Pipelines are often controversial constructs. They crisscross land and sea gushing with dirty black gold, and wars are routinely fought over their politics. But the world’s most important pipeline isn’t visible. It is the pipeline of drugs that should save and improve the lives of billions of people. But until now this pipeline has been routed entirely to maximise return for the shareholders of large drug companies rather than to save as many lives as possible.

Tachi Yamada may hold the key to a historic re-routing of this pipeline. As president of the global health programme at the Bill and Melinda Gates Foundation he has the financial firepower of the world’s first and third richest men behind him, and the experience of creating one of the world’s biggest pipelines at GlaxoSmithKline. Two years after joining the Gates Foundation, he has just embarked on an epic struggle with tobacco companies, is seeking to turn one of the basic norms of scientific research on its head (see box), and still talks a lot about pipelines.