Just because we can design health services, doesn’t mean we should

Photo by Mykenzie Johnson.

The US spends the most money on health care resources, spending more on health than any other high-income country. Most of the spending takes place within the biotechnology sector in the development of new health care technologies. As a result, the US acts as an engine of global innovation with many of our powerful drugs and medical devices coming from the US biotechnology pipeline. However, in the last two decades, the biotechnology industry, driven by the profit motive, has developed a lot without improving our social life much. The commercialization of health care, while accelerating the production of medical technology, has created a system that produces better practices than is more socially beneficial and equitable. On the other hand, the medical-industrial complex that results from this process is rapidly destroying the health care environment.

Many health economists have recognized the dangers of overselling the industry. However, the biotechnology sector is poorly regulated compared to many large industries. Why is that so? Unlike almost all other products, health care is directly related to our death and dying. The inability to regulate the industry stems directly from the arguments that feed these death worries. In particular, the industry claims that increased regulation can stifle innovation and directly harm people’s lives. Some have even called the Medicare caps “the moral equivalent of genocide.” This ideological victory has made the industry attractive to investors due to its lack of protection from regulatory policies. These businesses bolster their argument by linking profits to innovation, when in fact it has been shown that innovation does not increase revenue. On the other hand, excessive investment in health care innovation diverts valuable resources from balancing efforts. Instead of spreading innovation evenly, our advanced technology only serves those who can afford the treatment.

The new “miracle” GLP1 agonists (Ozempic, Mounjaro, Wegovy) used to treat diabetes/obesity are a prime example. These drugs, while new, do little to improve public health; their benefits cease as soon as the treatment is stopped, so it requires continuous use, and ensures a permanent profit for the producers. This “magic pill” mentality encourages an overreliance on quick-fix solutions, ignoring underlying health causes and exacerbating health inequalities. Meanwhile, traditional and inexpensive diabetes medications, which have proven to work for a long time and are very cheap, are often covered and not used. This false distinction prioritizes profit and innovation over the balanced delivery of essential and accessible treatments.

It’s no surprise that the pharmaceutical industry spends most of its efforts fighting initiatives that attempt to distribute drugs more equitably and expand access to care. They understand that there is there is no way it can happen offering their high-priced emerging technology without cutting earnings. Recognizing this, the industry is leveraging our collective mortality concerns to push back against regulatory measures.

What would an appropriate response to the coming influx of medical technology in the United States look like? Ideally, a central regulatory agency, working under the FDA, could review newly approved drugs to determine the optimal manufacturing conditions for drug manufacturers. The agency would distribute these products to patients, prioritizing need and equity (similar to an organ transplant network). Such a system would work well within a strong public health care framework (eg, single payer) that would regulate the use of these medical technologies to balance personal autonomy and social justice.

The dominance of the health sector by commercial interests ensures that the primary objective is profit, not health. Therefore, the goal is to innovate sustainably and in areas that are needed in society rather than generating a lot of money. Yes, there may be less innovation, but the emerging innovations will be important and spread through existing platforms to distribute technology equally. We should not be swayed by the pharmaceutical industry’s hypocritical appeal to death anxiety. We must not allow these organizations to continue to hide behind thin sanctity. And, as with any advanced technology, just because we can innovate health care, doesn’t mean we should.

The numbers for the biotechnology industry are coming, and it is through an honest assessment of our technological strengths and weaknesses that we will be able to secure sustainable health services.