In the field of modern medical science, we can identify certain epochs. Some of these will be our concern here, for they offer important insights into the development of modern medicine and offer equally important predictors of where it is heading in the future. In fact they are so important that they qualify to be called nothing less than revolutions.
Till the early twentieth century, medicine was an activity dependent on a small privileged elite. This changed by the mid-twentieth century into a vast publicly owned enterprise with enlightened governmental approach, support and funding. One example of this was in the 1940s, sixty five years ago, when Vannever Bush in the US, for example, persuaded the government there to divert resources allocated for the then war effort (World War II) to fund basic research in academic institutions. Similarly, in India, what was earlier dependent on the benevolence of zamindars/philanthropists and some missionaries who set up charitable dispensaries/hospitals to serve certain sections of the population was supplemented, and then overtaken, by governmental funding after independence in 1947.
This major governmental support to medical science was an important development that led to great advances in medical research and facilities all over. Such funding and consequent blossoming of medical science was nothing less than a revolution, which we can legitimately consider the first revolution in modern medicine.
A second revolution was soon to follow four decades later. It was fuelled by a vast upsurge in medical research, training and therapy, with capital pouring in from private enterprise and philanthropy. This revolution is still on. It is aided by efforts like the Bayh-Dole Amendments of 1980 in the US, for example. This epoch making amendment conferred intellectual property rights to institutions and connected scientists even if they had developed their products/inventions with government funding. It was followed by incentives in tax laws that resulted in a massive inflow of venture capital into biomedical research. As a result, academia was suddenly besieged by profit seeking industry that saw immense vistas of opportunity opening up before them. Pharmaceutical majors, propped up with massive private funding by venture capital, were quick to seize the initiative.
Institutions realized their commercial potential and their vast possibilities for the first time, and were not averse to jump on to the bandwagon.
In India too, major foreign and indigenous pharmaceutical players were quick to cash in on the opportunity during this same time. As massive funds made new drug formulations available in the west, their Indian counterparts, and some enterprising wholly indigenous concerns, did not forget to latch on to the promising commercial opportunities opening up before them. They imported drugs wholesale, and/or their technology. And with glossy monographs, CMEs, sponsorships, and gifts thrown in, widened their commercial activities to greatly influence medical prescription and practice. Some amount of research in the form of clinical trials managed to get funds for departments and institutions, and researchers felt suitably rewarded. Some Indian drugs also entered the market, but they hardly captured world markets, except for a few Ayurvedic/herbal formulations that managed to hold attention abroad, but not on the basis of very sound scientific trials.
Alongside this, we also saw an interesting development in the last few decades in India. Private entrepreneurs, aided by political bigwigs, entered medical education to cater to a huge clientele of young people fresh after two years in college and desirous of making a career in medicine. Since reservations in government/municipal medical colleges for socially disadvantaged sections closed admission options in these institutions, many promising young people have gone in for costly private self-funding medical courses. As they come out of such institutions, they can be expected to want to recover their millions invested in medical education with some urgency. The institutions and research activities they get connected with will be quite keen to forward financial interests, for in so doing the financial interests of such individuals will be taken care of. At a time and phase when others (the free-seaters) are likely to be influenced by certain noble intentions of medicine, such high fees paying graduates and postgraduates can be expected to be keenly aware of the role money plays in medicine, right from its training to practice and research. And they can be further expected to forward the process of the corporate enterprise of medicine with some urgency and equal conviction. In other words, their role in commercialization of medical education and research can be expected to be substantial.
Another interesting development alongside this in India is the proliferation of a large number of corporate hospitals run as business enterprises with listing on stock exchanges, or owned by industrial/ business barons, with foreign/NRI collaboration and entrepreneur input, both financial and intellectual. Such enterprises are profit oriented business concerns and market health care to interested clientele. Medical personnel involved in such institutions are likely to be heavily influenced by commercial interests and the profit motive, for they have targets to meet, both for out-patient and indoor admissions. Else their contracts may get terminated. Also, they are vast repositories for influx of commercial influences from the institutions of the west that are their guiding stars. And as those are already on the course of rapid corporatisation, such institutions following suit is a foregone conclusion. So both medical education and research, in India and abroad, are bound to experience great upheavals in working methods and ethical concerns as commercially viable scientific inventions, and forwarding of commercial interests, hold center-stage in biomedical education and research in this century.
The massive entry of private enterprise into medical education and research heralds great changes in the mindset and set up of academia and is nothing less than a revolution of sorts.
If the Academia-Government Connect was the First Revolution, the Academia-Industry Connect is the Second. The first promised funds and legislative support for academia, the second provides funds and logistic support for academia. Hence, both these developments have been welcomed with some glee in academic circles. However, as is common with all such happenings, the flip side is getting uncovered by and by too.
All revolutions start with some noble objectives. But they are always in danger of being hijacked by vested interests that use the mass upsurge to fulfill private agendas. This second revolution hardly had any pretensions to great idealistic leanings anyway, and therefore has been hijacked to serve questionable interests right from day one. Unresolved issues related to conflict of interests, royalty, patents, practice guidelines, research publication are vexing enough. But fundamental questions about the ethical propriety of an academia-industry connect are being raised not just by the usual alarmists, but by concerned researchers who see disturbing portents in this connect.
Whether we want it or not, or like it or not, this second revolution is well and truly on. We can choose to be willing or unwilling participants. We cannot be uninvolved, much as some fence sitters would desire. It makes sense to be either willing participants, or unwilling protestors. Both these are possible only on an informed basis.
This Academia-Industry Symposium is an attempt to study the stand points of these participants, both willing and protesting. It also presents the viewpoint of some alarmists, whom we may dismiss to our own peril. And finally, it articulates also the small voice of the activists and advocates, which small voice is likely to become a uproar in the near future if academia and concerned industry do not wake up soon enough.
A conflict of epic dimensions is on the cards in the next few decades. Log in, and stay invested, gentlemen.