Priti Krishtel, cofounder of I-MAK.
By allowing “patent walls,” U.S. policymakers create incentives for pharmaceutical companies to chase profit alone, even at the expense of public health and scientific innovation. But Priti Krishtel, co-founder of I-MAK, an organization that has worked in 50 countries and saved health systems more than $2 billion, has a blueprint to restore the integrity of America’s patent system to incentivize progress. Ashoka’s Manmeet Mehta recently sat down with Priti and asked her to explain the relationship between patents and drug affordability.
Prices of some drugs have risen seven times the rate of inflation. What’s driving our skyrocketing prescription drug prices?
I came across this problem 20 years ago while working at a human rights organization representing people living below the poverty line and affected by HIV. My clients were losing loved ones, or they were surviving but forced into poverty that lingered over generations. We investigated and ultimately determined that the root cause of the affordability crisis is the patent system. Patents are essentially monopolies on medicines. Without competition, the price of life-saving drugs becomes unreachable to many of the people who need them.
What is the popular misconception about patents?
Patents used to signify scientific progress. My father worked in the pharmaceutical industry his entire career and we were so proud of his patents. But over the last 40 years the meaning of a patent as a public declaration of achievement has been replaced by narrow private interest. A great example is Theranos. So many patents were given to Theranos for blood testing—in reality there was no invention underlying those patents. Take 12 best-selling drugs in America: on average they have over 70 patents. Some of these drugs have over 100 patents. It’s supposed to be one invention, one patent.
What is going on within the patent system to enable such a market?
I-MAK’s lawyers and scientists investigated this very question. We found that companies build “patent walls,” stacking one on another like bricks to create a fortress around all aspects of their intellectual property, to ensure that no one else could produce the drug or even research anything related to it. One early case involved access to pediatric HIV drugs. We launched a patent challenge, challenging the claims to inventiveness behind a patent in the wall. We won, and that approach—strategic litigation—became one approach we use to put millions of people on treatment to save lives.
So how do we balance public and private interests?
Today, the incentives in the system are wrong. Pharmaceutical companies are rewarded for chasing profit rather than their delivering against their core mission of inventing new drugs. I think scientists care about that mission. I think people who work at pharmaceutical companies care about that, too. We’ve got to correct the incentives to make sure every person can get the medicines they need to stay healthy and alive.
A better system would do five things, we call it (R.A.I.S.E.). It would (1) Raise the bar on what it takes to get a patent; (2) Amend incentives, including that the system would not generate its revenue by the number of patents issued, but by the merit of what’s in those patents; (3) It would fundamentally Increase public participation—by increasing transparency and accessibility to the patent office, (4) It would give everyday people legal Standing to go to court just like drug companies; And finally (5) it would Expand Congressional oversight.
Raising the bar is a key first step. If patents are only awarded for true inventions, then the strategy of erecting patent walls to make monopolies longer and longer collapses.
How would this new blueprint benefit society in light of the Covid pandemic?
Global pandemics are going to be the new normal. Surviving them demands R&D that is collaborative, not competitive, and based on open science and transparency rather than hoarding compounds and allowing them to gather dust.
For pandemics, there’s no certainty of profit so we’re not seeing R&D to better prepare us. That already happens with neglected diseases that cause 2 million deaths per year.
Covid highlights that taxpayers are the real angel investors in private sector R&D. There’s a huge amount of public funding for research right now. There should be a social contract—that the results of these investments are made available to the public at reasonable cost.
The industry’s reputation is abysmal. Covid presents an opportunity to turn that around. Honestly, our collective survival depends on them doing the right thing rather than being shackled to the market. But without incentives they’re not going to move in the direction that we need them to. We have a huge moment of opportunity right now to reimagine the system to incentivize research on public health, not commercial, grounds.
What’s ahead for you and I-MAK and why are your hopeful?
Having been an advocate for many years, I’m not satisfied merely trying to improve something. I want to get to the heart of the system. This is intergenerational work, it takes many years and many people. Like I said earlier, the connective tissue between movements is getting stronger. There’s a word I really like from architecture and biology—tensegrity—which means a kind of mutually supportive construction of things that are both independent and essentially related. That is what we’re beginning to see happen across and between movements that are working for a more equitable world.