Let me begin this medical seminar with a pop quiz. Which one of these words best describes Jonas Salk: (a) Altruist, (b) Pure Scientist, (c) Chump, or (d) All of the Above. This is not exactly a trick question. You see, the man who discovered the polio vaccine never made a penny from it. When asked who owned the vaccine, Salk answered, "the people."
This scientist didn't live in obscurity or die in poverty. But what would have happened if he'd begun his research today? Would the funders and the institutions have preferred that he apply his genius to a cure for baldness or impotence rather than polio? Would the scientist himself have held out for a piece of the vaccine action?
I spring this polio pop quiz because I have just read in the Journal of the American Medical Association another half-hearted attempt to shore up the crumbling wall between the academy and the marketplace, the researcher and the salesman. The article, co-authored by Joseph Martin, dean of the Harvard Medical School, is one more entry in the unhappy, ongoing debate about science and business, nonprofit and profit, altruism and chumphood.
Ever since 1980, when a new law allowed medical academies to patent and license the federally funded fruits of their research and to cut researchers in on the royalties, pharmaceutical and biotech companies have gotten far more entangled. There have been some dicey side effects to this greening of research.
As Marcia Angell, who kept a spotlight on such conflicts of interest when she edited the New England Journal of Medicine, says, "Increasingly, academic medicine is merging its mission with that of drug companies."
At the very worst, we've seen companies try to repress or change the results of research they funded but didn't like. One company sued researchers because the scientists published disproof of the company's product. We have no idea how many other scientists are intimidated or beholden. But along with this, a more subtle result has been to skew professional norms. As some scientists become business partners, those who don't go for the gold, or don't go where the gold is, can be recast as losers.
In an economy that has changed at Internet speed, there is a growing expectation that everyone wants a piece of the action. Some universities are becoming like licensing agencies for intellectual property. Others have created offices to turn campus research into high-tech business plans.
Meanwhile, the mania to patent everything and everyone right down to the DNA has made some researchers less likely to share their work. Why share it, when you can sell it? As Stanford Law professor Margaret Jane Radin notes, "We have a culture in which someone who gives something to humanity is a chump."
Will this extend down to volunteers for medical research? In some studies, whole communities participate in genetic or behavioral research, committed to the common good. If the researcher or the biotech company makes a bundle, will their voluntary contribution feel like chump change?
When a university becomes a business, there's a real risk that tenure goes to the money makers. And when the profit motive infects medical research, there's more push for another Claritin than a less profitable cure.
In the JAMA article, the authors propose modest ways to create some safeguards and distance between the medical academy, the research and the companies that fund them. Fine. But they equivocate, "Any solution must also preserve the personal incentives that motivate innovation, while minimizing the risk of perturbing judgment."
I am not naive about money as a motive. Nor do I believe that scientists should take a poverty vow. But sometimes it seems as if we've boiled down all the incentives for creative work - everything from altruism to intellectual curiosity - to one: financial.
The more we frame everything in society as a cost-benefit analysis, the more it becomes true. We lose sight of other motives and more common goods.
Before he died, Salk told a reporter what his reward had been. He had given parents a gift: "Freedom from fear. That's the most powerful of all emotions. . . . I sure learned how important freeing people from fear would be." Some chump.