Sir James Black places his walking stick on one side, eases himself into a plump yellow sofa at the Royal Society of Medicine's headquarters in London and begins to talk in a soft voice. But he is soon working himself up into a passion.

He becomes agitated when discussing a Harvard Business Review article from 2008 by Jean-Pierre Garnier, the former chief executive of GlaxoSmithKline, on the future of drug development. He agrees with the prognosis, but is fundamentally at odds over the prescription for change.