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Amanpour

Interview with Former Ukrainian Foreign Minister Dmytro Kuleba; Interview with Former U.S. Deputy Secretary of State Wendy Sherman; Interview with "Rethinking Medication" Author, Harvard Medical School Professor of Medicine and Mass General Brigham Healthcare System Senior Internist Dr. Jerry Avorn. Aired 1-2p ET

Aired May 15, 2025 - 13:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

[13:00:00]

CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: Hello, everyone, and welcome to "Amanpour." 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? Former Deputy Secretary of State 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?

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've been the first time since 2019.

Remember, it was Putin himself who proposed these talks. Zelenskyy says he won't meet with anyone but Putin himself and Donald Trump has weighed in

saying, nothing will happen on Ukraine until he himself 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.

DMYTRO KULEBA, FORMER UKRAINIAN FOREIGN MINISTER: It's good to be back.

AMANPOUR: You know a lot about these meetings. Describe what you think went happened today. I mean, was it ever serious that Putin was going to

come?

KULEBA: 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.

AMANPOUR: And that was shortly after the full-scale invasion.

KULEBA: Absolutely.

AMANPOUR: The delegations met, right? Were you there?

KULEBA: No, we never actually considered sending a foreign minister to meet an underrepresented official Russian delegation. And second this will

not legally official talks. From the legal perspective, for a couple of months, this were just two sides seeing each other without following proper

legal procedures.

AMANPOUR: What do you think -- 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, no chief of staff, obviously no Putin. And President Zelenskyy called it a phony delegation. What do you

think would've happened?

KULEBA: Well, you know, there are phony wars that we know from history, and now we have a case of phony diplomacy. You see 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 three 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.

AMANPOUR: That's what he says?

KULEBA: Exactly. That's his narrative. It's a false narrative, but it's still his narrative. So, he just reinforces his message that he's willing

to negotiate. But the question is, if you're willing to negotiate, why did you attack it all?

AMANPOUR: OK. Why did you attack? You could say, well, he thought he was going to get, you know, all of Ukraine, famously, as everybody says, in two

to three days. It obviously didn't happen. It's been more than three --

KULEBA: But he still believes in this.

AMANPOUR: No, come on.

[13:05:00]

KULEBA: No, he does. I assure you. It's just -- for him, it's a matter of -- you know, the difference between him and President Zelenskyy and

European leaders is that they are bound by electoral cycles, even if though -- even if they're interrupted by the war. But Putin isn't. He has a long,

you know, eternity ahead of him.

AMANPOUR: So, what, he still eventually believes in getting Ukraine?

KULEBA: One way or another. Absolutely.

AMANPOUR: So, there's absolutely -- so, what can, for instance, a new administration seek to change in this dynamic, a new American

administration?

KULEBA: Putin can put his plan on hold. I don't think he will ever be able to abandon the idea of subjugating Ukraine because that's his whole

mission. And apart from that, since middle 17th century, every Russian czar actually succeeded in doing that. So, for him not to succeed it is just to

end up in the wrong basket of 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, to delay them, and sell for by 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.

AMANPOUR: So, we are speaking later with Wendy Sherman. 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?

KULEBA: 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, Vladimir, let's meet, let's see what we can do together. And the carrot, if you do not -- and the stick is,

if you do not end the war, then this, this and this bet and that bad thing will happen to you.

What we've seen so far were 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 because in the nearest days or weeks, but we have to understand clearly that first thing to do is oil prices or oil

sanctions.

Second thing to do is to continue supporting Ukraine militarily because Putin's assessment evaluation is that the west faltered, 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.

AMANPOUR: Can I ask you though, you know, 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 kind of move 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 ceasefire and then a proper peace negotiation. Do you think that's constructive?

KULEBA: Well, the need to change attitude towards the strategy was apparent, was 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? Because he just doesn't --

AMANPOUR: But don't you think it's changing a little bit that President Trump is less, you know, sticking it to Ukraine.

KULEBA: It's changing a little bit, but I can tell you that in terms of reaching a ceasefire, today we are 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 were not

negotiations about ceasefire. This were maneuvers to make -- to keep President Trump on his side.

[13:10:00]

AMANPOUR: Putin's maneuvers?

