 I have talked about networks and edges fairly recently. Connections between nodes often reflect gaps between different industries. This is my chosen definition of innovation--the spaces between industries. Words like innovate, strategy, and value befuddle me. We allow them to morph into self serving interests without feeling required to offer up a definition or at the very least--clarify the context where they are applied. I have taken more than my share of economics classes both at the undergraduate and postgraduate level. The only service of those earlier classes was to provide the lexicon I use daily in deciphering the modern application and even re-awakening of an entire out-dated model. Rethinking Economics is an international effort to reclaim theories for societal good. Here are a few of the books I would recommend, YMMV but your ability for independent thought will be a reward for sticking with any of them long enough to get the gist. An observer from outside a well-worn ideology often asks the questions that need to be asked. In writing about health economics I often challenge the word "value". Value to whom? The health system? Pharmaceutical company? Health provider? Patient? Community? Society? You can see where I am going here. In health economics, value is often defined as a measure of cost-benefit. What about other influencers of value? Value is confined to a measure of cost-benefit utility that obscures the influence of
Discussions of value in health innovation lack a wider and more dynamic understanding of the broader social and political–economic dimensions in which value is created, nurtured, and evaluated.--Mariana Mazzucato, Rethinking Value in Health Innovation: from mystifications towards prescriptions Click on the link above to read the article summarizing many ideas presented in her books and publications. I also summarize some of the thoughts in the blog but with the constant assumption that if you find the thoughts at all compelling you will choose the source over the ruminations. Hearing the prevailing argument about innovation in pharma I also thought it made sense. But when you look at the financial side of the industry you can see the actual amounts directed to R&D, vs. share buybacks, marketing, executive pay--investments not linked to tangible market value. Profits are made from redistribution of wealth not necessarily rewarding public investment at the community level--the real engine of innovation and novel drug development. Available for preorder (delivered in May), The Value of Everything by Mariana Mazzucato dives deeply into how companies are valued according to the amount of wealth captured for themselves rather than for the value they create for the economy. According to Mazzucato, the value-based discussions ignore the role of publicly granted monopoly protections combined with rigid demand curves for the latest life-saving medicines. New medicines are covered by patents. Therefore, operating as monopolists in a given therapeutic Industry accumulates a huge profit margin driven by extended patent protections--not specifically reinvesting innovation or creating value but through financial speculation and shareholder profits. A common phrase at JP Morgan Healthcare Conference sessions, "market expansion" speaks directly to the objectives aligned with disease care--not health care. Rather than reflecting value as conceived of in the conventional narrative, prices are instead artifacts of financial market expectations that are used to maximize short-term growth. The monopoly dimension of health innovation is grafted onto a second dimension: the financial environments in which these monopolists operate. Large publicly traded biopharmaceutical companies are valued on stock markets that are not based on their profits, but on the anticipation of growth in profits over time. Look at price escalation in hep C therapies. As increases in sustained virology response (SVR) are observed they are incrementally tethered to price increases. Comparing each innovation to a prior standard of care mutes the impact of rising prices and their impact on budget considerations.  We need only to read about CAR-T therapies in oncology. According to Table 1 in the article, Novartis set prices at $475,000 and Kite Pharma is pricing > $325,000. The public investment has been described as the following: NIH invested > $200 million to develop the CAR-T technology, 10+ years of investment across universities and research at central Bethesda campus. Novartis licensed technology from a publicly funded laboratory at the University of Pennsylvania, and Kite Pharma received significant support in running clinical trials from the NIH. National Institutes of Health--Mariana Mazzucato, Rethinking Value in Health Innovation: from mystifications towards prescriptions The distinction between creating value and extracting value is compelling. Where is the value creation? "Rather than reinvest accumulated capital into further innovation, companies are increasingly turning to financial maneuvers to boost share price." The hepatitis C case provides an illustration of this phenomenon: If you are lucky enough to have a role in evolving healthcare--think of the nodes. Gathering insights from health economics, policy, clinical research, and medicine provides a rich network. But more importantly think of the connections or edges between them--this is where possibility exists. What is a cynic? A man who knows the price of everything and the value of nothing.--Oscar Wilde
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