Photo by Mackenzie Johnson.
The United States consumes an incredible amount of health care resources, spending more on health care than any other high-income country. Much of this spending is occurring in the biotechnology sector towards the development of new healthcare technologies. As a result, the United States serves as an engine of innovation for the rest of the world, with many of our most powerful drugs and medical devices coming from the American biotechnology pipeline. However, over the past two decades, the biotechnology industry, driven by the profit motive, has innovated extensively without significantly improving our public health. Healthcare commoditization, while accelerating the production of medical technologies, has created a system that creates profitable innovations over those that are socially beneficial and equitable. In turn, the medical-industrial complex emerging from this process is rapidly destabilizing the healthcare ecosystem.
Many health care economists have recognized the dangers of over-commoditizing the industry. However, the biotechnology sector is poorly regulated compared to many large industries. Why is this the case? Unlike almost all other materials, Health care is directly related to our death and dying. The failure to regulate the industry flows directly from the reasons that feed this dying concern. In particular, the industry claims that increased regulation will stifle innovation and directly harm human life. Some have even said that the Medicare caps are the “moral equivalent of genocide.” This ideological victory has made the industry attractive to investors due to its relative immunity from regulatory policies. These companies further bolster their argument by associating profits with innovation, when in fact it has been shown that innovation does not directly increase revenue. In turn, overinvesting in health care innovation diverts valuable resources from equity efforts. Instead of distributing new innovations evenly, our most advanced technologies require only those who can afford to pay for treatment.
The new “miracle” GLP1 agonists (Ozempic, Mounjaro, Wegovy) used to treat diabetes/obesity are a prime example. These drugs, while innovative, don’t do much to move the needle on improving public health. Their benefits end when treatment is discontinued, thus requiring continued use, and guaranteeing lasting profits for producers. This “magic bullet” mentality relies too much on quick-fix solutions, ignores the root causes of health issues and exacerbates health inequities. At the same time, traditional and inexpensive diabetes drugs, which have proven long-term effectiveness and are very cheap, are often under-appreciated and underutilized. This misalignment prioritizes profit and innovation over the equitable dissemination of essential and cost-effective treatments.
Not surprisingly, the pharmaceutical lobby spends most of its efforts fighting measures that seek to more equitably distribute drugs and expand access to care. They know it exists There is no possibility Providing their expensive emerging technologies equally without limiting revenue. Recognizing this, the industry is exploiting our collective mortality anxiety to push for regulatory action.
What would an appropriate response to the future arrival of medical technologies in the United States look like? Meanwhile, a central regulatory agency, operating under the FDA, evaluates newly approved drugs to determine appropriate production levels for drug manufacturers. The agency will then allocate this product to patients, prioritizing both need and equity (similar to an organ transplant network). Such a system would work best within a robust public health care framework (eg, single payer) that could regulate the use of these medical technologies to balance individual autonomy with social justice.
The dominance of the health sector by commercial interests ensures that the primary goal is profit, not health. The goal then is to innovate continuously and in areas that are socially necessary rather than profitable. So yes, there may be few innovations, but the innovations that do occur are necessary and spread through the platforms that exist to distribute technology equally. We must not be swayed by the pharmaceutical industry’s callous appeal to death-anxiety. We must not allow these companies to continue to hide behind the cloak of sanctity. And, as with any advancing technology, just because we can innovate in healthcare, doesn’t mean we should.
The biotechnology industry is to be reckoned with and only through an honest assessment of both our great technological strengths and vulnerabilities will we be able to maintain a sustainable healthcare infrastructure.
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