By Mark Robinson
As the animations of markets increasingly shape the timbre and character of medicine, scholars studying ethical issues in health and medicine must be increasingly attentive to the role of market forces as they shape modern health care.
For those interested in the social, ethical, and conceptual dimensions of contemporary health and medicine, there has been a sustained focus on a key set of important challenges; how do we ensure adequate access to health for marginalized and global populations? What are the social and ethical implications of emergent technologies? How are issues of consent articulated in the everyday interactions of the clinic? What are our obligations to persons in terms of end-of-life care? These longstanding concerns regarding access, new technologies and the rights of patients comprise the major thrusts and foci of bioethics, health care ethics, and associated areas of inquiry.
Yet, one factor that increasingly modulates the options for patients, including the very therapeutic options that patients have, is that of market forces in health-related decision-making.
The financialization of health care — from the conglomeration of health care management companies to the effects of corporate restructuring upon pharmaceutical innovation — has had unparalleled effects on the shape of modern health care. From the design of biotechnologies and emergence of diagnostic categories to the problem of access to experimental treatments, the role of market forces in the enunciation of options, therapies, and even disease categories themselves – reflect the ways that markets literally structure contemporary health and medicine.
Despite the increasing impact of financialization on health care, ethical analyses in medicine tend to underanalyze or entirely miss this key aspect. Indeed, fields such as health policy and pharmacoeconomics or pharmacoepidemiology have incorporated analyses that are attentive to the role of market-oriented decision-making in contemporary health care and many notable scholars are beginning to use the language of markets to make sense of bioethical challenges.
However, large swaths of work in bioethics tend to miss the critical role that global finance and/or specific finance-driven decision-making have in shaping or producing the very disparities or access constraints that typically compel ethical reflection. The role of market-driven decisions in what could be called, the “supply chain of global health” means that analysts of emergent trends in health and medicine will confront societies in which health outcomes are ineluctably tied to factors that may seem external to the clinical encounter. Shareholder concerns about achieving short-term profits, for example, have compelled pharmaceutical companies to divest from whole disease areas, leading to a paucity of new drugs in those categories.
In my work on the emergence of the field of Translational Medicine in the U.S. and across the West since 2003, I have traced the push by the U.S. National Institutes of Health to reconfigure biomedical research in ways that make it more connectable, usable, and far more conducive to private investment.
For its proponents, Translational Medicine will bring about grand new medical innovations by reorganizing how medical research gets done. From new academic departments to new research funding programs, the rise of Translational Medicine has spelled dizzying changes at university laboratories across the U.S. While its proponents see it as a largely scientific and medical intervention (focusing research toward more application and product-oriented ends and connecting researchers from different disciplines who are working on similar problems), a deeper analysis shows that Translational Medicine is also designed around the needs of private companies that seek to partner with universities around research and development.
The creation of new partnerships between universities and industry is a central and explicit component of the move towards Translational Medicine. The case of Translational Medicine shows how market concerns increasingly shape the kinds of medical innovations that will be designed and developed for patients, as well as the kinds of questions that scientists ask in the laboratory.
Market animations structure myriad other health care realities as well. For example, it is increasingly the case that analyses of the particular side effects from new biotechnologies require understanding the ways market forces contour the shape, speed, and function of newer models of biopharmaceutical research and design.
How are changing investor climates impacting the rise of certain therapeutic approaches over others? How have corporate reorganizations impacted pricing for life-saving medications? While clinical care has and continues to evolve as a result of a host of factors (including technology, for example), the reorganization and consolidation of health care organizations reflect increasing health care corporatization.
It is in this structural continuity (around finance-related decision-making) where we find the need for something like an economic bioethics. To adequately understand and make sense of global health care contexts that are increasingly modulated according to financial levers, it is imperative to fully understand and analyze issues of finance, markets, and capital as part of larger bioethical agendas and analyses.
Mark Robinson is a 2018-2019 Student Fellow at the Petrie-Flom Center.