In science, paradigm shifts often begin with a quiet “that’s odd.” But in the political economy of biomedical innovation, the most damning truths begin with: “Everyone knows this.”

Everyone knows that American universities—funded by taxpayers—perform the foundational research that leads to most new drugs. Everyone knows pharmaceutical companies swoop in once the risk is gone, license the discoveries, and monetize them with monopolies. Everyone knows that drug prices are outrageously high, that access is limited, and that natural compounds and integrative approaches are structurally excluded—not because they don’t work, but because they can’t be owned.

So the question isn’t what we know. It’s why, knowing all this, we haven’t changed the rules.

Recent celebratory pieces, like the one published in STAT by Kinch and Gardner, tout the “stunning” statistic that 50% of new FDA-approved drugs between 2020 and 2024 were based on university patents, 87% of them from U.S. institutions. Stunning? Only if you’ve been asleep since Bayh-Dole passed in 1980. The article lauds the public-private dance without asking: Where’s the public return on investment? Where is the moral contract between public funding, massive profits, and public access? Where is the plan to fix what we all know is broken?

Let us look at why most of us at the party remain sober and see what remains unchanged.

The Bayh-Dole Act was intended to ensure that federally funded discoveries could be commercialized for public benefit. But instead, it created a new form of academic rent-seeking. Universities now measure success not by healing or access, but by patent portfolios and licensing revenue. Faculty are pressured to secure IP rights and form spin-offs. The march-in rights that were supposed to guarantee public access? They have never once been used.

In the early 2000s, as the Plenary speaker at a Pharma conference in New Jersey, I advised pharmaceutical companies directly: if you want to bring natural compounds to market, lobby Congress to create a 20-year profit window tied to doing the clinical research. Establish a structure that rewards validation of what nature has already provided. They declined. I declined their numerous job offers.

Instead, Pharma chose a different strategy: reduce regulatory burdens, suppress liability, and fast-track risky products. They exploited legal mechanisms like the PREP Act to shield themselves from responsibility. They gamed the system to maximize return, not to expand access. Meanwhile, promising natural compounds remain neglected because there is no incentive to invest without exclusivity.

Consider curcumin, the bioactive ingredient in turmeric. With substantial peer-reviewed evidence supporting anti-inflammatory and anticancer effects, it remains commercially undeveloped. Why? Because no company can patent it in its natural form. What of the increased effectiveness if compounded with black pepper? There are no rosy ads on television during Superbowl for that nugget of know-how. Because if they study it, they risk losing the ability to sell it. If they modify it, they compromise its integrity. And under current FDA rules, anything investigated as a drug can no longer be marketed as a supplement.

So, we remain, collectively, ignorant as we and our loved ones get sicker and sicker.

We have also failed to recognize and incentivize process innovation. Integrative medicine thrives on protocol-based care: carefully sequenced combinations of diet, behavioral therapy, micronutrients, herbal extracts, and yes, sometimes pharmaceuticals. These are not pills—they are systems. But the system only rewards discrete, ownable objects. NIH won’t fund integrative protocols. FDA won’t regulate them. Venture capital won’t touch them. And therefore patients rarely benefit from them at scale.

And yet in a market of consumers played with chronic illness, they have become the most valuable commodity.

The culture of medicine is now structured around this enforced exclusivity economy. Endowed chairs at Universities are funded by donors aligned with industry. Academic priorities reflect what is patentable and tech-transferable, not what is effective. Integrative modalities—which resist reduction to single molecules or gene targets—are cast aside as unscientific, not because they lack evidence, but because they lack financial pathways.

Everyone knows this.

So why haven’t we changed the rules?

Because there’s no mechanism. There’s no framework for partial exclusivity without full monopoly. There’s no shared-value model for natural medicine R&D. There’s no regulatory home for multi-agent or non-linear therapeutic protocols. And there’s no incentive for entrenched institutions to go first.

But someone must.

We need a new structure—not to destroy pharmaceutical innovation, but to liberate it from its narrowest instincts.

Reform Bayh-Dole to mandate enforceable march-in rights and public return.

Create a new regulatory category for shared-value natural innovation.

Fund NIH trials for systems-based and integrative protocols, with open-access licensing.

Legally recognize and reward process patents without requiring product monopolies.

Let us build a healing economy that values outcomes over ownership. Let us invest in medical models that work, even if no one can own them. Let us redefine success in medicine—not by revenue, but by resilience, regeneration, and reach.

Integrative medicine is not fringe. It is the future we were too captured to build. But the frontier is still here. It’s just been fenced off. And we built the fence.

We can tear the house down, or we can add an addition.

The question is no longer what we know.

The question is: What are we waiting for?

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