تبدیل خطرات بالینی به ارزش اقتصادی: نقش انتظارات و نهادها در توسعه فناوری سلامت  Converting clinical risks into economic value: The role of expectations and institutions in health technology  development

1. “What if” expectations in innovation policy Technological innovation in a knowledge-based economy is “an intensely future-oriented business with an emphasis on the creation of new opportunities and capabilities” (Borup et al., 2006: 285). As a result, future-oriented expectations pervade innovation policy. For instance, in their report to the Canadian Government, the members of the Independent Panel on Federal Support to Research and Development took care to provide an explanation for their cover page, which featured a geographical representation of the country lifted up by a glowing light bulb. The explanation goes as follows: While the great American inventor Thomas Edison is given credit for “inventing” the light bulb, the story is really one of incremental innovation. In 1810, British chemist Humphry Davy invented the “electric arc,” a precursor to the light bulb. A series of innovations followed and, by the 1860s, the race was on to develop a commercially viable light bulb. Joining this race were two Canadians, Henry Woodward, a medical student in Toronto, and Mathew Evans, a hotel keeper. In 1874, they patented a nitrogen-filled light bulb that lasted longer than others of the era. But they could not get financing for their work, and in 1878 were eclipsed by British inventor Joseph Swan and then in 1879 by Thomas Edison. Realizing the commercial viability of the light bulb, Edison was successful in obtaining major financial backers. He used these funds to continue his experiments, but also to buy out many patents, including those of Swan and of Woodward and Evans. As we reflected on our consultations held across Canada, during which we heard first-hand of the struggles and successes of Canadian entrepreneurs, we wondered: What if Woodward and Evans had been able to interest investors? What if they had been able to obtain financing to carry on their work and beat out Swan and Edison to be the first to commercialize the light bulb? (Jenkins, 2011). This story resonates well with the idea of a knowledge-based economy in which commercial entities “seek capital, in the form of speculative investment, to transform [research-based] discoveries into commercial products and services” (Morrison and Cornips, 2011: 264). The story also illustrates two key observations from the sociology of expectations (Borup et al., 2006; Brown and Kraft, 2006; Brown and Michael, 2003). First, by foregrounding a likely rivalry between inventors located in different countries, the story casts Canada as racing against the United States and Britain. Albeit it does so implicitly, the story designates winners and losers, thereby setting the stage for a particular past political economy to be understood (Brown, 2003). Second, the “what if” questions encourage readers to envisage a more desirable future. The speculations about Canadian inventors’ ability to attract investments and surpass their British and American counterparts capture the main thrust of the Report, which posits securing access to capital as the key turning point in the light bulb development story. Contemplating such “what if” questions opens up a straightforward path of action to the Government of Canada, eager to see a wealthier future unfold.