In the course of the pandemic, the use of digital technologies and their weight in daily life has increased, and debates on the relationship between healthcare and digital have also emerged strongly. The pharmaceutical industry itself shares some aspects of the digital sector and the concept of ‘platform’ can be useful for understanding the most recent transformations. Issues that we explored with Hannah Kuchler, a reporter for the «Financial Times» who in recent years has followed the evolution of the US technology sector and today deals with healthcare and biotech.
You have covered the Silicon Valley for the FT for over five years. What do you think were the most significant changes during your time there? Do you think that the role of the Silicon Valley and its relationship with politics changed?
Hannah Kuchler: Completely. When I started covering the Silicon Valley in September 2013 there was a lot of hype about the tech industry, and valuations were soaring quickly. For example, in 2014 Facebook bought WhatsApp for $ 22 billion: an unprecedented deal which attracted further money and excitement for the industry. Then the 2016 election came. The week after the results Mark Zuckerberg famously said that it was ‘a pretty crazy idea’ to think that Facebook could have influenced the election. He probably never regretted any public statement more than that one. That moment was followed by years of soul searching about the role of the tech industry in society, and specifically about the role of the industry in politics and democracy. It became clear not only that the tech industry had become the main gatekeeper to news and information, but also that it had not taken on the tradition and the know-how of the media industry about how to make sure that people are well informed.
Hannah Kuchler: Do you think the Silicon Valley’s own understanding of its role changed? Has tech culture changed in these years?
There surely was a change, and interestingly one can see it also in the rank and file of the tech companies. Initially it took me a while to get my head around the fact that employees in Silicon Valley really believed that their mission was to change the world through the companies they worked for. It seemed so incongruous to me that people could get fantastic educational achievements, then move on to very well-paid jobs to change the way in which people did advertising, and yet still believe that their mission was to change the world. But during my time there, I had to realise that these people really believed in this narrative. In the years following the 2016 election there was a lot of reflection on the individual level. Some people left the industry, others started to pressure their leaders to consider the issues that were emerging. And this did not just apply to the US, but also to places like Myanmar and Sri Lanka.
How did this experience working in the Silicon Valley come useful when you started to cover the health sector and health crisis?
Hannah Kuchler: One of the reasons why I went to cover the pharmaceutical industry after spending years in tech is that I am interested in how technology is going to affect the new frontier of this sector. Technology opens a lot of possibilities for health, both in a good and in a bad way. On the one hand, digitisation could open new opportunities to reach more people, and to provide better preventive care. Gene editing technology such as CRISPR can change therapies for the better. On the other hand, there are many ethical aspects which are problematic, and we need to have a conversation about these aspects – conversations that, in a sense, did not happen in the tech industry when they were needed. There are quite a few parallels between the two sectors. Lately I spent a lot of time covering the pandemic, but there are big open questions on which we need to build an informed discussion. I think of the role of journalism as priming the conversation on these issues. However, the need for a better and informed discussion also applies to the pandemic, for example concerning disinformation, anti-vaccine sentiments, the distribution of a vaccine, and the current media landscape.
To what extent should we think of big pharma as a technological sector? Is the concept of ‘platform’ of any use to understand this industry?
Hannah Kuchler: It is interesting that you ask this question, as a lot of pharma companies are currently trying to sell themselves as platform companies. This makes sense, but it’s still early to understand completely what this will imply. The way they think of a platform is not as a sort of social media platform where everything is built on top of it, but rather as a having a product which can be reiterated very quickly. A traditional biotech company would possibly spend ten years researching and developing a single drug, maybe starting from university research, then building trials in labs and eventually in humans. Now the big pharmaceutical industries are trying to identify a new model. Let’s take the example of the vaccine. Moderna developed a covid-19 vaccine starting from the genome of the virus, and producing a drug that, once injected, teaches the body to make its own antibodies against sars-cov2. Once the genome of the virus was made available by Chinese scientists, Moderna was extremely quick in developing the spike and the rest of the vaccine: it only took them 42 days to produce the drug. Everything else since then has been testing. And the reason why this is possible is that we now have a technology that works starting from genetic sequences. This can be thought of as a platform in the sense that this technology makes it possible to plug in different genetic sequences to get disease-specific remedies. We can use crispr and other gene editing techniques as a kind of genetic programming technology. There are people who argue that pharmaceutical companies will end up looking more like tech companies because, instead of starting from scratch each time with the development of a new drug, we will have something closer to a process of updates, like we now have with the software of our smartphones. And this is because we are able to tweak the genetic sequence, and we can do this basically by programming.
The European Commission launched a public consultation for a Pharmaceutical Strategy for Europe. It argued that today’s regulation and financing of the sector do not necessarily align the interests of big pharma to society’s needs, that there are market failures, and that dependency on third countries for importing medicines should be reduced. What are the critical points?
Hannah Kuchler: It is clear that there are market failures. Some of the most common examples are antibiotics and resistance to antibiotics. As antibiotics are not very expensive, pharma companies do not have the right incentive to come up with them. There are some governmental and other funding bodies trying to address this issue, but it hasn’t worked very well. The reason for this is that there can’t be a massive market for an antibiotic when it comes out. This is because a new antibiotic should not be overused, otherwise microbes may become resistant to it, making the antibiotic itself useless. This is a very complicated issue currently without a clear solution. In terms of importations, covid-19 has brought up a lot of concerns about global supply chains, and how much we are reliant on countries like China for the supply of active pharmaceutical ingredients. I have to say that I am personally surprised of how these supply chains seem to hold in these exceptional circumstances. I am not coming to this from a nationalist point of view, but it is clear that it is not rational to concentrate all essential drug ingredients in one place.
