Ten years ago, Victoria Hale wrote a manifesto targeting five diseases in need of drug development and turned it into a business plan for the first pharmaceutical not-for-profit in the United States. Today, her organization, the Institute for OneWorld Health, is on the verge of proving that its no-profit/no-loss model can work. Its first drug, paromomycin — a treatment for visceral leishmaniasis, an illness spread by sand flies that mostly afflicts the poorest of the poor — is months from completing its final stage of clinical trials. Up next: malaria. Backed by a $42.6 million grant from the Gates Foundation, OneWorld Health aims to create and market semisynthetic artemisinin, a key malaria-fighting ingredient that's in short supply.