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maceutical companies to get quick accep-tance of newly approved medicines and put-ting pressure on profits.

Today, 42% of doctors practice as salariedemployees of hospital systems, up from 24%in 2004, according to Cegedim RelationshipManagement, a marketing consultant.

As a result, the pharmaceutical industryis shifting its sales efforts from doctors tothe institutions they work for. In 2005, drugcompanies employed about 102,000 U.S.sales representatives, who mostly pitch todoctors. By mid-2014, according to ZS Asso-ciates, a consulting firm, their numbers were

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system, Sharp HealthCare, to consider thetwo drugs’ effectiveness. It was the kind ofpitch she once used to persuade doctors towrite prescriptions.

The administrator, Electa Stern, said shewould run the effectiveness data by doctorswho are helping decide what to put on a sys-temwide formulary. “And then we will betaking a look at cost.” There are about 2,600doctors in the Sharp system.

Ms. French’s sales calls are part of a shiftthat is rewriting the drug-marketing play-book. As hospital systems get bigger, theyare putting distance between their doctorsand drug sellers, making it harder for phar-

SAN DIEGO—Kendall French used to pitchdrugs to doctors who could prescribe them.

But many of those doctors now work forhospitals that don’t give them final say overwhat is on the menu of medicines they canpick. So when the GlaxoSmithKline PLCsaleswoman began plugging two new lung-disease drugs to a big San Diego hospitalsystem this spring, it was to an administra-tor who doesn’t see patients but helps writethe menu, also called a “formulary,” of ap-proved medications.

Ms. French urged the administrator in the

of violent extremism” embodiedin groups such as Islamic Statenow dominates his foreign-pol-icy agenda.

“The only language under-stood by killers like this is thelanguage of force,” Mr. Obamasaid. “So the United States ofAmerica will work with a broadcoalition to dismantle this net-work of death.”

While leaders met at the U.N.,the Pentagon said U.S. and Arabwarplanes carried out a newwave of strikes on extremistgroup Islamic State in Syria, em-phasizing regional support forthe latest expansion of the aircampaign against the group.World leaders recoiled at a newextremist video showing the be-heading of a French hostage.

Despite the U.S. appeals, thescope and longevity of his coali-tion to fight Islamic State re-

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UNITED NATIONS—The U.S.unleashed a barrage of diplo-matic pressure on world leadersgathered in New York, imploringthem to join an international co-alition against Islamic extrem-ism.

President Barack Obama, in aseries of appearances through-out the day, outlined a very dif-ferent U.S. approach to the Mid-dle East than he did last year atthe same forum—one that leansheavily on American militarypower and tightly focuses onways to diminish Islamic extrem-ism. He urged leaders in the re-gion to do more to combat whathe described as the most press-ing threat to global progress.

In his sixth address to theUnited Nations General Assem-bly, Mr. Obama said “the cancer

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What’sNews

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World-Widen The U.S. unleashed a bar-rage of diplomatic pressureon world leaders gathered inNew York, imploring them tojoin an international coalitionagainst Islamic extremism. A1n The U.S. and Arab allieslaunched airstrikes in Syriatargeting mobile oil refineriescontrolled by Islamic State. A8n Iraq’s new governmentserved as a U.S. liaison toSyria and Iran before Ameri-can-led strikes in Syria. A9nMass shootings are hap-pening more often, resultingin more deaths and usuallyending before police reach thescene, an FBI study said. A3n The Education Departmentreported a drop in the num-ber of Americans defaultingon their student loans. A2n Russia’s Parliament spedup measures to tighten controlover foreign Internet firmssuch as Google and Twitter.A13n The Obama administrationoutlined updated plansaimed at building on effortsto protect the Great Lakes. A4n The U.S. government willpay the Navajo Nation $554million to settle claims it mis-handled oversight of land. A4n A grand jury decidedagainst indicting Nascar starTony Stewart in the death ofa fellow driver last month. A6n India’s space programtook a giant technologicalleap by putting a satelliteinto orbit around Mars. A17n Los Angeles’s City Councilapproved one of the nation’shighest minimum wages forworkers at large hotels. A2

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Chinese leaders are dis-cussing replacing the

central bank chief amid dis-agreements over the direc-tion of financial policy. A1n Some junk-bond investorsare paring risk as they try togauge when rate hikes mighttrip up a yearslong rally. C1n New-home sales in the U.S.climbed 18% in August froma month earlier, hitting thehighest level since 2008. A2n Apple withdrew an updateto its latest iPhone, iPad andiPod software hours aftermaking it available. B1n BlackBerry unveiled thePassport smartphone, a de-vice the firm is counting onto help revive its fortunes. B4nWall Street firms led byGoldman Sachs are close to adeal to create an instant-messaging service. C1n U.S. stocks rallied, withthe Dow jumping 154.19points, or 0.9%, to 17210.06. C4n Comcast and Time WarnerCable fired back at critics oftheir proposed merger. B1n GlaxoSmithKline is set toname RBS’s Philip Hampton tosucceed Christopher Gent asthe drug giant’s chairman. B6n Harvard University choselongtime insider StephenBlyth to run its endowment. C3n Federal security agenciessaid that previously unseenmalware was used in the at-tack on Home Depot. B2n Tory Burch has hiredRalph Lauren veteran RogerFarah as co-CEO. B1

Business&Finance

BEIJING—Chinese leaders arediscussing replacing the centralbank chief amid disagreementsover the direction of financialpolicy, raising questions overhow quickly and deeply Beijingwants to remake the economyamid slowing growth.

