Why do we do what we do?

I recently came across a rather thought-provoking essay by Arundhati Roy in which she mused on the long-term impact of representative democracy and what it has become in modern society. Below is an excerpt:

The question here, really, is what have we done to democracy? What have we turned it into? What happens once democracy has been used up? When it has been hollowed out and emptied of meaning? What happens when each of its institutions has metastasised into something dangerous? What happens now that democracy and the Free Market have fused into a single predatory organism with a thin, constricted imagination that revolves almost entirely around the idea of maximising profit? Is it possible to reverse this process? Can something that has mutated go back to being what it used to be?

While the wording is perhaps a little extreme, Roy brings up an interesting question: what happens to an idea when its practice has drifted far from its original ideals, motivations and practices? The various medical industries in the United States, be they concerned with bio-tech, pharma, med-tech or healthcare, have grown into one of the most conservative and profit-driven sectors in the marketplace. This is all somewhat odd given the very fundamentally social nature of health work in general, but what does this mean for the future?

The interplay between pharamaceutical companies, hospitals and the health insurance system has yielded a care-delivery infrastructure that is grotesquely inefficient. Medical technology and pharma/bio-tech companies have grown tremendous patent portfolios in an attempt to stave away competition and a focus on high-margin products with proprietary reagents has left many areas of need (diseases and geographic regions) woefully neglected. Even technology development programs with a focus on technologies for the developing world follow the same patterns: a focus on controlling intellectual property and exclusive licensing to private-sector partners. While these systems have undoubtedly seen some success, one must wonder whether there mightn’t be a better way.

Why can’t we encourage competition rather than fight it? More players in the market means lower prices and more innovation as a necessity. Why can’t publicly funded research be placed into the public domain? Taxpayer dollars paid for the technology, removing a great deal of the risk that patents normally are meant to reward. Why do we start businesses in this space to maximize financial return? Shooting for financial sustainability and focusing on social return would encourage business practices and technology development that, in the end, would reach the most people quickly and cost-effectively. Isn’t that why we do what we do?

The truth is, there’s no real reason why we can’t do these. The infrastructure that currently exists to start and fund technology development and care delivery efforts are heavily biased to support the current standard, but that only makes things difficult for entrepreneurs- not impossible. Besides, if these things were easy, well, where would the fun be in that?