Let’s Talk About Intellectual Property and Global Health

There’s something unique about building and creating in a humanitarian field. Your goal, on one hand, is to work yourself out of a job: you want your inventions to be so contextually appropriate that they remain feasible, so culturally apt that they are used correctly, and so accurate that the results are akin to those in a New York hospital. Your achieve success when you eliminate the health problem you were attempting to stem.

On the other hand, when you design for lower-resource settings you are designing for emerging markets. You hope that the health benefits of your invention will contribute to a cycle of productivity: of lower disease incidence, of more school days for children that would otherwise be ill, and ultimately of economic growth and increased earnings. You are building your work into the fundamentals of a nascent health system, with the hope that your design will flourish within this new system and remain relevant. Stemming a health problem is not the end-all; it is a stepping stone on the way to sustaining access to continued care.

I’m working at a foundation right now, and the purpose of IP protection for nonprofits and social ventures comes up for debate on what I would hazard is a weekly basis. While both sides propose that such organizations should want their efforts to result in the maximum amount of social good, one argues that the best way to achieve this is to share productive innovations openly – that overriding the egotistical human desire for ownership would result in greater total implementation, and a greater total number of lives saved.

In other words: if you truly want to help people, how dare you attempt to make a career for yourself in this field rather than voluntarily giving away your efforts. I find the degree of guilt-tripping that this mindset perpetuates very short-sighted. “Don’t you want your efforts to go to saving babies/reducing disease rates/increasing crop yields?” Well, yes, of course we do – if we didn’t, we would be working at for-profit engineering firms. But social ventures cannot perpetuate their ability to do good*, and to create new solutions, without receiving living wages and a financial safety net with which to invest in further research and design.

My stance is that this method of operation drives high-talent individuals away from the social sector and forces said ventures to remain beholden to donors.  Being beholden to shareholders (by licensing bottom-of-the-pyramid designs to for-profit companies) is equally limiting: it delays the urgent business of providing such technologies to the locations most in need, rather than middle-income markets.

I maintain that the best way to maintain creators within this space is to provide them with a sense of ownership, and that maintaining high-quality creators is critical to building relationships with end users and clinical partners. In order to accomplish these things, creators need to out-perform other organizations when competing for donor funds or applying for grants. And in order to do this, they need to be able to protect their intellectual capital.

So, where do we go from here?

Peter Haas of the Appropriate Infrastructure Development Group mirrors my thoughts exactly:

“Sorry to break it to you, but this field is one largely of boutique players and very insular boutique operations in large companies. There aren’t many jobs out there to be had, and you need to look hard to find the ones that come up every once and a while. Most people in this field make their own jobs as entrepreneurs and consultants.”

Aside from the opportunities pointed out by Mr. Haas, it’s worth noting that a (relatively) tremendous amount of funding for global health research is channeled through universities. Interest in the field is growing for students of all disciplines, and it’s also worth noting that many low-cost health technologies are prototyped equally cheaply by students.

Stanford provides a particularly successful model for developing new opportunities, in part by honing their openness to student entrepreneurship in the for-profit tech sector. D-Rev, Embrace, and Medic Mobile all have roots here. That is not a coincidence. Stanford’s willingness to allow students to pursue their own inventions, which are unlikely to turn a profit if licensed, has resulted in a transformational impact: the products are life-saving, yes, but more substantial are the hardware and software engineers, the business students and fellows, the executive directors who are now freely and actively working to create more life-saving interventions.

But few seem to have followed suit. Diagnostics for All came out of Harvard, which kindly licensed patterned paper diagnostics from the Whitesides Group to the nonprofit (and I would hazard that Whitesides’ influence played no small role in this decision). But licensing fees are often out of reach of burgeoning nonprofits, and even if that were not the case, I understand that universities would be hesitant to relinquish potential profits. It makes more financial sense for these institutions to keep BoP technologies in-house, where they can be used to bring in grants (see Jhpiego at Johns Hopkins) and where tenured professors can pursue this type of engineering-for-change without worrying about financial security or market viability.

This model is not useless, and it does lead to the continued production of low-cost health technologies, often at the prototype scale. But it is also not transformational. For broader impact, universities need to leave the door open for students to pursue their inventions to market. New product-centric social ventures focused on health design for low-resource settings will broaden the scope of new health interventions, even the financial playing field for these organizations with higher-than-standard overhead, and provide an outlet for students to pursue this field instead of other potentially lucrative options. To summarize that mouthful of a sentence: this combination is what we should aspire to if we want to sustain this field beyond its boutique origins.

