Free Medicine

The principles of free software map cleanly onto drug development because drugs are really information products in two ways. First, the molecular structure of a drug contains information about how to modify the drug's target, which is a specific molecular structure based on information contained in DNA. Second, the value of a drug is the information provided by credible, government-sanctioned clinical trials, which show the safety and efficacy of the drug. Open source principles can promote free drug development in both respects. Networks of scientists with access to collaborative computational tools, like molecular libraries and free data sharing, can rapidly and effectively search for and refine potential targets and leads. Then, distributing clinical trials globally and freely sharing data reduces their expense. Such an "open source" drug discovery network has started for tuberculosis drug development.

While promising, this open source vision merely replicates today's drug R&D methodology. It is well suited for the treatment of simple or acute problems, such as short-term symptoms like acute pain, or most infectious diseases. Many problems have already solved by generics, and even where needed, profitability of infectious disease treatment is limited by the ability of Third World patients or governments to pay. Ensuring exclusivity is consequently less important, and thus fewer barriers to free drugs.

The real battle is going to be over what Big Pharma sees as the future of medicine. We are now going through the first stage of a comprehensive revolution, built on three big shifts.

The future of medicine requires absorbing the revolution as a whole: rethinking the integration of information and health. This is not eagerly hyped "personalized medicine," which is about specifying the population for which a drug is prescribed. Rather, the way forward is Free Medicine, exemplified by successful first steps towards the use of social networks for conducting genome-wide association studies at one end of a new pipeline, and clinical trials at the other end, with biological "tinkering" in the middle. These developments will facilitate distributed innovation (or peer production) driven from the doctor-patient level. This is not itself new in medicine. Innovation once emerged from case studies rather than mass trials. In an era when we can measure individual variability, it makes sense to return to a more distributed and flexible form of medical development.

Since the necessary technologies are constantly getting better and cheaper, the hardest work will be educational, cultural, and political. The alternative is a less effective and more expensive -- ultimately crueler -- system relying on monopolizing DNA sequences, tissue from patients, naturally occurring molecules, and treatment algorithms. Instead, Free Medicine takes advantage of sharing and distributed invention. And, it works on health as a process, rather than just making drugs as products. Free Medicine will lead not to just better health care, but to better health.

This essay's great virtue is that it thinks long, gaining the advantage of depth of field, seeing medicine evolving over decades. The essay's great difficulty is that it thinks long, accumulating predictive error over time, necessarily becoming "a trajectory" rather than "the trajectory" of the endeavors it forecasts. What happens in the meantime is also crucial, because of path-dependence.

I think this is a pretty good guess about the direction of travel in the absence of significant societal distortions from the Big Pharma parties whose involvement you mention but do not analyze. They want the vested-rights system from which they benefit to exist long enough, and to accrue enough apparent normative authority that they can commandeer the "biological engineering" industry that your hypothesized science brings into existence. They want it for themselves on a long-duration individual-monopolies basis secured through the patent system, such as they benefit from now in the closing period of this phase of the industry. Their patent-intensive approach, as we can see around us, allows significant distortion of the societal research investment, comprehensively replacing socially useful research by patentable research (a different and in no way congruent category), with significant second-order effects on the way medicine is practised and the way the information health care accrues is distributed and used.

You also do not take full account of the immense social changes, in health care particularly, that will be brought about by omnipresent intelligent sensor networks. You refer to the streams of genetic and other biological information available. When the environment is comprehensively measured everywhere, inside our bodies and outside, by billions of inexpensive network-attached sensors, the process of maintaining health and preventing injury is modified as fundamentally as the 20th century modified it, first with the automobile and then with the seat belt and the air bag.

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