Friday, November 6, 2009

Gene Patents, Healthcare Debates, and Information Technology

I just watched David Koepsell up on Grit TV do an excellent interview about the important questions which must be posed before we continue to allow existing patent practices to govern incentives for genetic research. New technologies may require new laws, as we so lately learned about our financial economy! Laws conspire for our common good, and we really wouldn't want to live without them.

Genes continue to be isolated and their "purposes" catalogued, even as the science of genetics poses new questions about any strict code-to-expression correspondence between genotypes and their phenotypic expression. So at least one of my problems is that the thing getting patented already has a problematical relation to its potential uses.

I think if you patent a light bulb, and I want to use it in my Easy-Bake Oven, then I owe you a royalty, if I don't have to buy the light bulbs from you. But if I use the light bulb's glass bulb, say, to make my mini-terrarium, then I think I can go ahead and patent that terrarium and owe you absolutely nothing in return.

Patents on genes are based on a temporary theoretical construct which would have them actually relate-able, directly, to their uses in possible treatments. Now these treatments, perhaps, ought to be patentable, but not each and every ingredient in them surely.

My instincts are with Dr. Koepsell that there is something fundamentally wrong, and against both the spirit and the letter of patent law, with granting monopolies on all products which can be created based on something each of us contains naturally, in our genetic encodings. Not only is it like patenting gravity, but it's like patenting gravity for the purpose of doing hopscotch.

What scintillates in my overtaxed brain though, is that it may also be wrong to parade "victims" of patent monopolies when the very thing these victims seem barricaded away from might not have existed if the owner of the patent wasn't allowed to claim exclusivity in its development. I think that might be the core of the defense argument in favor of patenting genes.

We're talking life and death here, but just because you die in the first days of a stupid war, is your death any more just if they turn it into a good war after your fact? If you get polio before the vaccine, then is there more tragedy because you could have avoided it if only you'd come in contact later? I guess it feels that way, but we shouldn't make too much of emotional appeals against the facts, right?

I can be as hard headed as the next guy about tough breaks. But I think Dr. Koepsell is on the right track that we really need to look beyond the surface of these debates, beyond the application of the law as it currently exists, to the assumptions underneath these laws.

There should be no question that if money is available in one direction, then people won't be looking in some other direction.  That's the gold rush mentality referred to in Koepsell's book. If the money weren't there, there might be a rush in some other direction.

In the public interest, we might want to guide things in directions other from the ones which have the most profit potential. Or we might want certain things to remain protected within our commons, even though there is no natural law which puts them there. Things like highways, parks, the view.

Especially if and when it becomes the case that private profits come along with free rides on publicly born "externalities", we might have to make public adjustments to how patents are granted. Such things as mining public lands, or bringing carbon dioxide out to breath along with the fossil fuel you mine need to be brought inside the price the public charges for the franchise.

We know that there are plenty of diseases which just will never make the corporate top ten because there is either too little incidence or the people affected are beyond some safety barrier of race or geography or, yes, poverty.

Patent monopolies are comfortable when they are granted over widgets of want - things we really don't need, but which would make our lives nice if we could afford them. Granting patents over needs feels a lot like enclosing our commons, and too bad for the peasants which used to graze their cattle there.

Well, so what if we could step ahead in time a beat, to where either all the basic miseries of life have been remedied, and the only tragic deaths are the ones where someone wasn't looking when the train was coming. Up against this fictional time we'd have to pose, for certain, a dystopian alternative where the miseries have been remedied only for those who can afford them, and everyone else is left out in the cold.

From either of these futures, we should be able to look back at the current arrangements for healthcare, say, and find in them something as medieval and grotesque as the insane asylums where we used to "care" for the deranged among us. We will see extravagant and medieval-seeming procedures offered against theoretic certainties of happy endings.

Where once those endings were up in heaven, and therefore we could concern ourselves only with the souls we preserved whatever their screaming present, we now have brought those pleasures seeming down to earth. With strategic silicone implants or chemical pumps for erectile blood, we can even give you the simulation of perpetual youth.

When nothing in the end can really protect us from the certainty of life's ultimate, well, ending.

The dystopian only looks that way because of problems with distribution. And these problems in turn only exist because we hold out the promise of something better. And that something better is only available to the very wealthy. Who, in turn, eat away more of the commons in resources and expertise and, well, care.

