BACKGROUND Who benefits from the commercial biomedical research and development (R&D)? Patients-consumers and investors-shareholders have traditionally been viewed as two distinct groups with conflicting interests: shareholders seek maximum profits, patients - maximum clinical benefit. However, what happens when patients are the shareholders? With billions of dollars of public risk capital channeled into the drug development industry, analysing the complex financial architecture and the market for corporate control is essential for understanding industry's characteristics, such as pricing strategies or R&D priorities. RESULTS Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds to tax-derived governmental financing shows that the majority of biomedical R&D funding is public in origin. Despite this, even in the high-income countries patients can be denied access to effective treatments due to their high cost. Since these costs are set by the drug development firms that are owned in substantial part by the retirement accounts of said patients, the complex financial architecture of biomedical R&D may be inconsistent with the objectives of the ultimate beneficiaries. CONCLUSIONS The divergence in economic and public health performance of the drug development industry is resultant from its financial underwriting by enormously expanded pension schemes, governmentally mandated to represent the interests of "captive" beneficiaries, as well as similar policymaker-designed funding flows, whose standards of transparency, accountability and representation are substantially lower than that of governments themselves. Strengthening those elements of institutional design and thus ensuring active responsible shareholding in the interest of the patients-savers is an under-utilised, but potentially high-impact opportunity for advancing public health.

中文翻译：

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养老金和国家基金主导生物医学研发投资：信托责任和公共卫生。


背景 谁从商业生物医学研究和开发（R&D）中受益？患者-消费者和投资者-股东传统上被视为利益冲突的两个不同群体：股东寻求最大利润，患者寻求最大临床利益。然而，当患者成为股东时会发生什么呢？随着数十亿美元的公共风险资本进入药物开发行业，分析复杂的金融架构和公司控制市场对于了解行业特征（例如定价策略或研发优先事项）至关重要。结果 将政府规定的退休计划、中央银行和促销银行以及主权财富基金的投资添加到税收来源的政府融资中表明，大部分生物医学研发资金都是公共来源的。尽管如此，即使在高收入国家，患者也可能因费用高昂而无法获得有效的治疗。由于这些成本是由药物开发公司设定的，而这些公司的大部分资金由上述患者的退休账户拥有，因此生物医学研发复杂的财务架构可能与最终受益人的目标不一致。结论 药物开发行业的经济和公共卫生绩效的差异是由于其通过大幅扩大的养老金计划进行的财务承保，政府授权代表“专属”受益人的利益，以及政策制定者设计的类似资金流，其标准透明度、问责制和代表性远远低于政府本身。 加强制度设计的这些要素，从而确保为了患者储蓄者的利益而积极负责任的持股，是一个未得到充分利用的机会，但对于促进公共卫生具有潜在的高影响力。