Our search for solutions to the shortage of essential cancer drugs and biosimilars led us to a broader view of many other problems and policies with an underlying economic element. In 2013 and 2015 Ahmed Elzawawy called this “The Fourth Way”, a proposal for flexible brainstorming.
Among multiple factors, the main obvious cause of the shortage of essential cancer medications and generics in the USA is economic, particularly the lack of incentives for production. More scientific exploration is needed. The aim should be the economic sustainability and affordability of better-value cancer care, not whether a drug is a brand or a generic. That was our starting point, and it is still our main work as clinical oncologists, but it led us to see things more globally.
A problem as complex as the shortage of essential cancer drugs in the USA opens a broader view of the underlying issues in the USA and the world. It could offer a clue and a model for other problems and policies with economic elements.
Three fixed choices
For the last two centuries, the choices for an economic system have been fixed around:
- Letting the market work freely (unlimited liberalism and the older historical form of capitalism).
- Complete public, governmental control and ownership (historical Marxism).
- Various forms of a third way in between.
We think it is time to reflect and to propose a fourth way. The pre-Socratic philosopher Heraclitus was right: change is the only constant.
It was thought that liberalism and conservatism had nothing in common and would never meet. After decades of communism, “liberal conservatism” was recalled in Russia from early 19th-century philosophers and politicians such as the Vekhi authors, Pyotr Stolypin, Boris Chicherin, Vladimir Solovyov and Pyotr Struve. The modern Russian author A. V. Vasilenko summed up this school: despite the paradox, “without a strong state, liberal reforms are impossible”. The British academic Richard Sakwa describes it as a unique synthesis of liberalism and conservatism, as discussed by Professor Paul Robinson in The American Conservative in April 2012.
On the other hand, today’s notions of liberal markets, as well as the older ideologies of state control, seem set to change. In “Conscious Capitalism: Liberating the Heroic Spirit of Business” (Mackey and Sisodia, Harvard Business Review Press, 2013), Howard Schultz, then president and CEO of Starbucks, describes how companies can balance profitability with their social role and serve a wider range of stakeholders. Yet few leaders understand how to do it.
With the third and fourth revolutions in science and the flood of information and communication, the new generation is less attached to historical or fixed ideologies and shows great flexibility in tackling issues.
The proposal
The Fourth Way sees the next generation building a newer, flexible system with freedom of thought, perhaps a newer liberalism aiming at the good of all. It would consider human aspects and continuous evolution, and increase the number of winners as much as possible, in a scientific way. Applied to oncology, it hopes for the economic sustainability of better-value cancer care and for moonshot progress in science.
- Do not be limited by any predetermined economic policy or theory.
- Identify your goals, aims and objectives.
- Choose strategies that reflect open thinking and hope.
- Adopt flexible tactics. Use what the information revolution and innovative ideas offer to reach your goals, and consider realistically the interests and motivations of stakeholders. Science is the way.
- Be centered on human beings: their quality of life, social and economic dignity, hopes and expectations.
- Everything should be legal and scientific, and consider humanitarian aspects.
- Consider how to make any solution or policy economically sustainable.
- There is a place under the sun for all. It is a win-win scientific approach for all stakeholders that maintains economic and scientific progress.
Destructive confrontation, or removing realistic and legitimate incentives, is never a long-term solution. Using our minds smartly, and perhaps the concept of the Fourth Way, could give insight not only into the shortage of essential cancer drugs in the USA but into economic policy in general. When we face complicated problems, it is time to think outside the box and globally. This could be one of the positive aspects of the debate around globalization.
I never claim to have full wisdom or the absolute right vision; that is not within human nature. This is a personal proposal. Everyone should feel free to modify it, support it and share it with whomever they like.
As I have said of the Win-Win scientific initiative: despite its humanitarian motivation, it is a completely scientific initiative that calls for more research, evidence and innovative studies.
Kindest regards to all in our world.
Professor Ahmed Elzawawy, MD