Economics is like a church, and it fulfills the same function the church had fulfilled for centuries: the justification of the status quo.

The domestic power structure - how power is exercised in the United States, for instance - greatly influences the structure of international institutions. So, for example, the Clinton administration was very influential in shaping the WTO treaty, and, because of the way the US domestic political system works, this meant that corporations could use the US government to wield a huge influence.

Companies are actually much better than governments and other bureaucracies at organizing in a holistically efficient way the extremely complex path from the examination of molecules all the way to the delivery of medicines to patients. Already in the conception and selection of research projects, companies would anticipate all the challenges down the line that they will need to overcome in order to achieve actual health impact. Bureaucratic organizations, by contrast, are notoriously bad at this sort of optimizing.

You may know that in India now the Tata car is becoming all the rage; you can buy it for one lakh - $2000 dollars - it's very, very cheap. So India seems to be going the route that China went a few years ago and that developing countries all over the world seem to want to follow, namely, to rely on these personal vehicles, which is just an irrational way of organizing transport.

Because present procedures by design favor the affluent, the poor are being increasingly marginalized. And because the poor are so marginalized, they can exert little influence on institutional design decisions. We need to break out of this vicious spiral and create momentum in the opposite direction.

In the United States there are only two exceptions: banks have to report deposits they suspect to be related to either terrorism or drug trafficking. But if your funds derive from trafficking women and children for sexual exploitation, for example, or from illegal arms trafficking or any other illegal activity, then banks in the US are legally free to accept your money and are not required to report your deposit to the authorities.

By using general consumption PPPs, the World Bank is, in effect, saying to the poor: "Sure, you cannot buy as much food as the dollar value we attribute to your income would buy in the United States. But then you can buy much more by way of services than you could buy with this PPP equivalent in the United States." But what consolation is this? The poor do not buy services - they are services, on their luckier days.