March 1, 2022

Podcast

Episode 9: Maximizing the Good of Innovation

By Issues

The United States is justifiably proud of the accomplishments of its taxpayer-funded biomedical innovation system. But these innovations don’t benefit all Americans equally, which means, among other things, that the richest live 10 to 15 years longer than the very poor. In this episode we speak with Shobita Parthasarathy, a professor at the University of Michigan and director of the Science, Technology, and Public Policy Program. Parthasarathy explains how to think differently about the country’s innovation system—by removing societal bias, rethinking patents, and ensuring equitable access to medical advances—to allow all Americans to thrive.

Transcript

Lisa Margonelli: Welcome to The Ongoing Transformation, a podcast from Issues in Science and Technology. Issues is a quarterly journal published by the National Academies of Sciences, Engineering, and Medicine and Arizona State University. I’m Lisa Margonelli, editor-in-chief of Issues in Science and Technology. And on this episode we’re talking with Shobita Parthasarathy about innovation. Shobita is a professor at the University of Michigan, where she’s a director of the science, technology, and public policy program.

In her Winter 2022 Issues essay, “Innovation as a Force for Equity,” Shobita argues that bold, systemic change is required to ensure that innovation serves everyone equitably.

Shobita, thank you so much for joining us today.

Parthasarathy: Yeah, I’m excited to do so.

Margonelli: You wrote this wonderful piece for the Winter Issues in Science and Technology called “Innovation as a Force for Equity.” And I wanted to talk to you a little bit about what you were thinking and what we mean when we talk about innovation.

Parthasarathy: Yeah, sure. I have been working in and around questions of innovation in my entire career on some level. My first book was Building Genetic Medicine, and in that I was looking at genetic testing, and I kind of followed one genetic test for breast cancer. And then through that case, learned about and eventually intervened a little bit in the discussions around human gene patents and also became completely fascinated by the patent system and stories we tell ourselves about innovation and the things we don’t talk about when it comes to innovation.

I suppose, as somebody who is really dedicated to the project of equity and justice in the world, I don’t think we talk enough about what the responsibility is in science and technology and science and technology policy. So I wanted to kind of think really hard about that.

Margonelli: One of the things you mentioned in the piece is that the top 1% of the country by income lives on average 10 to 15 years longer than the poorest 1% of Americans, which is an amazing figure. Especially considering that all of us are taxpayers, and we spend a lot of money and are really proud of all of our biomedical innovation. We spend, I think, $45 billion a year on biomedical innovation. What are the things that our innovation system innovates for—if not for equalizing society?

Parthasarathy: I think it’s sometimes hard to talk about and think about, and I kind of put that caveat here because I might be saying some controversial things, but it requires us to be critical in ways that I don’t think we’re necessarily accustomed to being when it comes to science and technology. I really do think that it maximizes the good of expanding the scientific workforce. And I think when I say that—

Margonelli: What does that mean?

Parthasarathy: Right, so what I mean by that is that we’re really selecting for basically the priorities of scientists and the priorities of the marketplace. And I think that we—now I’m taking off my hat as a scientist and putting on my hat as a member of the public, let’s say—we’re taught that those are public priorities. We’re not taught to kind of unravel those things.

But if we actually unravel them, we see that at the very least I would not argue that the scientific community is representative of the needs of the public, right? Certainly not racially or in terms of gender or in terms of socioeconomic status. And so the kinds of problems that scientists may think are important, they might be interesting, elegant solutions, they may be cutting edge in the context of their fields, but they may or may not actually be addressing the problems that publics think about and see.

Margonelli: So, how does the public get in there?

Parthasarathy: Well, ideally, I think we need to actually engage publics at the very earliest stages of discussions about scientific priorities. And I mean that really at the outset. What should the priorities of scientific funding agencies be? How should we evaluate the kinds of things that we fund and not? How do we evaluate success in a scientific study? Those are places where I think that publics can play a really important role.

