As I write, the industry chatter is all about GSK’s decisions not to patent some of its products in some poorer countries and its novel payment terms for gene therapy in advanced economies. Added to its return on capital targets, ending payments to external speakers and changing sales incentives, GSK’s choices set it apart from its peers. They are widely seen as an attempt to lead industry practice towards a higher moral standard. From the perspective of evolutionary science, this is fascinating and has strong parallels with current thinking into the evolution of human nature. As always in this column, I ask you to allow me to digress into the science a little before I come back to the practical implications.
For decades now, evolutionary science has been the dominant scientific perspective in explaining how we humans came to have our current phenotypes. From lactose tolerance to eyelid folds and skin colour, Darwin’s theory of natural selection has helped us to understand the similarities and differences between humans. More recently, however, the influence of evolutionary thinking has spread from biology into areas that were formally the domain of philosophers. For example, why are humans altruistic and where does our sense of morality and ethics come from? Some of the work in this complex area has been criticised as being unscientific and speculative but, as the science progresses, it is gradually yielding an evidence-based explanation of why human nature is the way it is. For example, in 2011, Abigail Marsh and her co-workers published a paper showing that variation in just one gene – the Serotonin Transporter Genotype – could be used to predict moral judgements.
As recent pricing debates have reminded us, our industry needs a ‘licence to operate’ because it is socially important
Work of this kind supports the idea that, over the course of evolutionary time, the Darwinian process of variation, selection and amplification led to certain behavioural traits – such as altruism and morality – that seem to be characteristically human. This field of evolutionary psychology is less developed than its anatomical and physiological counterparts. But the general idea is that ethical, moral behaviours developed as adaptations to living in extended social groups and, as evolutionary theory demands, they implied some kind of survival advantage. In short, we developed a predisposition for moral behaviour because, in our evolutionary environment, its benefits outweighed its costs. Our ethical survivors out-competed their amoral cousins.
Now, back to the life science industry and GSK. How would evolution help us to understand what is going on here? Well, in an evolutionary sense, GSK’s behaviour is a mutation. The traits of transparency and concern for access are, to a degree, ‘abnormal’ when compared with the entire population of life science companies. You can think of them as an allele with the price-gouging behaviour we have seen recently in other firms. The day before I wrote this article, I watched a senior GSK person explain its position to a room of industry peers who were somewhat shocked and bemused by GSK’s decisions. Their reaction and their doubts about whether such decisions could be made in their own companies was good evidence of how atypical GSK’s thinking is.
Sticking with the evolutionary analogy, GSK’s mutation – let’s call it the morality gene – will be selected for or against by the market environment. It may be disadvantageous, leading to higher costs and lower returns in comparison to its peers by causing parallel imports and restricting its access to markets where corruption is endemic. On the other hand, it may be advantageous, allowing GSK to establish trusting, mutually beneficial relationships with payers and to attract talented people who are morally motivated. If the former is true, the gene will die out. But if the latter result occurs, GSK’s behaviour will be copied and will spread to be the norm in the industry, or at least in the innovative parts of the industry. Either way, we are observing in GSK a variation in the industry’s gene pool and this is the first step in the variation, selection and amplification process that characterises Darwinian evolution.
Of course, our understanding of evolution is limited and we have only weak predictive powers but I would speculate that GSK will, in the future, be seen as the ancestor of future business models. As recent pricing debates have reminded us, our industry needs a ‘licence to operate’ because it is socially important. If public opinion turns against us, government action will follow. In a future of increasing demands for healthcare but with limited budgets, transparency and fair pricing will probably be essential to winning and holding such a licence to operate. We can’t know if that will become true, of course, but my research points strongly in that direction. And if it does, GSK will not only survive but thrive.