KULEBA: And Zelenskyy maneuvers as well. He was also maneuvering to keep the -- to avoid Trump's wrath and anger and moves, which would put Ukraine

into an I weaker position.

AMANPOUR: But Zelenskyy did go for a ceasefire, which is what the U.S. wanted. I mean, he's really met the moment and thrown the ball into the

Russian.

KULEBA: Yes, 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 newsfeed about what happened overnight in the United States, who said what,

all the negotiations and there is a lot of noise about negotiations. There is a lot of noise about ceasefire.

You remember vice president and president saying, we are about to get a deal. We are as close to getting the deal as we ever been. Today, we are

closer yesterday. But then Ukrainians open another newsfeed, and that newsfeed 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 words about ceasefire transforms into ceasefire. Nothing changes. We still

get bombed. Russian army is still on the attack. So, I mean, we can continue like this. I mean, all stakeholders can continue like this, but it

just does not bring us closer to peace.

AMANPOUR: So, I want to ask you, first and foremost, what -- because one of the narratives, certainly from Russia, and they believe that they're

winning, 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 for the Study of War. So, over the past 16 months, as Russian forces seized the initiative, Moscow took

1,827 square miles of Ukraine, an area smaller than Delaware. This is according to their data. Now, over that period, the U.S. government

estimates that Russia lost more than 400,000 troops to death or injury, a high cost for resting control of less than 1 percent 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?

KULEBA: Well, strategically, if we zoom out, it doesn't. I mean, if you read daily news, 20 square kilometers here, a village there, a small farm

there. And all of this achieve every -- each and every of these achievements is celebrated by Russian propaganda, and sometimes President

Putin himself commences his army for taking another village.

When you zoom in that deeply, of course it looks like Russia is having upper hand. Guys, three years into the war, Ukraine is still on its feet.

Russians -- Russia's advance has slowed. No, he doesn't. But there are certain voices, especially in the United States where 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.

AMANPOUR: 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 foreign minister position. Is there a struggle in Europe? The idea of being a -- having to choose between giving

their weapons and ammunition to Ukraine, or having to fill the massive gap that the Trump administration has created to -- for their own security? Do

you think the Europeans have what it takes?

KULEBA: They certainly have the infrastructure, there's the money, and the potential to put all these pieces together and to seriously address the

issue of Europe's defense, which would Ukraine -- which Ukraine would also benefit from.

There are two risks they're 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, OK, 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.

[13:15:00]

So, the Europeans death clearly woke up. They were shocked and staggered after the J. D. Vance speech in Munich in February. Less than two months

later, J. D. Vance gave another talk at the Munich Security Conference, far less confrontational. And you immediately see these 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 confront them. We don't have to escalate.

So, the risk of Europe, misreading 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.

AMANPOUR: And according to, you know, 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.

KULEBA: Europeans have to do a very simple 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 up with his new program of new supplies to Ukraine. And then you get --

AMANPOUR: It's unlikely.

KULEBA: 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 frontline.

AMANPOUR: 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 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 euros a year. I mean, what will happen if that happens?

KULEBA: Ukraine will -- 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 Romania is anti-Ukrainian. Hungary is anti-Ukrainian. Slovakia is mildly 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 E.U. mechanisms to inflict damage on Ukraine. And we have Turkey who is always playing its own

game across the sea.

So, how we -- they will be -- we will need to show, to demonstrate the real art of diplomacy and even stronger resilience to defend our interest.

AMANPOUR: It doesn't sound good.

KULEBA: Well, in the end, everything will be good, and if it's not good, then this is not the end.

AMANPOUR: Foreign Minister Dmytro Kuleba, thank you very much indeed. Stay with us. We'll be right back after the break.

(COMMERCIAL BREAK)

[13:20:00]

AMANPOUR: 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,

touting 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.

WENDY SHERMAN, FORMER U.S. DEPUTY SECRETARY OF STATE: Great to be with you.

AMANPOUR: 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 and I don't know what, but 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 hope for, 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?

SHERMAN: 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 advantage on the battlefield that he can outlast Ukraine.

And so, when both President Trump and the Europeans proposed a 30-day ceasefire, he thought it was getting to be difficult for him. And so, he

said, OK, let's have an agreement to 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 and 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 no 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, Yermak 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 till now there has been really no pressure on President Putin to do anything other but continue the war.

