How should we allocate the cost and benefit of medical technology?

How best to ensure access to modern medical technology?

  • Fully privatised. Knowledge is power, therefore all knowledge must be owned

    Votes: 0 0.0%
  • About like we do, it is the "last mile" that is valuable so that should be owned by whoever came up

    Votes: 1 12.5%
  • Fully public. How can you own knowledge, can you own the wind?

    Votes: 6 75.0%
  • Radioactive monkeys should provide all medical care, that will solve the problem

    Votes: 1 12.5%

  • Total voters


Oct 24, 2003
“We wish to suggest a structure for the salt of deoxyribose nucleic acid (D.N.A.),” wrote James Watson and Francis Crick in Nature in 1953 “This structure has novel features which are of considerable biological interest.” [1]

In the 70 years since this was written and the field of genetics was born, vast amounts of money have been spent reading and understanding this code. In recent years we have got to the point of writing it. This is taking the form of gene therapy, using CRISPR–Cas9 to rewrite our genetic code in our living cells. Over the past decade, regulators have approved several such gene therapies, for example CAR-T-cell therapies, which engineer immune cells to treat cancer. Hundreds more are in clinical trials. A lot of money has been spent to get from that DNA structure to the knowledge to treat cancer by changing the genes of immune cells. The vast majority of this money has been spent by taxpayers on government funded research, with some small slither (I would guess ~1%) spent by the pharmaceutical industry, almost exclusively on the "last mile" of research that is defined as patentable.

These therapies typically cost something like US$1 million for a single treatment, and has a very low marginal cost. Ie. once we know how to do it and have got the system and the people operating well we could treat as many people as need it for not much more money.

This results in a system where the patents for the technologies allow a vastly profitable monopoly and we have many companies struggling to acquire patents on this novel technology. This has all sorts of downsides for the research itself, including incetivinging secrecy in their research, resulting in a complex web of patents inhibiting innovation (see the image of the companies that have IP in the COVID vaccine below [2]) and generating considerable uncertainty when legal battles take years to make their way through the courts [3].

The big downside of course is that we as taxpayers spend so much money on drugs and other medical treatment, and do not get enough of it. Of all the money we spend on patented drugs, only 5% is reinvested by the pharmaceutical industry in drug research [5] and most of the world does not have access to all the drugs they need.

What could we do about it?

We could nationalise this IP. This could look like declaring some aspects of this unpatentable, such as a technique that derives the information from the patient are not covered by patents (so drugs would be OK, but you cannot patent a technique for gene editing). It could look like some sort of patent pool, like in the early airplane industry [4]. It could look like just ignoring patent restrictions on important medicines, like India does [5].

If we were to go the right wing way, that could be to extend out ownership to all science. Give everyone or every institution the rights to commercialise anything deriving from their published work. I think this would fail, either by being totally unenforceable or by completely destroying any scientific advance. But perhaps it would work, perhaps government funded research could be published under a copyleft licence equivalent to the GP, and only people who did not want to share would have to worry.

Or are we doing it just right? This is just the optimum way to split the problem between the public and private sectors, and any change would result in more people dying in the future if we did not encourage the private sector to invest in this tiny bit of the whole problem?


[1] Watson Crick paper from 1953 (paywalled) Sci Hub (blocked in UK)
[2] Covid vaccine patent web paper
Spoiler Image :

[3] Crispr Patent Wars
[4] Patent pool solution to Wright brothers patent war
[5] Reference is a 1 hour 23 film about the drug industry with particular reference to HIV/AIDS
Spoiler Fire in the Blood :
[6] Article that prompted post
[7] Radioactive monkeys?
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As covid showed us, if you fund the science the cures can come fast. It should be a mission of our civilization to publicly end disease.
I have a middle of the road position whereby (1.) research funded by the state ought to be publicly and freely accessible, (2.) redundant efforts should be reduced as much as possible, and (3.) the regulatory structures in place should benefit the public but also not disincentivize private development.
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