Ethical Perceptions

March 9, 2008

I recently finished up an introductory class in bioethics. This was a great class, and being able to take a break from the daily rigors of science, engineering, and business concepts and actually contemplate the ethics of those things was a welcome change of pace. It was something truly unique that I don’t think you’d get anywhere else but KGI. Our last discussion revolved around the ethics of drug pricing and what is an ethical pricing practice for life saving medicines. Several times the professor made the observation that the biopharma industry was fundamentally different in the way the public perceives it with regards to price and profit and that there were different ethical considerations with making therapeutics as compared to Dell making laptops or BMW making cars.

I got to thinking about this and after some thought; I think I don’t agree (sort of). Many students in the class have the opinion that the fundamental function of a company is to earn profit for their investors and if that is true than perhaps the answer would be yes, biopharma has different rules, but I think that’s not quite accurate. I think the real fundamental function of a company is to maximize shareholder value and that is different than monetary profit. Profits are contained within value but are not synonymous with value. Shareholder value is exactly that, what the shareholder values. Most of the time that value is dominated by the desire for more money but it contains a lot of other little things in there as well. In the case of biopharma, the fundamental definition of value is the same as Dell or BMW, it’s just that the pie chart of value is divided up a little differently since you are dealing directly with peoples well being. In this case, medicine relates to our need for self preservation at a much higher level than greed does so the pie slices are divided up differently than normal and that is where ethical issues arise. BMW still has that self preservation pie slice but it is smaller since a car’s fundamental purpose is not to save life like a medicine’s is. The funny thing is, if you really think about it, bad engineering in a car can kill just as quickly as a faulty drug can and improvements in engineering in a car can save just as many (or more) lives as a new drug can since we are exposed to cars at a much higher rate than medicines so the aggregate effect can be much larger. For some reason though, the fear of bad engineering or the heroism of good engineering in a car doesn’t play on human emotion as much we fear disease and honor medicine. I think the reason for that is the very same thing that differs driving from flying. Statistically, flying is much safer than driving, yet way more people get nervous stepping onto a 737 than traveling down the freeway at 70mph in a 2000lb steel can. Why is that? It’s the unusualness of the experience that does it. Flying is way more unusual than driving so it gets special attention in the human unconscious mind. The same thing goes for drugs. When we encounter them it’s an unusual experience in our lives and it gets special attention and that is why our ethical perceptions are different about them. In fact, that is where the root of the ethical conflict arises about drug pricing. Pilots don’t get nervous flying because it’s not unusual to them. Similarly, people who work in biotech are exposed to the issues every day and understand why the metaphorical biotech plane flies so their usual experience is at odds with the unusual experience of their customers.

So what does this have to do with sustainable biotechnology? Well, that same bioethics professor would from time to time make comments comparing making life saving drugs to making widgets. I would always think to myself, “but I want to make widgets! Am I any less noble?” And you know what; I don’t think I am any less noble than the students going into biopharma. Widgets may not be sexy, but like the car, they have a much larger aggregate effect on human life. I could have asked that class for a show of hands of how many took a medicine or used a medical device that day and gotten a few hands. Then I could have asked for a show of hands of how many students drove a car powered by fossil fuel (probably all), or how many used non-biodegradable Polyethylene terephthalate containers (most), or how many walked on carpet made from Polypropandiol terephthalate (all), or how many used bleached paper (all). The point is, being “green” or “sustainable” really boils down to a conscious attempt to recognize and evaluate the ethics of our infrastructure, those things that are by nature, usual to us and therefore not immediate to our minds like flying or medicines. It is the opportunity to think extraordinary thoughts about the most ordinary things. It is the ability to be heroic with the very mundane. I think that is pretty noble (and pretty cool).

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