Incentive constituency, surrogate outcomes
by Thomas Faunce
Hi All
Jamie, thanks for the opportunity to be involved in this. Here are some initial thoughts, ranging from nuts and bolts to broad canvas ideas. (1) Changes such as those proposed here to the R&D incentives system require a founding constituency, a sector of champions with an appeal to policy makers. The legislation could facilitate involvement of corporate (multinational) non-profits in this area through tax incentives etc. (2) The prize fund system might reward business plans as well as outcomes in terms of QALYS. (3) Prize gatherers and seekers will probably push for outcomes to involve surrogate markers (decreased viral load, improved white cell count) rather than QALYS on the grounds that its easier to get objective data rapidly. (4) Who will organise the ground rules and funding of the outcome clinical trials? (5) Industry is using restriction in the experimental use exemption (Madey) and grant schemes pushing researchers into linkage projects, to limit the capacity for independent public-funded research to gain patents and become self-sustaining. Perhaps a scheme for private-public sharing of patents would be a good initial step. That is, we may need to think of the logic steps to achieve the full Prize Fund, rather than ask for it all straightaway. (6) At the moment governments allocate R&D funds according to national benefit priorities, one of the few areas where they can continue to discriminate against multinationals working in a specific sector of technology (avoiding TRIPS problems) how to convince them to globalise this? (7) Why not fund the prize from a Tobin tax type tithe on global financial transactions...making the global money markets assist the global burden of disease would be more appealing, but may require (8) removing the anacronistic system of national governance through (industry-targeted and captured) elected representatives, rather than voluntarily registered citizen electronic voting on each important measure
Hi All
Jamie, thanks for the opportunity to be involved in this. Here are some initial thoughts, ranging from nuts and bolts to broad canvas ideas. (1) Changes such as those proposed here to the R&D incentives system require a founding constituency, a sector of champions with an appeal to policy makers. The legislation could facilitate involvement of corporate (multinational) non-profits in this area through tax incentives etc. (2) The prize fund system might reward business plans as well as outcomes in terms of QALYS. (3) Prize gatherers and seekers will probably push for outcomes to involve surrogate markers (decreased viral load, improved white cell count) rather than QALYS on the grounds that its easier to get objective data rapidly. (4) Who will organise the ground rules and funding of the outcome clinical trials? (5) Industry is using restriction in the experimental use exemption (Madey) and grant schemes pushing researchers into linkage projects, to limit the capacity for independent public-funded research to gain patents and become self-sustaining. Perhaps a scheme for private-public sharing of patents would be a good initial step. That is, we may need to think of the logic steps to achieve the full Prize Fund, rather than ask for it all straightaway. (6) At the moment governments allocate R&D funds according to national benefit priorities, one of the few areas where they can continue to discriminate against multinationals working in a specific sector of technology (avoiding TRIPS problems) how to convince them to globalise this? (7) Why not fund the prize from a Tobin tax type tithe on global financial transactions...making the global money markets assist the global burden of disease would be more appealing, but may require (8) removing the anacronistic system of national governance through (industry-targeted and captured) elected representatives, rather than voluntarily registered citizen electronic voting on each important measure
4 Comments:
I think the idea of looking for incremental approaches is a good one. It isn't common to get a wholesale transformation of policy in a single blow, so it is useful to think about how an alternative method of funding can be phased in.
What do you have in mind here?
----"(2) The prize fund system might reward business plans as well as outcomes in terms of QALYS."----
It is possible to introduce the prize system as an option, in which case it works alongside the current system. As the reward fund gets larger, it will draw more drugs out of the patent monopoly system and into the prize fund system. This may be a way to introduce it incrementally.
I don't think the voluntary incremental approach for a prize fund is necessarily better, in the US context, for a variety of reasons. But for certain cases involving populations with low incomes, it could be an option. People are indeed looking at this as a possibility for the new WHA initiative, as a voluntary option, and we think it would be preferable to the various AMC proposals being considered by the G8 these days.
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