Healthcare is a system many of us seek to change. But what might actually be happening? We are slowly being changed by the system. What if we succeeded in improving health across our nation? Hospitals would close, economies would shift, and profits would diminish.
What happens if we reimagine patent law and large profitable pharmaceutical companies are challenged to introduce generic and more affordable drugs onto the market much sooner?
Introducing a little transparency into the actual costs borne by industry would allow better solutions to be developed and imagined. We shouldn't ignore the research & development in academic settings and how that is funded by tax-payer dollars. No. Not in every case but we aren't allowed to fill silences with perturbations of a system where so few profit at the expense of all of us.
What if we stop believing that innovation is fueled by economic excess instead of economies of sustainability, technology, and viability?
Have you ever heard an industry client question the profits they are making on their blockbuster drugs or only lamenting that they deserve the windfall because of other pipelines that were silently halted?
And I basically became very interested in the silences, what we were not allowed to talk about or what we, just by custom, didn’t talk about when we came together to talk about making the world better.
Read the latest headlines about Michael Bloomberg's ginormous investment in the Johns Hopkins? Anand also asks why not question a system where billionaires have so much excess to donate?
Working at the level of systems means that problem components are in interdependent and constantly changing relationships. Linear approaches that address one component or factor at a time are inadequate in addressing dynamic conditions.
I am working on a data literacy project where I am investigating the opioid crisis integrating data many have not considered. The question posed by Anand again is chilling and speaks to the larger driver of a crisis looking for linear solutions--that won't work.
Working as a consultant I was once jokingly accused of heckling the very client that hired me to provide expertise in immuno-oncology. I didn't see it that way but I was never brought in "live" again. The company, in my opinion, had made a bold choice in pre-clinical formulation regarding the FC region that triggers cell-mediated cytotoxic effector functions--in particular antibody dependent cellular cytotoxicity (ADCC).
I requested the pre-clinical data so I could review and see if there was perhaps a unique aspect of this particular molecule we could highlight to help differentiate a "not first to market" investigational drug. When I received the document, the section I requested was not included. I found this interesting but was dismissed and never saw the information. After a few conversations that included "mansplaining" from an apparent team Google search I could see the consensus irrevocably leaning toward the status quo--I dropped it but still recall how little we are willing to probe when trying to secure the next round of business.
All around, us the winners in our highly inequitable status quo declare themselves partisan of change. They know the problem, and they want to be part of the solution. Actually, they want to lead the search for solutions. They believe that their solutions deserve to be at the forefront of social change. They may join or support movements initiated by ordinary people looking to fix aspects of their society. More often, though, these elites start initiatives of their own, taking on social change as though it were just another stock in their portfolio or corporation to restructure. Because they are in charge of these attempts at social change, the attempts naturally reflect their biases.
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”