Innovating for Equity

In “Innovation as a Force for Equity” (Issues, Winter 2022), Shobita Parthasarathy provides an astute analysis of the current innovation system in the United States and calls for efforts to more seriously and systematically link innovation and equity in policy and practice. I agree—but implementing her recommendations will not be a simple matter.

Parthasarathy suggests that the US innovation system “has come to represent a narrow range of interests” (emphasis added). However, that is how the US system was set up from the outset. It hasn’t come to this recently and will be challenging to alter. In the debates over a government role in science and technology during and after World War II, Senator Harley Kilgore of West Virginia argued for allocating government funding based on social need and spreading research funding across the nation. He made reference to broad citizen involvement in setting priorities. By contrast, Vannevar Bush, who we celebrate for creating a blueprint for the National Science Foundation, sought to allocate government resources on the basis of a narrow conception of merit guided by elite scientists. As a result, as Parthasarathy notes, today “most federal funding goes to a handful of universities in a few states … [and] women, historically marginalized communities of color, and disabled scientists receive less funding than their white, male, able-bodied counterparts.” This, in turn, has arguably led to a narrower set of research questions asked, methods utilized, and innovations developed than might have emerged from a Kilgore-inspired system.

In her article, Parthasarathy calls for advisory committees on patent and innovation policy that would bring together a broader set of social interests than has historically been the case. She further urges the establishment of community-based innovation offices in federal funding agencies, attention to equity in determining which science and technology projects the government will fund and support for nonmarket-based approaches to health innovation. These changes are much needed, but we confront a deeply institutionalized system, and as Parthasarathy knows, organizational innovations of the variety she recommends have been experimented with by the European Union, private foundations, and universities but have not moved much beyond pilot stage.

What would it take to move from marginal pilot experiments to formal and more permanent implementation of the approaches Parthasarathy calls for? Likely it would require substantial and systematic pressure applied to the federal government. A year ago, I would have felt certain that substantial reordering and reorganization of innovation policy was not in the cards. However, recent changes at the federal Office of Science and Technology Policy (OSTP) may suggest real possibility. To begin with, President Biden created a new Division of Science and Society in OSTP. That division is tasked with ensuring that all US citizens have “equitable access” to the benefits of scientific and technological innovations. And with the departure of Eric Lander as that office’s head, Alondra Nelson, the head of the Science and Society Division, will, at least temporarily, oversee all of OSTP. These are important developments. If advocates such as Parthasarathy continue to push now, perhaps the nation might see a move toward a novel approach to innovation policy.

Daniel Lee Kleinman

Shobita Parthasarathy makes a compelling case for the comprehensive changes needed to ensure the US health system is equitable for all.

As a health justice attorney working on patent issues for two decades, I share the author’s concern of how our current patent system allows drugmakers to drive up drug prices exorbitantly. The organization I cofounded, the Initiative for Medicines, Access & Knowledge (I-MAK), has undertaken extensive research on the patent assets of many of the top-selling drugs in the United States. Our analysis of 10 top drugs found companies file an average of 131 patents per drug. This allows companies to lengthen their patent monopoly periods and raise prices at whim. For the cancer drug Keytruda alone, we estimated that eight extra years of exclusivity granted through additional patents will end up costing Americans $137 billion. These higher drug prices are not just an economic issue; they are a matter of life and death: in the past five years, 13% of Americans have lost a loved one because they could not afford the cost of treatment, including prescription medication. That figure is double for people of color.

Opportunity for creating structural change to solve for this inequity lies with the US Patent and Trademark Office (PTO) itself. To do so we must tackle the current norm that Parthasarathy aptly describes as: “Patent policies and practices facilitate private sector efforts to build and maintain monopolies over inventions, and then charge extremely high prices for access.” President Biden’s pick for PTO director, Kathi Vidal, is soon expected to receive Senate confirmation. She will then be presented with the critical choice of upholding the PTO’s status quo of prioritizing businesses over consumers, or she could drive meaningful progress toward equity in one of the nation’s most important—but often overlooked—government agencies.

We do not expect her to single-handedly solve these issues. For the past year, I-MAK has been advancing our Participatory Changemaking process to drive forward democratization of the patent system by convening different stakeholders with the ultimate goal of shifting the power dynamics of the patent system, and ensuring that the PTO isn’t just an exclusive club for the few, but a true public agency. We first released a Public Participation Policy Blueprint focused on how to build equity at the PTO by integrating public voices into the patent system. Additionally, our new Strengthening Competition Policy Blueprint outlines several recommendations for strengthening the process to challenge weak patents, instituting changes to accelerate access to lower-cost generic drugs, and facilitating greater collaboration between federal agencies to ensure the quality of patents being issued.

Reforming the US health system requires reforming our patent system. As Parthasarathy rightly indicates, “innovation and health care equity need to be relinked in our public policies.” By prioritizing the public good over private interests, we can create the domestic and global health systems we both need and deserve—where race, economic status, or location does not dictate whether you live or die.

Priti Krishtel