Summary
International health organizations used a process called "cost-effectiveness analysis" to evaluate proposed public health projects. They judged how much something would cost and then how effective it would be. These estimates were compared to other proposed projects to decide what to fund. The project to treat MDR in Peru challenged this model. It suggested that the World Health Organization's facts were incorrect but also that how it was thinking about projects was wrong. Jim Kim led PIH's efforts here.

Kim had been born in Korea, but was raised in Iowa. His family was one of only a few Asian families in Muscatine, and Jim was isolated as a result. He went to the University of Iowa, then to Brown, where he found consolation in identity politics, educating himself on America's history of dealing with ethnic minorities and his Korean heritage, even traveling to Seoul as part of his PhD thesis for anthropology. However, by the time he met Farmer, Kim was coming to the end of this exploration and was looking for a new direction. Over the years they spent together, their philosophies fused, even though the specific methods they used eventually split: Jim Kim enjoyed the political side of things more than Farmer did.

Kim had studied the pharmaceutical industry for his dissertation and knew what factors determined the cost of a drug. Kim tried to get the World Health Organization to encourage the production of second-line drugs, but when they backed out of the meeting, he held it himself. This led to help from the International Dispensary Association (IDA), a non-profit which helped the poor by working to lower drug prices. They approached smaller companies, working around WHO's bureaucracy and legitimate fears about misuse of drugs and following the model of the Green Light Committee, who had done something similar earlier for another vaccine. In the end, they drove down the drug prices tremendously: 97% for some drugs, and 90% for the complex drugs PIH used to treat MDR in Peru. PIH hoped to build on this success and to plan for funding after Tom White's passing by approaching major donors for money.

Analysis
This chapter accomplishes several tasks. First, in the biographical sketch of Jim Kim, Kidder introduces another character to the narrative. In doing so, he documents the expansion of PIH's core, as well as the variety of approaches it could accommodate. Moreover, by showing Jim embracing and then growing past identity politics, Kidder could underscore Farmer's message about the ideologies being less important than economic realities. Second, just as Paul Farmer's adult mission took part of its shape from his childhood experiences, so did Jim Kim's. It was a very different route from Farmer's: more privileged economically, much more isolated racially and culturally. Like Paul, Jim was clearly intellectually gifted, as evidenced by the easy move from one school to another, and his ability to subordinate the challenges of a doctoral program to his quest for a personal vision. Third, the successful campaign to lower drug prices demonstrated the centrality of Kim's knowledge and political savvy to Farmer's (and PIH's) mission. This expertise allowed Kim to do things Farmer could have done only with difficulty, things that were essential to their shared project of helping the suffering poor. Finally, that same successful campaign serves as a challenge to both WHO's worldview and the reader's. If the organization who coordinated public health projects around the world could be so wrong in their economic thinking and accept needless suffering, how much else could be changed, and who else could be saved?