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CLAYTON, N.C. — Farms here once stretched as far the eyes could see. Teens on the cusp of adulthood could look forward to steady paychecks from textile mills.

But now, as Roger Hill looks out from the front doors of Powhatan Original Free Will, the 130-year-old Baptist Church where he preaches, some of the houses of his childhood neighbors are gone, along with the wide-open acres where he used to hunt. The growing footprint of pharmaceutical giants has replaced them.


This small town of 20,000 might seem an unlikely place for the world’s largest maker of insulin to build a stockpile of drugs needed to fight a chronic disease affecting 30 million Americans.

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