FIGURE 4-1 Health care spending as a percent of GDP by country.
SOURCE: Data from the Organisation for Economic Co-operation and Development, 2007 ( [accessed October 3, 2013]).

predictability would then propagate through the rest of the system, bringing greater clarity to regulation, reimbursement, and health care delivery.

Duyk demonstrated the impact that uncertainty can have on investment by explaining a scenario from the work of Gneezy and colleagues (Gneezy et al., 2006). The average price that someone would pay to purchase a $50 gift certificate from a friend is $26. Similarly, someone would pay $45 for a $100 gift certificate, or about 50 percent of the original purchase price, Duyk noted. However, when uncertainty is introduced into the circumstance and the buyer knows only that the gift certificate is worth either $50 or $100 but not which amount specifically, he or she is willing to wager only $16. In this case, the risk is overvalued, resulting in an undervalued product. “Anything we can do to create certainty and predictability in translational research has enormous economic impact, [so] I wouldn’t underestimate [value] in the system,” Duyk said.

To improve the translational pathway, the entire translational research ecosystem needs to be considered, he said, explaining that all the parts need to be taken into account, just like a car needs to be cared for: it needs fuel, tires, and insurance so that it functions properly. The challenge is that the entire ecosystem needs to change around new technologies, such as genomics. “Sometimes, the technologies induce the change. Other times, you, as an innovator, have to figure out how … to allow change to occur.”

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