The Personal and the Academic

There’s a lot that I could write about my personal experience with cancer. And it’s likely that I will return to that at some point, especially if I feel physically worse.

But one big reason for starting to write publicly was to try to find my way back to my research. During treatment, I finished a book that I’ve been working on for a very long time—but while I was relieved to complete it, I found that in my new reality I didn’t care very much, either about the book itself or, really, academic research in general. As my attention was consumed by my health, I found that I couldn’t really think about much else.

At the same time, at some level I was the same person. As I tried to process the experience of cancer treatment, I found myself looking for books that could help me make sense of it, whether spiritually (Pema Chodron), personally (No Cure for Being Human), or practically (Dr. Susan Love’s Breast Book). As treatment receded but my health problems persisted, I also started reading the sociology of chronic illness. (I did buy Emperor of All Maladies, but couldn’t bring myself to read it while said malady was feeling a bit too immediate.)

Certainly even in the midst of treatment it was clear that some of the things that intrigued, puzzled, or disturbed me were contiguous with my existing academic interests, but in new contexts.

As I decided between two chemo regimens, one longer and harsher but that would statistically reduce the risk of recurrence by two percentage points, I wondered how people make sense of numbers as they make decisions about their health.

As I noticed my oncologist’s dismissal of evidence based on observational, rather than experimental, data, I thought about how differently experts treat evidence depending on whether experiments are possible in their field of expertise—and what experts in such fields underweight by focusing only on the kinds of knowledge that experiments make possible.

And as I blindly tried to navigate a complex medical organization, I wondered why we had produced a system in which expertise is exquisitely specialized and coordinated, yet so little attention is given to how patients experience it.

In the month since I’ve started this writing practice, I’ve quickly generated a long list of topics that interest me. It is refreshing to remember that I can, in fact, still be intellectually engaged.

But I am letting myself be pulled in the direction of the things I already study—because if I’m not writing as a form of therapy, then I’m writing to regain my academic identity. (Maybe those are the same thing.) In the short run, I think that means exploring topics that are closest to my existing research. Not necessarily economics-the-discipline, but more the reason economics drew me in the first place—because I’m interested in how the ways that we think about economic things shape institutions and how we govern them.

In my first book, I wrote about how we came to understand academic science as having an economic role to play, and what that meant for policy (in terms of patenting, funding, and so on) and for the universities that housed scientific research. In the book that’s coming out in a couple of months, it’s about how a broad way of thinking associated with a particular discipline spread across policy spaces, reshaping the range of options that seem reasonable.

The things I’ve been writing about in the last month are very much in this space. Our ideas about how companies generate new inventions intersect with a range of political interests to shape an intellectual property regime that allows companies to protect their inventions from competition for 40 or 50 years. Scientific research evolves from producing simple-molecule drugs to complex biologics, but our model of regulatory policy does not evolve accordingly, with the result that competition decreases and prices rise.

And most recently, I’ve found myself thinking about different models for setting drug prices—and how a shift from cost-plus pricing, based on the cost of production plus a profit margin, to value-based pricing, in which prices are set based on the value they provide to patients, is really a transformative change. I suspect that the people making these decisions, whether they are drug companies seeking to maximize their profits or government agencies looking to control costs, are not fully attuned to the systemic implications of such broad shifts in models—but thinking about these things is very much in my wheelhouse. So that’s what I’m planning to explore next.

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