I would say that we have already passed that point where it can be demonstrated that most of the impact to collective longevity can and should and must be attributed to nutrition and education and lifestyle and environment. That no matter how much more we spend, we will not change the overall statistics any appreciable amount, and in fact the more we've been spending the more we might be moving in the wrong direction.

In America, we already slip from top spots in longevity, infant mortality, life-style morbidity; and our intense mis-schooling drops the bottom out from educational outcomes. Might it be that in that many aspects of our arrangements the whole is now being destroyed in the interests of a very few?

I'd say there's pretty good evidence.

I don't doubt that there are and will continue to be wonderful and massive paybacks for medical breakthroughs which save lives. These will have no statistical relevance to the overall longevity of the population, unless by funding them, we ignore the less profitable but more impactful changes we should and must make for the good of the whole.

That is to say that fixing the few who suffer from trainwreck diseases, or imagine that they do when old age gets likened to a trainwreck, will not have much impact on the statistics of the whole, and also that fixing these few cannot be done at the cost of the wellbeing of the many who are otherwise healthy.

In the arena of energy, we are slowly coming to realize that cheap oil is subsidized by the potentially catastrophic externalities of global warming, perpetual warfare, and good old fashioned pollution, all of which must be born on the back of the general public.

There is some reason for hope that Information Technology will be both capable to and get deployed for the purpose of bringing some of these externalities into the cost of energy at the point of its purchase. So, you will pay less at night to keep excess capacity humming, and way more for things which carry massive public costs on their backs. And you will be glad to do so because if the price is accurate, then the overall cost to each is brought way down in line with reality.

The derivatives gurus won't get filthy rich anymore at the cost of overall collapse. The owners of the mines won't get filthy rich at the cost of everyone's environment. The sick rich people won't make plastic surgeons filthy rich at the cost of everyone's healthcare expertise, and the plastic surgeons can be re-deployed to help the burn victims and sufferers of genetic disease who really need them.

Simply because the primary care physicians earn the most of all. As do the schoolteachers. In my dreams, of course.

We become jaded by now that there are any economic arrangements which can assure these outcomes. Liberal youth reliably become conservative codgers after we wake up to the fact that grand schemes never work. A bit of greed is fine, I'll agree, so long as the entire house of cards doesn't collapse. Until it does.

Unlike many of my wealthy compeers, I feel pretty optimistic. I think there's actually less corruption in government than there used to be. I think business people tend in the direction of wanting to do good as well. I do think we have a problem with size, as I've indicated plenty of times elsewhere. But I hardly think it's hopeless.

Obama is the first master of the television age. I think he's given the lie to the inevitability of actors becoming presidents, though we still have to work on the beautiful people part which got its start with JFK. These morality plays get writ too large, with Mr. Nixon looking his ghoulish part against the Howdy Doody of Reagan-Bush.

Information Technology will play its part, just as soon as we liberate it from dreams of artificial intelligence. The computer has never been a very good metaphor for the emotive mind. Real minds make all sorts of choices among background noise, and pay attention according to felt tendencies. This is what determines our collective plotlines too, and so we have, right now, the final chance to become authors of our own lives.

So, imagine this: The meter at your house will help you to set the time to warm your heatsink. You can do it yourself with windmill or solar panels, and pump some back into the grid when you're feeling flush.  The closer you are to the point of generation, the cheaper the price can be, since that much less gets lost along the heated transmission lines. And ultimately the entire grid will rearrange and reorganize itself according to what makes the most sense.

The same can and will happen with medical technologies. Some people will always want to make frankenstein monsters of themselves, for fear of losing love. Most people, when provided the right information, will understand that love is not transmitted that way, and that its simulation is pretty short lived too. Expensive treatments can be put in some context, and provided always to the train-wreck victims among us. It will incrementally cost almost nil to each of us.

This, I think, is a future worth aiming for. I have no doubt that one day soon we'll all collectively realize that so-called "single payer" healthcare is the only way to go. We will get over the ridiculous notion that healthcare can be construed as a "good" just like other widgety things. And we'll stop altogether granting patents over what is common. No doubt at all.

That day will come when Google, Inc., has been reabsorbed back into our commons where it belongs. Meantime, they're on the right track, with cloud technologies for medical records, investments in the smart grid, and plays to de-anonymize you. It's almost like what government should be doing.

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