Last leg of return from Geneva! (luckily a fast trip so I'm on a prompt connection 2 hours earlier than planned.) It was
a busy and productive week. I like phoning you soon about my mtgs, cum Moshe, with Konikov (Rothschild) and with Bourcelot
(Renault) in Geneva. Bourcelot fortunately had 2 technical consultants with him, and we covered a lot of ground in 1 hour.
(Interestingly we met at WHO, next to the conference room where ACMR was hammering out a statement on continuing microbiological
research Jacques Monod almost botched it by pressing too hard. Lwoff and de Duve had also participated -- so it was a fairly
high powered affair.
Anyhow Bourcelot will be sending us a shopping list of specific technical problems on which they (Energie Solaire, S.A.) are
looking for answers. He implied they had done a lot of market research on SCP and amino acids with promising results! They
are more interested in ford and energy than p[ . . . ] but he did perk up at some of the veterinary stuff. So I think this
a real French connection.
Konikov said we should talk to Rothschild if we still needed dollars, after we had a technical partner. He said they simply
could not make their own evaluation, but he respected what he knows of me from the Weizmann Institute so he had no need to
know more of the science; only the commitment of an industrial partner was
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needed to validate the commercial side. There may be some use of this, in a narrow zone of contingencies mirling [?] say Syntex
Moshe and I were discussing pre slicing ideas. This is easy along technical lines:
say interferon (and antiboties [sic]!) -- Sherring
nutrition and energy -- Renault
antibodies -- Syntex
But I think we are going to need to frame more explicit models of markets, profits and "goods" before financial people
can comprehend what we're up to. If necessary we can lay out a few alternatives with parameters still negotiable. But
we did, I think, look a bit half-baked to Konikov for lack of a clearer pattern of participation, estimate of return etc.
of course, more on all this soon
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For now, I want to ask you to give some thought to a humanitarian concern, that stems from my work for WHO. In fact, the director
Mahler has all but persuaded me to return to Geneva for about 3 weeks in September to be a kind of personal brain trust for
his comprehensive 6 year plan. He is pushing hard to get somewhere with world health (which means Africa and India). I hope
to consult with you more ca[ . . . ]ly on some ideas in the next few weeks. if he had a few more people like yourself in his
management structure he would have few problems!
But one explicit issue right now. Mahler moralizes ad nauseam about this; but you and I can see real structural problems (a
la Djeressi, 1985) in free-enterprise-cum-FDA meeting the therapeutic needs of the poor countries: e.g. development of anti-parasitic
or anti-leprosy or other contraceptive agents.
So what would it take (managementwise) for WHO to succeed in a non-profit approach to drug development for these clients?
let us think of this in a welfare-economic framework with optimal [ . . . ]tility as the value function, and stipulate that
we can the working capital from say the World Bank if a rational case can be made.
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The problem is of course how far to get optimal resource allocation without conventional market discipline.
But keep in mind that WHO has some potent assets: its moral attraction (e.g. people like us will do some work for nothing,
or rather (might [?]) bootleg subsidies from our employers)
:its legal standing -- it has access to extraterritorial status . . . .
It seems to me the pharmaceutical industry would benefit if there were a public sector effort for poor country problems betting
some action on these would reduce public anger at big drug projects, it might also expose some of the efficiency of private
enterprise in its own sphere. Finally by getting away from intra-country politics it might be a pathfinder in more rational
and less wasteful alterations to the FDA system.
Of course there may be political problems: the US drug industry might pressure the US to veto the idea. But I have some feeling
that there may be mutual cancellation of political pressures on WHO from outside and that a strong-minded director like Mahler
could have a free hand in pointing to objective goals. Anyhow let's assume that!
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But what next? What corporate form and management structure stands a chance of avoiding the "U.S. Post Office [mark to
note, and the public-employee union and the political pressures to subsidize unprofitable sectors are at least partly responsible.]
Syndrome". Are there counterexamples of efficiently run public enterprises with a research component? TVA? (AEC is too
much distorted by the military imperative to be a useful precedent).
I have not raised any of this with Mahler, nor will I before consulting Carl (and Alex?) and yourself about the logic of the
"WH Pharm, Ltd," would not necessarily have many, even any, of its own labs; work could be sub-contracted -- mind
it could even reduce its costs by joint ventures where profitable markets were left to its entrepreneurial partners, and it
furnished front-end money and FDA-overriding test opportunities as highly leveraged [?] cost reduction for poor-country applications.
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is only one of many patterns, and probably not ideal to start.
FDA indeed might be delighted to have another authentic authority take on responsibility for drug-developments that don't
belong in the US context. ("safety" at any cost!)
So here is one way out of an intolerable impasse. Have you any better ideas? or better ideas to make this one work?
I have only been playing with these ideas for a couple of hours, and am not deeply attached to them. In fact this one stems
from a (perhaps facetious) suggestion that I made to Dr. Lin -- that China undertake the same role. I am sure China will (and
will probably do better than the USSR 100:1 in this sphere) -- but not for another 5-10 years at least.