What was the role of new technologies in the effort to face the pandemic? We were flooded with numbers, but numbers did not always make sense. What was the role of big data and contact tracing apps in the health crisis?
Hannah Kuchler: The most important data in this crisis was of course testing, which meant getting the right data in the first place. In the US the lack of testing in the initial phases meant that it really was not possible to have an idea of what the situation was. In the same way as people are obsessed with following the polls before an election, in a pandemic people tend to think that the data must show the story, but as a reporter one has to realise that there are circumstances in which the data does not show the story, because the data has not been collected yet, or it has been collected badly. The big warning for reporters from the pandemic is that, unless we are collecting the right data, we do not know what is going on, even if our aim should of course be on collecting the right data. Contact tracing is an interesting case from the point of view of big tech companies trying to get into the health sector. Of course, it looked like a very good opportunity for them to access the sector thanks to their experience with smartphones. However, they faced a backlash quite early on, because companies have been very privacy conscious, and governments were very careful on which tracking technology to use and which not to use. There were some attempts from governments to build their own apps that did not really work out, which has once again showed that big tech companies are very powerful, because they know how to build these technologies quickly, while others don’t.
Given this background, what do you think will be the role of digitisation and big data in the health sector? What will be the boundaries on privacy in this context? What data will be open and what will be proprietary? Are there signs of a convergence of big pharma, big tech, and finance/insurance?
Hannah Kuchler: On the one hand, there are some very simple things. For example, we are seeing an increase telemedicine, and this will probably grow even more, because it is a cheap and easy way of delivering care, and people are getting more and more used to doing video calls. The next step in this direction will probably be the use of wearable devices, in order to monitor patients remotely. In the US some hospitals did this with low risk Covid patients, who have been assisted remotely from their own homes, while beds were kept free for more seriously ill patients. However, we have to keep a very close eye on health inequalities. There is a risk that these wearable devices that are on the market now will remain limited to the so-called ‘worried well’, i.e. people who can afford these devices and who tend to already be individuals in good health, who put a lot of effort in tracking their daily lives. Instead, these devices would be most useful for other kinds of people, like those affected by chronic diseases like diabetes, or people who would need some serious preventive care, and we need to make sure that these are the people who will be able to access this technology. On the other hand, and coming to more complex themes related to data and privacy, there is rightly a lot of anxiety about these issues, especially in systems like the US in which insurance companies are very interested in having access to information on one’s pre-existing condition. It is also undeniable that the technology we have has the potential of creating systems of surveillance on individual behaviours, which should be protected. All of these issues should be watched very closely. But overall, the reason why we have privacy concerns is that there is currently no trust in the system. If you could own your data, and have real transparency and trust on where it goes, in what format, and its security, then we would enable things that could be very beneficial for the patient. However, we are currently quite a long way from having all of these things in place.
What is the critical issue?
Hannah Kuchler: One of the main issues is the concentration of power. If big tech companies get into healthcare, they are going to have a lot of capabilities, because they have capital, experience, and expertise. Moreover, they also have a lot of other data, and they operate also in other sectors, like advertising. This means that they have interests to use data coming from the health sector for other kinds of business. One of the main issues will be how to make sure that the interest of companies and government organisations that hold these data are aligned with the interest of the patient. Transparency may be key here. Let me give you one example. Apple has a medical record service. In the US all hospitals run on different record systems, and Apple offers a system to try to bring these systems together, with people sharing their own health data from their phone. When you choose to show your medical records, one of the things you are told about the organisation you are about to share your data with is how that organisation makes its money. For example, Apple makes most of its money from devices, while Google from advertising, which would make a personal decision about sharing health data potentially different. I think that a central point is for the user to be put in front of a more transparent choice, where it is clear, if one decided to share their data, what that data would be likely used for.
Another industry in which the digitisation is showing its disruptive effect is journalism. From your point of view, how is journalism changing right now? Have people started to find an equilibrium between digital and print? What new business models are emerging? How is the profession of the journalist changing?
Hannah Kuchler: Journalism has been in a crisis ever since I joined it, so I do not have experience of a time in which my sector was not going through some difficult phase. I am very lucky, because I work for a company that has found a business model that works well, having a fairly high paywall and providing very original reporting and a very high-level global network, and to offer these services to people who are willing to pay for it. This model works pretty well, and in fact we are seeing a lot of other major outlets who are imitating it, like The New York Times and The Times of London. In my opinion, people are gradually getting used again to the idea that news is something you have to pay for. On a more critical note, I hope we will be able to invest more in local news. People tend to underestimate the importance of local news, but I would argue that local news gives an important contribution to the whole ecosystem of information in two important ways. The first is that a lot of people have never meet a journalist, and that didn’t use to be the case. It is much easier for people to despise or not trust journalists if they never met one, while a healthy local journalism can be essential to build trust in the system of information. The second aspect is that the local press used to be a wonderful feeder for the national press: the local press would provide very good journalists on the ground, who would scout for important stories that were not being covered, and then the national press took them up. If we don’t have that, we end up with a system of information that is more and more concentrated around New York or Westminster, or other bubbles of power. In a few words, I think that journalism is still very much in a flux, that some models are starting to become consolidated, and I am still particularly worried about local journalism.
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