What Happens When the Best Solution Isn’t the Most Profitable One?

I’ve been thinking about incentives lately.

Not just in healthcare, but across science, technology and business.

We tend to assume that if something is genuinely useful, eventually somebody will develop it. If a treatment improves health, researchers will study it. If a technology reduces energy costs, companies will build it. If an idea could improve people’s lives, capital will find its way there.

I’m not sure the world works quite that neatly.

Innovation requires people, time and money. Researchers need funding. Companies need to generate a return. Investors need some reason to take a risk.

Most of the time, that system works remarkably well.

But it also creates an interesting question.

What happens when something is valuable to society but difficult to monetise?

Commercial Incentives Shape What Gets Built

Pharmaceutical research is enormously expensive.

Developing a medicine involves laboratory research, clinical trials, regulatory processes, manufacturing and years of uncertainty.

Companies understandably look for opportunities where intellectual property can protect that investment long enough to generate a return.

Patents are one of the mechanisms that make high-risk research commercially possible.

The problem is that the reverse can also be true.

An intervention that is inexpensive, already widely available or difficult to protect commercially may attract less private investment even if the underlying scientific question is interesting.

That doesn’t mean useful treatments are deliberately ignored.

It means the economic incentive to spend hundreds of millions of dollars studying them may simply be weaker.

That distinction matters.

Researchers Have Incentives Too

Scientists are curious people, but curiosity alone doesn’t pay for laboratories.

Research requires grants, staff, equipment and institutional support.

That means researchers often have to pursue questions for which funding is actually available.

Governments establish priorities.

Foundations establish priorities.

Industry establishes priorities.

Universities compete for grants.

Over time, those decisions influence which questions receive enormous amounts of attention and which remain comparatively unexplored.

Again, that doesn’t require anyone behaving badly.

It’s simply how incentives work.

Healthcare Makes the Problem Easy to See

Consider prevention.

Helping people improve sleep, nutrition, exercise, metabolic health and other modifiable risk factors can contribute enormously to long-term wellbeing.

But there isn’t always a single product attached to those improvements.

A tablet can be sold.

A patented device can be sold.

A proprietary diagnostic can be sold.

Helping somebody consistently change behaviour is much harder to package.

That doesn’t make medicine bad or lifestyle medicine good.

We need both.

But it does mean different parts of healthcare can attract very different levels of commercial investment.

This Happens Outside Medicine Too

Energy provides another interesting example.

There are legitimate areas of energy research that could significantly improve efficiency, storage, generation and distribution.

Some technologies attract enormous investment because there is a clear commercial pathway.

Others struggle because infrastructure costs are high, returns are uncertain or existing systems are difficult to replace.

That is very different from claims about “free energy” or perpetual-motion machines, which conflict with established physics.

But there is still an important underlying question:

How many potentially useful technologies progress slowly because the economics around them are difficult?

You could ask the same thing about environmental remediation, open-source technology, public infrastructure or agricultural research.

Markets Are Powerful, But They Don’t Solve Every Problem

I’m a strong believer in entrepreneurship.

Markets create extraordinary incentives for people to solve problems.

But markets are tools.

They naturally prioritise problems that can generate economic value.

Sometimes social value and commercial value align perfectly.

Sometimes they don’t.

That’s where governments, universities, philanthropy and mission-driven organisations become important.

They can support areas where the societal return may be much larger than the immediate financial one.

AI Could Change the Economics of Research

This is one reason artificial intelligence interests me.

AI may reduce the cost of exploring ideas.

It can help researchers analyse literature, model possibilities, identify patterns and potentially narrow down which hypotheses deserve deeper investigation.

If research becomes cheaper, questions that were previously uneconomic to study may suddenly become more practical.

That could change the incentive structure.

Not completely.

Clinical trials, laboratories and real-world validation will still cost money.

But lowering the cost of discovery could widen the range of questions we’re able to ask.

Looking Ahead

I don’t think the answer is blaming pharmaceutical companies, researchers or investors.

They operate inside incentive structures just like everyone else.

The more interesting question is whether we can design better structures.

Structures that reward innovation while still creating room to investigate ideas that may not produce an obvious patent, subscription or product.

Because occasionally the best solution to a problem may also be the cheapest one.

And we should make sure our system is capable of discovering it.

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