We tend to think of publics as the recipients of our knowledge, right? We talk a lot increasingly about scientific communication as a means—we want to make sure that publics are believing and engaged and interested in what we do. But I actually think that if we really are interested in service, and if we’re interested in making everybody’s lives better, then we have to acknowledge that publics often have knowledge about their lives that we, basically as elites—certainly at research universities; we’re generally pretty privileged—that we don’t have easy access to. And we live very different lives.

Margonelli: So, it seems to me that what you’re talking about is that right now we conceive of those people as patients, like you call them publics, but we consider them as either citizens who pay taxes into the system, or we think of them in the system as patients where they’re seen as consumers. Every time I go to my asthma doctor, I get this horrible quiz afterwards about whether or not every single person I encountered in the office was polite to me. And it’s like, that is actually not what I care about at all. I do not see myself as a consumer of this.

But the way that we framed what health care is, and what biomedical innovation is, is around the idea of commodities and consumers also. Can you talk a little bit about how, for example, trying to work on asthma by thinking mostly about sprays I can put down my throat is a different way of conceiving of the problem than if you came at it not trying to sell something?

Parthasarathy: I talked a little bit about this assumption that our innovation policies should be made with the scientists’ priorities in mind. And one of those things is, of course, that science, through its hypothesis driven approach, hypothesis testing driven approach, and its focus on generalizability, right? There’s a real focus on developing truths that can then be scaled. And that dovetails really well with market priorities. But what’s interesting is that the generalizability that scientists go for and the scalability that markets go for kind of work in tandem with one another, and it’s almost like they kind of supercharge certain kinds of solutions over other kinds of solutions.

So, in the context of asthma, which I talk about in the article, we are then oriented towards an inhaler. And if we’re oriented towards an inhaler or particular kinds of pharmaceuticals, then we’re also tied to a particular pharmaceutical complex—whether it’s monopolies or intellectual property-driven monopolies, what have you, the prices that the market sets—as opposed to structural solutions. We tend to think that the market solutions not only are scalable, but they’re standardizable, that makes them better, they’re simpler, there’s the simple technological fix. And we tend to see the changes to the built infrastructure, changes to the environment, which we know are likely to be also useful—certainly in the context of asthma—we see those are more complicated, more difficult to actually implement.

But the problem, of course, is that there’s an inherent inequity embedded in that, right? Because a commodity is going to be more accessible to people who have more financial privilege, and changes to the built environment are going to be more available and accessible to everyone. And those are the kinds of things that we don’t really talk about.

I think it’s absolutely important, and I do talk about it in the article, that we need to think differently about health care access. We need to think about availability of health technologies and innovations early on in the design process. But I also think that part of the issue here is that we’re a little bit too focused on commodifiable innovation, and trying to lower the prices of commodifiable innovation isn’t going to get us all the way towards our goals in terms of equity because there are going to be large parts of our population who are never going to be able to afford or access some of these technologies.

Margonelli: Another thing that you brought up in your piece is that some innovation doesn’t just sort of ride on the coattails of inequality, it actually amplifies it, and it kind of amplifies a bias that’s found elsewhere. Do you want to talk about that? Can you tell me how that comes into play, and then how do we start to kind of turn this giant ship?

Parthasarathy: Right, I fully acknowledge it’s a giant ship. I think there is a huge body of scholarship in the field of science and technology studies, which is where I’m coming from, but now in a variety of other fields, that shows that values are embedded in technological design. That’s been demonstrated in all sorts of ways. And I think that what that also means is that societal biases are embedded in technological design. And for some that might be surprising or shocking. We tend to think that, OK, maybe humans are biased, but technologies are objective. They’re unbiased.

In the piece, I talk about the case of the pulse oximeter, which you know is on everybody’s mind in the context of COVID, which works by light refraction. So, if you thought about it for a minute, the most obvious conclusion would be, “Oh yeah, if it works by light refraction, then the skin tone is going to affect that,” right? But nobody was thinking about that. And I’m not sure how many people are really thinking about it now.

