Chicken or the egg ?

"What we are seeing here is the 21st century scientific parallel to the Great Depression of 1929." - Anonymous

I have had the pleasure of conversing with many academics, industry professionals & students about the issues surrounding today's healthcare systems, and what policies should be implemented to effect the changes we wish to see. Despite the complexities involved, there is always one basic question that somehow always perplexes the respondent - regardless of their background knowledge. Its also a great conversation starter mind you. Today, I pose this question to the greater community:

What is (or rather should be) the single most important goal of drug manufacturers (biotech/pharma)?

A) To discover new ways to treat/prevent a medical condition or disease
or
B) To maximize shareholder return on investment


Yes, I only provide you with two very simple options, but only because I believe that such a reductionist approach is necessary to re-evaluate an intricate system. From idealistic researchers to the more conscientious investors and economists, I have heard arguments for both sides. Many more have refused to entertain my requests for an answer to such a seemingly inane question.

Those that choose "A" are posed questions such as - Is discovery enough justification for massive capital investment? Will venture capitalists continue supporting purely altruistic organizations that continue to lose money? What would be the driving force for enterpreneurs if there is no sustainable reward? Legally, all publicly traded companies are mandated by legislation to pursue investment return on behalf of shareholders. Is the answer then, to ensure privatization of the drug discovery sector?

Choose "B" and once again many queries come to mind. No really good team comes to work to "maximize shareholder profit/return"- At least not in this arena. Companies largely dependent on innovation are only as good as their intellectual property, and if their goal isn't to feed that quest then what are they selling? How can they ever gauge what an adequate investment in R&D should be? In a society placing increasing emphasis on corporate & social responsibility how can a money hungry entity ever gain any trust? More importantly, how would it be possible to keep churning out new technology/products & progress science given the conditional basis that they must be profitable. After all trial/error has been the most foolproof strategy throughout history.

Given the ostensive business model of biotech/pharma companies, it seems that B is generally accomplished through A. It is also true that a well-rounded establishment should ensure that different functional areas have different priorities (eg. R&D chooses A, Finance & Sales deals with B, etc). The truth is that it is extremely hard to pick one as being a priority over the other. Both objectives are so intertwined that anyone who confidently picks one over the other risks being deemed "not educated/experienced enough".

I do not know what the right answer is, either realistically, idealistically, psychologically or even nasally. But I do know that the problem is cultural & very soon we will come at a crossroads where we will be forced to pick a priority unless society as a whole can come up with an alternative to Laissez-faire economics.