Vincenzo Pavone is a researcher at the Higher Council for Scientific Research, member of the Science and Democracy Network and founder of the Network for Social Studies of Science and Technology (RED EsCTS). We spoke to him during the day on Essential Medicines organized at the Complutense University of Madrid.
Pavone begins his talk on biomedical research and patents, making a parallel between the current innovation system and the automotive industry. He uses as an example the price of a high-end car costing 72,000 euros. “Is that really the price it should have? Those 72, 000 euros are only justified from an ideological point of view. For a car to fulfill its function, petrol stations, garages, roads, driving schools, hospitals, police are needed; without these and other infrastructures the car doesn’t make sense,” he says. “We assume that the cost of these infrastructures must be assumed socially. Considering the effort that public authorities and the community have to make to ensure a functional space, where vehicles can be used satisfactorily, the cost is much higher.” This is an example that different technologies share the same ontological situation.
He stressed in his speech that there were failures in the current system of research and development of medicines that have their origin in the way of understanding the relationship between the State, citizens and businesses. What are those failures?
The flaws are related to the way they connect those three actors. The issue of patents had its logic a hundred years ago when investing and selling a new drug was a difficult undertaking. Attempts were made to reward effort, innovation, originality, risks. Today knowledge is more accessible and risks are shared. A lot of investment comes from public institutions and originality is rewarded too often because patents are granted to medicines that are not very different from what existed before. They’re just a slight improvement. Today, there are no conditions justifying the use of patents to encourage innovation. It’s a problem.
The second is that the patent obsession is creating difficulties in producing knowledge and medicines. Many complex problems are only solved by introducing a new product, to be able to patent it and gain economic benefits. And that’s a limited idea of innovation. Patents, as they are now being used, are a perverse incentive. In some extreme cases knowledge is patented and then they wait for someone to need it to collect the royalties and continue research. That makes innovation slow and more expensive. The innovation system is poorly articulated.
And then there’s another problem that is the benefits that remain only in private companies. All this creates problems when developing new products, but is not recognized. Many public policy documents say that it is very difficult to bring a new drug to market because you have to do a lot of trials , you have to pass many barriers and you have to pass many checks. What pharmaceutical companies are asking for in some cases is to reduce those controls and those levels of safety checks to make the drug market faster. That’s not the problem.
There are many actors in the chain, what is the responsibility each one has?
On the one hand, the state should rethink its relationship with citizenship. Right now the State and the current of neoliberal ideology believes that the role of the state is to use public resources to encourage companies to bring new products to market, patenting them and generating economic benefits and growth, which generates more revenue and ultimately benefits citizens.
It’s not like that. The role of the State should be in the public interests and this involves balancing different interests that may be conflicting. The State should be interested in solving some public health problems and calling on other actors to do this. It should set the agenda for research, especially with public investment. It should be the public institutions that decide how public funds are invested and for what and then call on companies to join. Not as it is being done now, where companies are given money to take research and bring to market what they think is most urgent and beneficial.
That doesn’t stop companies from doing all the research they want with their own funds, obviously. But when there are public funds it must be with a shared agenda, with priorities and conditions set by the State. This requires review and today many left and right political parties are not on the job.
What other actors are involved in this process?
Civil society associations represent specific interests and should be involved in the innovation process, as well as researchers in human and social sciences because most medical, environmental, feeding problems are not simple issues that can be solved with a single technology. These are complex problems that need innovation that is technical, social, political and cultural.
Citizens should be more informed and ask for more information. All the campaigns being run are needed. Scientists need safe working conditions, so they don’t have to be aware of economic problems because that produces temptations. We must be free to be able to tell everyone who contacts us what we think according to our research data. And now we’re going the other way. Under the pretext of meritocracy and quality controls, work is precarious, preventing autonomy and independence.
In this context, how can we strike that balance between public interest and private benefits?
Even with all the criticism of patents, it seems reasonable that those who make the effort to bring new medicines to market will be rewarded, but it has to be done with nuances. It is necessary to know the actual costs of each drug and, in the case of wanting to grant a patent, it has to be a reasonable threshold. For example, 20% more of the costs they have spent.
In the case that it would not want to be transparent about the costs, I would personally not grant a patent and the solution would simply be a market strategy, where there is competition between the various producers of the same medicine.
If it goes down the patent path, all actors who have contributed their own portion of the benefits should be recognized. It is no longer worth saying how this has contributed to economic growth and how citizens have benefited. It’s not true. This economic growth is not equally spread within the population. Everyone who has participated, from sample donors to clinical trial patients, to the public institutions and researchers, should all have access to a portion of the benefit corresponding to the effort they have given to develop the drug.
There are solutions that are not very complex to introduce, but which require two things; that they are made together throughout the European Union and that are made within a new framework of a pact between citizenship, state, science and enterprise. There have to be concrete proposals and an open debate for discussion. Every time an investigator says the State should take the lead, many people say the State shouldn’t enter the market. Why? It has done it until the eighties.