But interestingly, in the spring of 2020, a colleague of mine at MIT wrote a piece that said, “Hey, wait a second, I think that there’s probably some bias in this technology that has now become absolutely essential to COVID care.” By that point, I think the article she wrote came out in the summer, I was aware that in Detroit there was an emerging story of how a number of Black people were being turned away from the hospital—and later dying of COVID. And I hadn’t followed those stories in detail, but invariably the stories have some component of the blood oxygen being checked. The blood oxygen is usually a measure of whether or not somebody has severe COVID, and it’s used around the world.

My extended family members in India were using the pulse oximeter, and I know this because they now say, after I’ve written about this case a couple times, they’re like, “Hey, wait a second. I didn’t know.” And we haven’t actually talked about this beyond Black and white.

So, she published this article and actually a group of University of Michigan physicians did a quantitative study and found that, in fact, the pulse oximeter was less accurate among their Black patients. That is, it undercounted the blood oxygen for Black people. And now, in that particular case, you have a technology that is never really interrogated. So, it is able to use its monopoly position, including its intellectual property position, to prevent anybody from questioning its accuracy, from looking at the data on which it’s based its technology.

What I want to suggest by using that particular example, is that we tend to say, “Oh well, these are questions that should be addressed by the regulator,” right? In this case the Food and Drug Administration. Well, it turns out the Food and Drug Administration doesn’t regulate this sort of thing. But even if it did, I think these kinds of concerns are far too important to simply leave to the regulator. These are the kinds of things that we should be considering from the outset. At every stage of the innovation system, these kinds of questions that are, in this case, particularly easy, we need to be asking.

And it’s by far not the only example of this, so another famous case is the spirometer, which actually has embedded in it race correction software that, again, assumes that Black people naturally have inferior lung capacity to white people.

Margonelli: The spirometer, if I can just interject, is used in treating asthma. So, every person with asthma who goes in to any sort of institution is asked to breathe in to this machine and then the software apparently corrects according to very biased tables about what can be expected. Which would affect how they’re treated and even the sorts of treatments that they’d be eligible for.

Parthasarathy: Exactly. Exactly. And we’ve seen this sort of thing. It’s come up more recently in terms of discussions about concussions and the NFL, it comes up with assessments of kidney function in terms of transplantation. Again, these are just the cases that we know about because there’s a collision of events that leads somebody to raise a flag and that flag to be recognized by others. I think the point is that this is there all the time, it’s everywhere, and we need to become more sensitized to it. The costs are great and, to my mind, yes, it might mean that the pace of innovation is a little slower. It would require a little bit more reflection, assessment, attention at early stages of innovation. But the benefits are vast, again, when it comes to equity.

Margonelli: I think it’s really interesting just to sort of go a little level deeper. The story that you tell in the article about the pulse oximeter is interesting because originally the first developer of a pulse oximeter was Hewlett-Packard, and they had actually done fairly elaborate studies to make sure that it worked with different skin tones. And then when another upstart company began doing it, and also pulse oximeters that were ripped off started showing up in the market at much cheaper prices, you had no oversight, no monitoring. People are just sort of accepting this piece of innovation into their lives and assuming that it’s accurate without really any way to calibrate it at all.

Parthasarathy: So, I think what’s so interesting about what you just pointed out, I don’t draw this out in the article, but I think it’s really crucial and relates to the question you asked at the outset and something I think about a lot, is how the culture of innovation has changed, especially in the last 20 to 30 years. So, when you’re talking about Hewlett-Packard, I’m sure that many people in Silicon Valley would scoff at a company like Hewlett Packard, they’re the old guard, they’re slow, they’re these old technologies.

Margonelli: They didn’t move fast and they didn’t break things.

