The British government is a great believer in targets. This is, they think, the way to get improvements in services. You set targets for people and you put the fear in them. If they don't meet your targets, then they're in trouble. Incentives, that's the game.

Only it doesn't work.

What you're after is a good service. Which in the target mindset has to be measured in something countable. Now good treatment in Accident and Emergency wards in hospitals is probably prompt treatment. So they time everyone as they walk, stagger or are wheeled through the door, and time when they get to see someone medical, and if the intervening interval is more than 40 minutes, then The Target Was Not Met.

By this means, A&E staff have undergone a subtle shift in incentive. Lord knows it's not a job for the shirker. So you might have assumed a fair amount of commitment at the outset. But now that commitment has been devalued as the primary motivation for the work and replaced by a desire not to overshoot the 40 minute mark, and risk pissing off the management-by-mindlessness suits.

A&E isn't, by its nature, the most predictable of businesses and even the best-managed wards will have their hectic moments. So A&E staff around the country have been having a quiet word with their ambulance crews. A fair few of their ‘clients' (in everything-is-a-commodity speak) arrive by ambulance. And when things are a bit busy, these cases are quite safe if they're kept parked, and unlogged, in the back of the ambulance rather than in the waiting room with the clock counting. Parked in an ambulance that is itself parked in the hospital car park, waiting for the rush to die down so A&E can take in new cases without fear of missing targets.

The problem now is that the ambulances, instead of being mobile sources of emergency assistance, have become stationary pseudo-waiting rooms. No one would think of doing this without the ill-conceived waiting-time target.

When an ambulance is needed to do what ambulances are supposed to do, then the waiting case is quickly off-loaded before the ambulance shoots off on its latest mission of mercy. It is only matter of a few moments, perhaps, but a few moments could be life-and-death where the ambulance is going.

When the perverse effect of this waiting-time target was discovered, the suits went back to their behaviourist drawing-board and came up with an answer. They'll add a target for the time it takes an ambulance to get to an emergency call.

There is this tendency for poorly thought-out incentives to produce understandable but undesirable avoidance behaviour. This can be seen in the patent system, especially when applied to drugs.

Now the PR machine that Big Pharma has on permanent retainer will keep telling you that patents are necessary as an incentive for research and development of new drugs.

The reasoning behind this, besides being largely inconsistent with the facts, is interesting. There are many other professions that call for ingenuity, experience and dogged hard work to come up with the winning idea. Police have to solve crimes when the perpetrators have done their best to mislead and confuse. Teachers, faced with an epidemic of ‘am I bovvered' attitudes, have to figure out some way of motivating learning. Back in the A&E wards, medical staff have to read symptoms and find diagnoses.

Do these people also require the same kind of incentive that the drug manufacturers claim as their right? The more polite in the medical profession sometimes call it monopoly pricing, but in reality it means gouging the living bejesus out of patients who have no alternative to paying up other than dying.

Should policemen get paid, and handsomely, only when they've put someone behind bars? Well, you could try it, but don't blame me when you find yourself neatly stitched up for some crime you never committed. ‘Incentivize' teachers by paying by exam results and you'll find every teacher starts ‘teaching to the test' and, if the US experience is an indicator, organizing mass cheating as well. General practitioners in Carlisle were rewarded for maintaining the health of patients on their list; but then the chronically sick and the sink estates of cigs, booze and fast food couldn't find a doctor to accept them on their lists.

What unwarranted behaviour do the drug companies indulge in as a result of having the patent system as their ‘incentive'?

Well, they lie, as a perusal of the attack ads against Thailand's compulsory licences will show.

They subvert the regulatory processes, by putting their own people on supposedly neutral panel to review patents and challenges to patents.

They waste their valuable expertise in finding miniscule alterations to someone else's brilliant invention and getting that patented as a me-too drug. Or they take a drug developed for one illness and cast about for some other illness it can treat (even such dubious maladies as ‘male pattern baldness') so they can re-patent the same drug for the second use.

And they divert part of their profits to intensive lobbying of legislatures to ensure they can make even more money in future. Thai patent law allows pre-patent challenges. If anyone puts in a frivolous or spurious patent claim, then before it gets locked up in the patent examination process, it can be challenged. Thai public interest groups have successfully mounted such challenges and spared Thailand the problems of illegitimate patents. But Big Pharma is currently pushing for a legal amendment to remove the opportunity for pre-patent challenges. You can still challenge, but only after the drug is on the market, with a patent, and at a monopoly price, with cheaper alternatives banned.

Now some of this behaviour is unethical in the first place. But some is just perverse and a direct result of drug R&D being rewarded by the patent system. Those currently profiting from these perversities will repeat the tired old Thatcherism ‘There Is No Alternative'.

But there is. Many, in fact. Lots of countries, including rich ones, happily excluded pharmceuticals from their patent systems until WTO regulations forced them to change. Many essential medicines have been developed by public-funded health institutes and universities (which private companies then have tweaked and patented). And drug companies are well aware that patents on life-and-death drugs can be legally suspended by governments at any time.

All we need is a better set of incentives.