AMANPOUR: So, Wendy Sherman, President Trump also just said in the Middle East that nothing would get done until he eventually meets Putin. OK. 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 playing, 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?

SHERMAN: 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 Putin -- that Ukraine will never get into NATO, but that it will have a constrained military that Putin will get even more territory

than he currently holds.

[13:25:00]

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.

AMANPOUR: 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 is 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 words, 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 be 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?

SHERMAN: 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-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. I think it's quite disturbing, to

say the least, that Jared Kushner was there, who really got his funds started with $2 billion from the Saudis. Nobody gives $2 billion to a

brand-new equity fund. I can't think of another instance where that has occurred.

And so, what the president's 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 authoritarian, that human rights are not

acknowledged in any way, that there are people who have been unfairly detained and imprisoned, that there isn't freedom in the way that we

understand it.

The president said that the U.S. will no longer intervene. They will no longer do nation building. 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.

AMANPOUR: So, let me, Wendy, put this fight. Let's -- you just --

SHERMAN: Quite an approach.

AMANPOUR: 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's -- let me play what he said that you just referred to.

(BEGIN VIDEO CLIP)

DONALD TRUMP, U.S. PRESIDENT: In the end, the so-called nation builders wrecked far more nations than they built, and the interventionalists were

intervening 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.

[13:30:00]

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.

(END VIDEO CLIP)

AMANPOUR: 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 these

wars of intervention, all this nation building, which collapsed in a heap of problems in Iraq and Afghanistan. Do you agree with what he's saying?

SHERMAN: 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 nation building. 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 to try to get a ceasefire and 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 where he's going to go.

AMANPOUR: Well, you know what he seems to have -- I don't know what the right word is, but has he boycotted Netanyahu? Has he -- what has he done?

I mean, he is not gone to Israel this time, completely different than the last time. And at the same time, they appear to put 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.

(BEGIN VIDEO CLIP)

TOM FLETCHER, U.N. EMERGENCY RELIEF COORDINATOR: 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?

(END VIDEO CLIP)

AMANPOUR: 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?

SHERMAN: 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 and Gaza to a point of starvation. We have taken

away any possibility right now, and I mean this, not just we, the United States, but the world has really turned away from providing the help and

creating 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 this 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.

[13:35:00]

AMANPOUR: Given that this war and the attack, the savagery of October 7th and the subsequent 19-month war coincided with the, you know, last two

years of the Biden presidency and the reports now that are being alleged of -- as you know, you're probably aware, of his cognitive decline and of

efforts by his inner circle to insulate him from scrutiny.

Based on your experience working for President Biden, were you concerned that this was happening and that potentially, you know, things were not

being managed from the top?

SHERMAN: 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 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.

AMANPOUR: I wonder if you're surprised that this book quotes essentially your boss at the time, Secretary of State Anthony 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?

SHERMAN: 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 continuing to press on, are you sure this is what you want to do? He has 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.

AMANPOUR: Wendy Sherman, thank you very much indeed for joining us.

SHERMAN: Thank you, Christiane.

AMANPOUR: Coming up after the break, Trump vows to make medication cheaper for Americans, but why are they paying so much anyway? Dr. Jerry Avorn from

Harvard Medical School tells Hari Sreenivasan.

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[13:40:00]

AMANPOUR: 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.

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TRUMP: Some prescription drug and pharmaceutical prices will be reduced almost immediately by 50 to 80 to 90 percent. 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 price as other countries.

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AMANPOUR: But how will he do that? And can he? Dr. Jerry Avorn from the Harvard Medical School joins Hari Sreenivasan to discuss why the cost of

medication in America is so high and what can be done to fix it.

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HARI SREENIVASAN, CNN INTERNATIONAL CORRESPONDENT: Christiane, thanks. Dr. Jerry Avorn, thanks so much 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?

DR. JERRY AVORN, AUTHOR, "RETHINKING MEDICATIONS", PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL AND SENIOR INTERNIST, MASS GENERAL BRIGHAM

HEALTHCARE SYSTEM: Well, the order was kind of aspirational in that the president, I think, did us a favor by reminding everybody that Americans do

pay about twice per capita of 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 roadmap to exactly how he was

going to be able to accomplish that.

SREENIVASAN: Backing up a step for our audience, why do Americans pay more for the same drug from the same company than other countries?

