If you ask yourself who is paying for pharmaceutical innovation today, the answer is that it's the more affluent populations paying for still-patented advanced medicines at the pharmacy, for comprehensive insurance coverage or for a national health system.

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.

Feudalism is an economic system where a few people own all the land and the others have no option but to be serfs on such a feudal estate. We now condemn feudalism. We condemn not merely the feudal lords but we condemn the whole structure of rules that sustained feudalism. I am asking people to think similarly about the world economy.

Economists operate with this image of the homo economicus, the rational economic agent, and while such agents are rare in the wider world, they are common in economics departments. Exemplifying the homo economicus paradigm, economists typically choose their research projects and hypotheses so as to promote their own careers, to maximize their lifetime income. This explains the astonishing pressures toward conformity in academic economics: how deviant views (except those by a few who have already achieved stardom) get crushed by an army of conformists.

For the present system to work, poor people must be excluded from the innovation, because if they could get access at an affordable price, then affluent people would find ways to buy it cheaply as well - and then the innovator would be poorly rewarded and introductions of new medicines would decline.

In the domain of pharmaceuticals, we need a metric for health impact, and with this metric we can then assess the value of the introduction of a new product and pay its innovator accordingly, say on the basis of the product's measured health impact during its first ten years on the market. In exchange, innovators must of course renounce the usual rewards they are otherwise entitled to, namely the patent-protected markup on the price of their product.

With the Health Impact Fund, the innovation is paid for separately, through publicly funded health impact rewards, and the product is sold at the cost of production to all. Here, the cruel injustice of preventing the poor from buying at cost - evidenced by today's suppression of the trade in generic versions of patented medicines - would no longer be needed.