Bucking the System (2021)

Episode Summary

Executive Summary: This TED Radio Hour episode explores how outsiders used data and public pressure to expose failures in major systems: Emily Oster showed school COVID risks were lower than feared, Preeti Krishdel argued patents artificially inflate drug prices, and Philip Atiba Goff reframed racism and policing as measurable behaviors. Together, they show systemic change starts by collecting evidence, measuring harms, and redesigning institutions.

Main Topics: Emily Oster and the school COVID data gap (Priority: 5/5): Oster explains how she and her team built a national database from more than 5,000 schools when governments failed to track outbreaks, mitigation measures, or reopening patterns. The goal was to replace fear and politics with evidence about school safety. Using data to make personal and public decisions (Priority: 4/5): Oster argues that data helps parents and policymakers understand tradeoffs and make informed choices. Her work aimed to translate complex research into accessible guidance during uncertainty. Patent reform and the cost of medicines (Priority: 5/5): Priti Krishdel describes how the patent system has shifted from rewarding invention to extending monopolies, allowing drug companies to stack hundreds of patents on a single drug and keep prices high. Public accountability in intellectual property (Priority: 4/5): Krishdel lays out reforms: raise patent standards, remove perverse incentives at the Patent Office, allow public participation and legal standing, and create stronger oversight to protect patients and innovation. Racism as behavior, not just bias (Priority: 5/5): Philip Atiba Goff explains that racism should be understood through actions and outcomes rather than attitudes alone, because measurable behavior can be analyzed, predicted, and changed. Reimagining public safety and policing (Priority: 5/5): Goff and Ithaca community responders illustrate how cities can shift certain crises away from armed police and toward trained social workers, mental health staff, and outreach teams. Systemic change through measurement and experimentation (Priority: 4/5): Across all three segments, the episode emphasizes that institutions improve when problems are quantified, hidden failures are exposed, and new models are tested in real communities.

Key Arguments: Emily Oster argues that school COVID decisions were made in a "data desert," and that school-level tracking revealed schools were not major super-spreader sites when precautions were in place. Oster and her team collected information directly from schools because federal and state systems were not coordinating or collecting the needed data. Priti Krishdel argues the patent system now functions as a monopoly-protection strategy rather than a public benefit mechanism, especially in pharmaceuticals. Krishdel contends that multiple patents on the same drug extend exclusivity far beyond the intended 20 years and drive up prices that can cost lives. Krishdel’s reforms seek to modernize patents so they reward genuine innovation while ensuring public access and oversight. Philip Atiba Goff argues racism should be defined by behavior and measurable harm, not merely prejudiced attitudes, because only then can institutions be held accountable. Goff says policing outcomes should be analyzed like any other organizational performance problem: measure behavior, identify gaps, and change policy. He argues cities should match responses to the type of crisis, using non-police responders when armed force is unnecessary. All three speakers present system change as incremental but evidence-driven: start collecting data, expose the failure, then redesign the institution.

Data Points: schools surveyed: over 5,000 - Emily Oster's national database of school COVID data survey frequency: every two weeks - Oster’s team repeatedly surveyed districts about mitigations, attendance, and cases patent term: 20 years - Standard monopoly period for patents under U.S. law patent applications on top drugs: 131 on average - Average number of patent applications for the 10 best-selling drugs in America market price reduction with competition: up to 80% - Research cited by Krishdel on prices after two or three competitors enter best-selling drug patent counts: 200, 300, even 400 patents - Examples of how many patents can accumulate on a single drug Keytruda extended exclusivity: at least 8 extra years - Example of a drug expected to remain protected well beyond the base patent term Keytruda projected cost: $137 billion - Estimated American spending during the extra exclusivity period Americans with a death tied to unaffordable medication: 34 million - Krishdel’s cited figure for people who lost a family member or friend in the last five years Americans saying someone died because they could not afford medication: 13% - Public reporting on medication-related deaths higher impact on people of color: twice as high - Medication-affordability death impact is said to be twice as high for people of color U.S. patent filings historically: 5 million in first 150 years - Krishdel contrasts early patent history with recent growth recent U.S. patents granted: 6 million in 30-40 years - Shows acceleration of patenting in the modern era prices of HIV medicines reduced: up to 87% - Outcome of patent challenges in India led by patient advocates and Krishdel’s organization deadly shootings involving serious mental illness: 25% - Goff argues this supports redirecting some crisis response away from police police beating disparity: 4 times more likely - Example Goff uses to distinguish raw disparity from explainable and controllable factors

Pivotal Quotes: "There was kind of no data collection effort on that. And I kept looking around for data on that and trying to figure out if there was data. Just like finding myself in a sort of data desert." — Emily Oster: Describing the lack of school COVID data early in the pandemic "The most common definition of racism is that racist behaviors are the product of contaminated hearts and minds. ... the only problem with that definition is that it's completely wrong, both scientifically and otherwise." — Philip Atiba Goff: Explaining why racism should be understood through behavior and outcomes "We can't rely on the voluntary actions of entities that are not incentivized to do this. This is why we need government." — Priti Krishdel: Arguing for stronger public action on medicine access and patent reform

Implications: The episode suggests major reforms begin with better measurement, not slogans. For schools, medicine, and policing, transparent data can expose harm, shift public debate, and create pressure to redesign systems for fairness, access, and safety.