DR. AVORN: 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 healthcare 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 some

advantage either in terms of 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 then, the company comes back and says, no, it ought to be higher. And there's a conversation that occurs

between the healthcare system and the manufacturer. And that determines what they pay for the drug. Here, it's whatever the company wants to charge

pretty much.

SREENIVASAN: 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 plowed in millions and millions of dollars into research and development for, you know, 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?

DR. AVORN: 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, yes, I would kind of like for there to be more of a marketplace encounter, not where one side gets to by fiat, say what

something costs, and then everybody has to meet that price or not get the drug.

SREENIVASAN: 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 percent. Is that possible?

DR. AVORN: No, it would be nice if there was a massive reduction. I think 90 percent 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.

SREENIVASAN: The CEO of the lobbying group for the pharmaceutical industry said, this is Stephen J. Ubl, and he said the -- 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 billions our member companies are planning to invest in America. What's your take on that?

DR. AVORN: Well, this is a very standard talking point from the industry trade group. And certainly, drug companies, when they make an important

innovation, deserved to be rewarded handsomely for it financially. And it's also true that they do need to be compensated for all the dead ends and

blind alleys that come with drug development, and that is the case.

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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 and 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. I 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 at where do a lot of new drugs come from, and when you trace back the patents and the grants and 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.

SREENIVASAN: You wrote a book on this topic. It's part of why we're having this conversation. It's titled, "Rethinking Medications: Truth, Power, and

The Drugs You Take." You also built a leading research center at Harvard to study medication use, outcomes, costs. So, you're eminently qualified to

discuss this.

One of the things that 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 on to the private sector, explain what happened.

DR. AVORN: Yes. We have 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 de-risking 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 the 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 pre-competitive research that is required to discover new drugs. And then, as soon as there is something that looks

marketable, we've 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 pushback 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 two to four to six times what the same company charges for that same drug in other countries.

SREENIVASAN: So, you're saying that essentially, let's say, that the primary research might be happening at a laboratory that -- at a state

university, let's say University of Indiana, and they come up with some amazing combination of chemicals that make sense and it 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?

DR. AVORN: They essentially buy the license to make the drug and the Bayh- Dole Act of 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 XTANDI, which is a fantastic drug for prostate cancer. It was developed a hundred percent 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 Astellas, which is a Japanese company. And now, they own

exclusive rights to make the drug, even though it was discovered in a public university with NIH funding.

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And for our trouble, we get to pay two to four times what people in other countries pay for the very same drug.

SREENIVASAN: When we talk about some of 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 of 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, you know, FDA related funding.

DR. AVORN: It is a massive disaster that is unfolding before our eyes. And Harvard, as you know, it 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 cutbacks that, you know, the Federal Aviation Agency and planes hit each other, then they may notice that rather quickly.

But cutbacks in biomedical 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 had hardly anything to do with the protests. Many of us believe this is really not at all about

antisemitism, and it is devastating a lot of research, which will never come back the way it would've before. You didn't -- 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.

SREENIVASAN: 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.

DR. AVORN: Exactly right. That I think a lot of patients, and frankly, 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 that

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 change 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 dystrophy to Alzheimer's disease, 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've then not come back and done the follow-up 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.

SREENIVASAN: So, in the book you also lay out kind of prescriptions for systemic overhaul. What would you boil those down to?

DR. AVORN: Yes, I tried not to be old 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 the 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 this kind of

meaningless thickets. Doing what all the other countries that President Trump this week was so much in awe of that gets 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?

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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.

SREENIVASAN: Dr. Jerry Avorn, a professor at Harvard Medical School and also author of "Rethinking Medication: Truth, Power, and The Drugs You

Take," thanks so much for your time.

DR. AVORN: Thank you for having me. I've enjoyed it.

(END VIDEOTAPE)

AMANPOUR: Important stuff. And that's it for now, but tune in tomorrow for my conversation with bestselling German author Daniel Kehlmann. His new

novel, "The Director," is a fictionalized account of the real Austrian filmmaker G.W. Pabst, one of the greatest of the silent movie era. He was

cast out by Hollywood and trapped in Nazi occupied Austria, where he finds himself making movies for Joseph Goebbels, head of the Nazi propaganda

machine. That's on tomorrow's program.

Thank you for watching. Bye-bye from London.

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