Parthasarathy: They did neither of those things. Certainly not in the case of the pulse oximeter. And now, right, we cultivate a culture, we certainly aspire to a culture that moves fast and breaks things because there are so many problems and everything needs to be fixed. But there’s a cost to that. There’s a real cost to that. And in some of the other work that I’ve been doing recently, it’s really become apparent to me that that “move fast and break things” is implicitly a critique of the state, of the role of the state.

And you see this year very clearly, it’s not that this upstart company takes advantage of the fact that in this new moment nobody is paying attention, and the culture doesn’t want people to pay attention because they want fast, exciting innovation. And there’s an assumption built into it that it has to be better than what came before. Not only is it not clear that it’s better than what came before, it hides all of these really potentially problematic dimensions.

Margonelli: So, one of the things that you propose in your article is that we could sort of reengineer our innovation system for equity. And it’s just striking. There’s billions of dollars going into the biomedical innovation system in particular, and I wonder, how do we turn that big ship around and make it work better for everyone?

Parthasarathy: Well, I think it starts with some courage.

Margonelli: Actually let’s back up one second. What you just said about the importance of the state is really key. The state kind of has to say, “Hey, we’re big. We represent everybody. We’re paying out all this money. We need to get something back.” The government, the taxpayers paid money for a lot of patentable medicines that now are very expensive for people to buy back. So, start by talking about the state, and then let’s talk about who’s an expert.

Parthasarathy: Yeah, this is a preoccupation that I’ve had in different ways for a long time because I think one of the things that I identified in the patent book, I sort of foreshadowed this before, is that certainly in the US context, there is an assumption that the private interest and the public interest are the same. And while there are ways in which innovation policy generally, and patent policy more specifically, have converged internationally, at the root I actually think that we see from other countries that they—most other countries see these as distinct, the public and private interest. In the US we really don’t.

And not only that, we kind of leaned more and more into it, perhaps as we’ve become more frustrated by political polarization and gridlock, some of us have felt more alienated. I understand all of the critiques of the state, but the bottom line is that there really isn’t any other unifying force that can represent the needs beyond the private sector, and there are many. And that is what the state is kind of meant to do.

So I want to resurrect that. I want us to think clearly about that, and I think it may be easier, it might be more straightforward, in regulatory domains. People are already thinking in those ways. But I think in the innovation system specifically, that’s really, really hard because we are so structured, certainly our science funding agencies, whether you’re talking about the NIH or the NSF or Department of Energy, etc., these agencies assume that the way to achieve technology for the public interest is through the marketplace, is through technology transfer offices.

And I’m not suggesting that that isn’t a place for that, but I think at the first level we have to reflect on—I mean, I would argue that it’s not the only place. There are many, many other potential ways in which we can benefit the public with technology or with innovation that may not be a technological solution at all, and that the science funding agencies have an opportunity, I think, to explore those kinds of interventions, for example, as I suggest in the piece, with offices that are dedicated to things like community-based solutions or non-market-based solutions that are actually going around looking for and trying to cultivate those things, these agencies that work really, really hard most of the time to argue that they’re outside of politics, right? And to demonstrate that.

I think my take on that is perhaps surprising, which is, I think that these agencies are always engaged in politics to a degree, and that the choice to focus only on the market as the mechanism for ensuring that their science achieves the public interest is itself a political choice. And it’s actually leaving a lot of people out.

Margonelli: We think our current obsession with innovation seems very, very now because we’re right in teeth of innovation. Everything’s happening all around us and last week it was Facebook, this week it’s the metaverse. But our cultural interest in innovation goes right back to the founding of this country. And in your book, called Patent Politics, you look at how this particular view of innovation was very much baked into the very initial founding documents. The patent office was one of the first things they set up. It was the only manifestation of the government in some ways. And it’s funny, once I started thinking about the patent office, everything around me says “patent pending.” There’s patents listed on everything. It’s so ubiquitous we don’t see it.