Chinese leader Xi Jinping isconsidering removing Zhou Xi-aochuan—the face of the Chineseeconomy to markets globally—aspart of a wider personnel shufflethat comes after internal battlesover economic overhauls.

The discussions occur as Mr.Xi, now two years in office, triesto place more allies into top posi-tions in the government, militaryand Communist Party, said partyofficials with knowledge of theplans. The personnel shifts areexpected around a major partyconclave to be held in October,the officials said, while caution-ing that no final decision aboutMr. Zhou has been made.

Over the past few months, Mr.Zhou has continued to press formarket changes, including liber-alizing interest rates. The Chi-nese leadership, meanwhile, hasbecome concerned that overhaulsnow will place another burden onan economy that is struggling tomeet the government’s target of7.5% annual growth.

One reason to retain Mr. Zhouis fear of the market reaction tohis departure, the party officialssaid. Removing him could add touncertainty about the directionof China’s economic-policy mak-ing and the strength of the lead-ership’s commitment to over-hauls, said the party officials, ata time when many other parts ofthe global economy are sputter-ing.

Removing Mr. Zhou “couldsuggest a subtle shift in the bal-ance of power between reformistand reactionary forces, with themomentum for change beingeroded by the loss of growth mo-mentum in the economy,” saidEswar Prasad, a China expert atCornell University.

The top contender to succeedMr. Zhou at the People’s Bank ofChina is Guo Shuqing, a formerbanker and top securities regula-tor who is currently governor ofShandong, a prosperous easternprovince, the officials said. Mr.Guo, a longtime friend of Mr.Zhou, is also considered a re-former. But it remains to be seenwhether he would push for over-hauls as hard as Mr. Zhou hasbeen, Chinese officials and schol-ars said.

Within the central bank, wordPleaseturntopageA16

BY LINGLING WEIAND BOB DAVIS

China’sCentralBanker onThin Ice

BY CAROL E. LEEAND JAY SOLOMON

U.S. Presses for World to ActObama Calls for a Coalition to Fight Islamic Extremists; ‘the Language of Force’

Timothy

A.C

lary/A

genceFrance-Presse/Getty

Images

BY JONATHAN D. ROCKOFF

NEW MEDICINE

Drug FirmsRedirect Pitch toHospitals

NEW YORK CITY—“I can’t de-cide if this car is more of a chickmagnet or an old East Europeanguy magnet,” said Andy Burzyn-ski as he maneuvered his limegreen 1985 Trabant through mid-town Manhattan traffic.

Based on the onlookers whowaved and grinned on the jour-ney from Queens,where the 48-year-old engineerlives, it is decid-edly the latter.The only excep-tion was a beam-ing blonde whowalked over while he was stoppedin traffic on 52nd Street to sayshe had grown up with Trabantsin the former East Germany.

Most people just snap photo-graphs or shout “what is it?”when they see—and hear—the re-markably loud 26-horsepower car.

Introduced in 1957 as the SovietBloc’s answer to the Volkswagen,Trabants—more than 3 million ofthem—were manufactured inZwickau, an East German citythat was once home to Audi. De-spite a multiyear waiting list atthe time, sales plunged after thefall of the Berlin Wall almost 25years ago and the last “Trabi”rolled off the line in 1991.

As Mr. Burzyn-ski and other en-thusiasts know, 25years also is theage that allowscars that fallshort of safetyand emissions

regulations to be imported as an-tiques—a must in the Trabant’scase. That means that the lastTrabant models, 23 or 24 yearsold, should soon arrive on U.S.shores.

The Model 1.1, derided byPleaseturntopageA18

BY SPENCER JAKAB

The Trabant Takes ManhattanOn a Tour of East Bloc Nostalgia

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‘Weedwackers in a Plastic Box’ AreCollector’s Item; ‘MacGyveresque’ Repairs

A Trabant 601

President Obama, with Secretary of State Kerry, persuaded worldleaders at the U.N. Security Council in New York on Wednesday toagree to choke off fighters and funding to Islamic State militants.

The Americans knew a lotwas riding on a Sept. 11 meetingwith the king of Saudi Arabia athis summer palace on the RedSea.

A year earlier, King Abdullahhad fumed when President Ba-rack Obama called off strikesagainst the regime of Syria’sBashar al-Assad. This time, theU.S. needed the king’s commit-ment to support a different Syr-ian mission—against the extrem-

ist group Islamic State—knowingthere was little hope of assem-bling an Arab front without it.

At the palace, Secretary ofState John Kerry requested as-sistance up to and including air-strikes, according to U.S. andGulf officials. “We will provideany support you need,” the kingsaid.

That moment, more than anyother, set in train the U.S. aircampaign in Syria against Is-lamic State, according to U.S.and Gulf officials. Mr. Obamamade clear he would only autho-rize strikes if regional alliesagreed to join the effort. Fewwould likely go along if the Sau-dis sat on the sidelines.

This account of that meetingand others leading to Arab in-volvement in the airstrikes waspieced together from interviewswith senior U.S. and Arab offi-

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BY ADAM ENTOUSAND JULIAN E. BARNES

DealWith Saudis PavedWay for Syrian Airstrikes

Mass ShootingsOn the Rise

Source: Federal Bureau of Investigation

The Wall Street Journal

Casualties in active-shooterincidents

0

50

100

150

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2000 ’10’05

Killed Wounded

BLOODY ACT: The FBI said moregunmen have tried to kill largenumbers of people in public inrecent years, with shooters seeking‘an act of catastrophic violence.’ A3

Expanding Conflict Strikes hit Islamic State

oil refineries.......................... A8 Iraq’s diplomatic role poses

risks in U.S. fight................ A9 French hostage is killed

in Algeria.............................. A12

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