Dr. William Carson

William Carson declared Harvard as his goal in the sixth grade.¹ He was growing up in Columbia, South Carolina, attending segregated schools, reading encyclopedias from the letter A. He bought the Insider's Guide to Colleges in ninth grade, researched SAT requirements and prerequisite courses, and built a plan. 'It wasn't random,' he has said.¹

He earned an A.B. in History and Science from Harvard, then an MD from Case Western Reserve University School of Medicine — choosing CWRU specifically for its organ-systems approach to medical education.¹ He completed a psychiatry residency at Tufts University School of Medicine in Boston, discovering his comfort on a locked psychiatric ward: 'I felt immediately comfortable. Mental patients need advocates. They are the most poorly treated people in all of medicine.'¹

Medical University of South Carolina (1988–1998)

For ten years, Carson was a Professor of Psychiatry at the Medical University of South Carolina, teaching students and seeing approximately twelve patients per day.¹ After a decade in academic medicine, an old friend called him into the pharmaceutical industry.

Bristol-Myers Squibb and Otsuka

He described his years at Bristol-Myers Squibb in Princeton as 'business school on steroids.'¹ He set a personal deadline of five years to determine whether he could succeed in pharma, began running trials on atypical antipsychotics including aripiprazole, and entered a relationship with Otsuka Pharmaceutical — the Japanese company holding primary rights to the molecule.²

Carson joined Otsuka America Pharmaceutical in 2002 with no office, a handful of colleagues, and a product that had just received FDA approval for schizophrenia.² He led the U.S. commercial launch. Abilify's U.S. revenue grew from approximately $364 million to over $1 billion in three years under his commercial leadership.³

The case study built around his career centers on a 2007 decision: how to structure the Japan clinical trial for Abilify as an adjunctive treatment for major depressive disorder. The choice was between direct hiring (culturally costly in Japan's employment norms) and a Contract Research Organization.⁴ The FDA approved Abilify for MDD adjunctive treatment on November 9, 2007.²

Abilify Mycite and the First Digital Medicine

Under Carson's leadership as President and CEO of Otsuka Pharmaceutical Development & Commercialization, the company developed Abilify Mycite — a version of aripiprazole with an embedded ingestible sensor that transmits data to a wearable patch, allowing physicians and patients to track medication adherence.⁵ The FDA approved Abilify Mycite in November 2017 — the first FDA approval of a digital medicine.⁵

All three CRO names in the HBS case study (Poltec, NuViewMatics, North Star) are explicitly fictional, as noted in the case itself.⁴ The clinical trial outcome and CRO selection are not in publicly available sources.

Japan and the CRO Decision

The central constraint in Carson's Otsuka chapter was not technical — it was cultural. Running a U.S. Phase III clinical trial for the MDD add-on indication of Abilify required either hiring clinical researchers directly (Option 1) or contracting with a CRO (Option 2). In Japan's employment culture of 2007, mid-career external hiring carried significant organizational costs: it disrupted the seniority structures and internal promotion expectations that defined Japanese corporate life. Option 1 would have been the equivalent of signaling distrust in the existing organization while simultaneously creating an external team with unclear long-term standing.

The constraint was that the medically optimal answer (direct control through direct hiring) was in tension with the organizationally safe answer (CRO as buffer). Carson's recommendation — the CRO structure — was not the researcher's default; it was the answer that worked within the Japanese organizational context he was operating inside. His ability to diagnose that constraint was itself the intrapreneurial act.

A second constraint is specific to Black physicians entering the pharmaceutical industry: Carson entered a sector that in the 1990s had very few Black physician-executives at the level he was operating. He was a first-time executive in the pharmaceutical industry, learning 'business school on steroids' at BMS without the peer network of other Black pharma executives who had navigated the same transition.

Retired Otsuka CEO January 2020; Biotech Boards

Effective January 1, 2020, Carson retired as President and CEO of Otsuka Pharmaceutical Development & Commercialization, Inc.⁵ He transitioned to Chairman of the OPDC Board of Directors.⁵

After leaving day-to-day operations at Otsuka, Carson joined the boards of multiple biopharmaceutical companies. He serves on the board of directors of Annexon Biosciences, which is developing treatments for complement-mediated diseases.⁶ He joined the board of Excision BioTherapeutics — a CRISPR-focused gene editing company with a lead program targeting functional cure of HIV — as a veteran pharmaceutical executive.⁷

At the Sphinx Organization, Carson was first elected to the board in 2013 and was honored with the title of Chairman Emeritus in 2018 for his leadership of the organization.⁸ Aaron Dworkin's daughter Afa S. Dworkin serves as President and Artistic Director.⁸