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At the start of his second year on the job, Novartis CEO Vas Narasimhan is about to face his biggest test yet: the launch of a breakthrough gene therapy on which he spent $8.7 billion of his company’s cash last April.

Narasimhan, at 42 the youngest chief executive of a major pharmaceutical firm, spent his first year in command (he took over last February) talking about big goals — he wants to upgrade the company’s culture, turning the still-staid Swiss company into something more entrepreneurial — and making deals.

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