So, we tend to think of patents as a bureaucratic stamp of approval maybe from the government or, “Yes, you own this,” or a formality at the very least. But they encode a lot of ideas about moral society. Can you talk a little bit about that?

Parthasarathy: Yeah, sure. So, I would say that some of us think about patents as kind of government certifications. We think also of patents as themselves signifiers of innovation, right? Because you got a patent, it’s extremely innovative. Think about the number of advertisements that you see where they talk about how this “patented technology” or “there’s a patent pending on this technology.” It is, in essence, not only a sign of innovation, but also kind of a government certification of the morality of that innovation, right?

And I think that that is something that, certainly if someone in the administration of the Patent and Trademark Office is listening to this podcast, they would say, “Absolutely not. It is not moral at all. It has nothing to do with morality.”

Margonelli: It’s expertise.

Parthasarathy: Yes, “It’s purely a technical certification.” As I was saying before, it is essentially saying that “We are trusting the inventor in operating for the public interest. We believe that this is the way that we should build our society by investing, by providing.” So, remember, what a patent is is that it provides to the beneficiary a right to commercialize their invention for a limited period of time. Today it’s 20 years.

And so it’s essentially the government saying, “We are trusting this inventor to commercialize this technology. We think it’s really important, and we think this is the way that we’re going to benefit society, build the economy, by creating new markets, and the technology itself is going to be good.”

And in the process, it actually is erring on the side of saying, “We want more technology and we don’t mind if it’s,” for example, as I talk about in the book, “a patent on human gene or a stem cell or genetically modified organism or, for that matter, a genetically engineered human embryo or COVID-19 vaccine.” Whatever it is. If we accelerate the conversation and think about an issue that has been top of mind for many now, the question about the patents on the COVID vaccine for example, by providing that patent, it is more than just certifying that it’s novel, non-obvious, inventive, etc.

It’s about saying, “This is such an important technology that we think this person should have a monopoly on it”—at the expense of people who might not be able to afford it, at the expense of people who need the vaccine and can’t get access to it, and other providers who might be able to offer this, both in the United States and elsewhere. These are moral choices. We can call them technical choices if they make us feel better, but I actually think that that obscures really, really important moral choices that we’re making.

And it’s more complex than just saying, “Oh, they’re captured by big industry.” I think that just like the science funding agencies we were talking about, they’re captured by, in fact, this idea that the work that they’re doing is actually technical, right? So, the problem is that they assume that the work that they’re doing is technical, and so it prevents them from really grappling with the moral consequences, the moral dimensions of what they’re doing and the moral consequences of what they’re doing. And that’s actually the problem.

Yeah, corporate capture ends up being a result because who has more technical capacity: your environmental justice organization or Monsanto, for example? Obviously it’s going to be Monsanto, right? So, it’s tilted in that direction. Obviously I could talk about this forever.

Margonelli: I think this is the beginning steps of starting to really do what you say we need to do, which is to reimagine innovation, rethink what its moral obligations are, rethink how it happens, who does it, whether it’s low tech or a commodity, whether it’s about better lives, what is innovation? I want to thank you. This has been such a fascinating conversation. It’s been really a trip into how we come to think the way we do about innovation.

Parthasarathy: It’s been really fun. Thank you so much for having me.

Margonelli: Thank you for joining us for this episode of The Ongoing Transformation. And thank you to our guest, Shobita Parthasarathy, for talking to us about reimagining innovation. For more of Shobita’s work, read her essay, “Innovation as a Force for Equity,” in the Winter 2022 edition of Issues in Science and Technology, and visit her website at shobitap.org.

Check our show notes to find links to these articles and more. Please subscribe to The Ongoing Transformation wherever you get your podcasts. Email us at [email protected] with any comments or suggestions. And if you enjoy conversations like this one, visit us at issues.org, and subscribe to our print magazine. I’m Lisa Margonelli, editor-in-chief of Issues in Science and Technology. Thank you for joining us.