*For more thoughts on the application of this line of thinking to the broader nonprofit sector, see Dan Pallotta’s wonderful TED talk from this year.

Let’s Talk About Intellectual Property and Global Health

Shots in the Dark

When it comes to a Sophie’s Choice sort of prioritizing, I tend to value national security over minor setbacks in other fields. This is not a popular sentiment in the field of public health, where evangelists are evangelists and the US government is a happy target frequently accused of, god forbid, acting on its own interests. In terms of bulk cost calculations – why spend billions on aircraft carriers when that same money could go to treating malaria? – I also think that Givewell types tend to undervalue hegemonic stability and underestimate, or have perhaps forgotten, the dangerous down stream flailings of a wounded giant. I am One of Those Democrats, and I’m not sorry for it.

But foreign aid, and particularly well-designed health assistance, is in the interest of national security. Unrest results from lack of satisfaction with the state of affairs; extreme dissent emerges in hungry, impoverished, and desperately ill populations where people have the balls to get angry (that is to say, in a less crude manner, societies where women possess limited rights – but that’s another post). And here are a few True Things:
1. Maintaining public health programs abroad is a critical part of the ability of the United States to influence policy abroad in a subtle, effective, and generous way.
2. Vaccination is unparalleled as far as things in our toolbox go. They save money – something entirely uncommon in international aid. This may sound very simple, but it’s extraordinary: a successful vaccination program allows us to prevent lengthy courses of treatment for expensive diseases in difficult-to-access areas.
3. The vaccination “scandals” in the US – such as Andrew Wakefield’s ridiculous shenanigans – have resulted in an inexplicable amount of damage. Accusations of vaccines causing autism in a nation where most people are literate, where 70% graduate from high school after completing a basic biology courses, have been crippling: as an example, one of the most conservative governors in the nation was bullied into not mandating a Gardasil vaccine. The amount of damage associated with something most people don’t understand is amplified as the education of the general population plummets. So when a rumor starts up that US vaccines are intended to render Muslim children infertile in Nigeria? People believe it, and consequently have their children die from preventable diseases.

In attempting to use DNA samples obtained from needles to confirm Osama Bin Laden’s presence in the compound, we did not give the Pakistani children in Abottabad the full 3 courses of the hepatitis B vaccine necessary to ensure functionality. Those kids are not going to have access to the full course – and if they do, why should they trust it?! Why on earth should they, when a legitimate ruse has been constructed against them in which vaccination was hardly considered a fringe benefit? I don’t see what this should have to do with the political sympathies of the children involved, or of their parents; when the United States lies abroad, when we conduct ineffective schemes in places where our word is already compromised, we make enemies. When we do a good thing poorly, we make enemies. Let’s stop doing that right now.

Shots in the Dark

Student Design Projects

I know people who are approaching BIOE 451/452 with the goal of walking out of the Sallyport with a degree in one hand and a patent application in the other. They are, however, vastly outnumbered by those who a) want to attend medical school/some other grad program, b) don’t care enough/wont’t create something good/will burn out or c) don’t know how money/patents work (I go here, and that’s hopefully). But a lot of the projects I’ve seen in previous years are good, and the global health projects in particular have a lot of potential for use at very low development costs (there is NO source of free labor like a graduating senior who wants an A in their capstone course). Here’s the thought process:
– Many engineering schools around the world feature degree programs culminating in design projects, in which the final product is a functional, marketable device.
– Many of these projects focus on global health; for example, bioengineering students at Rice have constructed low-cost automated syringe pumps appropriate for clinics lacking in staff, and cell phone cameras adapters for diagnosis of neonatal jaundice.
– Many students who spend their senior year working on such projects abandon them.

And here are some potential fixes:
– Financial support for students who want to make their class things into real things. USAID is trying to start making small-level grants workable, but it’s not there yet, and a student initiative of this sort would be the perfect place for them to begin.
– DESIGN PROJECT DATABASE. This would allow students from different universities interested in continuing work to interact with one another, rather than the pre-med they got paired with. This year alone I know Rice, Columbia, and Northwestern all had projects developing low-cost autoclaves: a PERFECT scenario where something like this could be useful for both exchange of ideas and potential future investment. A project like this would have to be university-led, as in design teams would need to be urged by a professor to actually submit occasional project updates throughout the year (which wouldn’t be hard for anyone doing regular documentation) (potential lead rice envision grant project, hmmmmmmaybe).

Student Design Projects