCTOR, BUT MORE IMPORTANTLY, THERE'S ALSO PRETTY STRAIGHTFORWARD POLICY FIXES THAT WE CAN ENGAGE IN.

REFORMING OUR PATENT SYSTEM TO DEAL WITH THESE KIND OF MEANINGLESS THINGS.

DOING WHAT ALL THE OTHER COUNTRIES THAT PRESIDENT TRUMP THIS WEEK WAS SO MUCH IN AWE OF THAT GET SUCH BETTER DRUG PRICES, IT'S NOT BECAUSE THEY'RE SOCIALIST COUNTRIES, IT'S BECAUSE THEY HAVE THIS SYSTEMATIC EVALUATION OF, HOW GOOD IS THIS NEW DRUG, IS IT BETTER THAN WHAT WE'VE GOT?

WHAT ARE WE WILLING TO PAY MORE FOR IT?

EXACTLY THE WAY CONSUMERS AND GOVERNMENTS AND CORPORATIONS MAKE ALL OF THEIR OTHER PURCHASING DECISIONS, BECAUSE, YOU KNOW, WE CAN'T GO ON PAYING TWICE AS MUCH AS EVERY OTHER COUNTRY FOR OUR DRUGS.

>> DR. JERRY AVORN, A PROFESSOR AT HAIR RECORD MEDICAL SCHOOL, AND AUTHOR OF "RETHINKING MEDICATION: TRUTH, POWER, AND THE DRUGS YOU CAN TAKE. "

THANK YOU FOR BEING US.

>> IMPORTANT STUFF.

THAT'S IT FOR NOW.

TUNE IN TOMORROW FOR MY CONVERSATION WITH DANIEL KELLMAN.

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