BB&T Contributing Writer

Editor’s note: The following commentary is excerpted from a column that appeared last month on the new “e-zine” web site, BioWorld Perspectives, a weekly perspective on the biotech industry by the publishers of Bioworld Today and Biomedical Business & Technology.

It often starts this way. The beanpole guy with a half smile, grubby in torn clothes, limping. Others hunch in doorways under rags and newspapers. Mid-afternoon Sunday at Polk and O’Farrell in San Francisco.

I’ve just registered for the JP Morgan Healthcare Conference — the annual deal-making meeting, where pacts valued in the millions are quietly begun between biotech and pharma firms — in the Westin St. Francis hotel about eight blocks east. The day is perfect for walking. I stow my fluorescent green JPMorgan bag in the car and take off. My feet aim instinctively away from Union Square’s tourist bustle, away from Chinatown, away from Russian Hill.

I find myself in one of San Francisco’s most down-and-out regions. Bedraggled, misshapen people twitch and howl in front of boarded-up windows. A few have laid out cracked cassette tapes, chipped bowls and other dubious treasures for sale or trade on sidewalk blankets. Other types of commerce take place more furtively. This white packet goes into that palm, paper money goes into this one.

At Polk and O’Farrell, I don’t see anybody with JP Morgan bags over their shoulders, nor will any geeks from the Macworld convention probably stray here, though I will spy them hurrying — eager for new games and gadgets — toward Moscone Center, later in the week.

“Hey, man, can I ask you a question?”

“Not only is one leg bad, but he has sores on his face, and he seems to breathe harder than normal, as if he’s been running. Maybe he stole something and was chased. He doesn’t seem like a sprinter.

Just as obvious as the weather is the shriveled woman behind him, not more than 30 years old in calendar years, but looking ancient, weak, her face gaunt and ravaged under a wiry nest of hair..

“God bless you,” the guy says, his rough hand taking the coins. Most of them say this.

Maybe my chosen direction wasn’t the best idea after all, I’m thinking, as I plunge deeper into San Francisco’s tenderloin. I walk enough here but today the scene packs strangely more force. Is everyone in this neighborhood physically or mentally ill, or high?

I keep recalling the woman against the wall. She’s emaciated because maybe she’s got a golf ball-sized tumor in her colon, and Erbitux, last time I checked, costs $10,000 a month. Or maybe she’s lucky; she has HER2-positive breast cancer, and she can get Herceptin for $3,000 monthly to enjoy more of these nice days at Polk and O’Farrell.

And then I want to go back to Union Square — a clean, happy and prosperous way, with trim-to-plump shoppers getting and spending. They lay waste their powers, as Wordsworth said, but at least they have powers to waste — until diagnosed — after which many can afford therapies that might allow them to shop longer.

I’m ashamed of my own thoughts, my need to flee Polk and O’Farrell. None of this, I realize, can I discuss at cocktail parties sponsored by investment banks. “Liberal guilt,” I’ll hear, before we move on to talk about hedge funds and how they’re competing with venture capital these days. “I like your tie.”

At cocktail parties and elsewhere, I’ve talked with biotech CEOs who struggle with their ambivalence about drug pricing. Shareholders — who made the research advances possible — demand to be paid for the discoveries they enabled. Why shouldn’t they be paid?

To me, though, the issue feels more basic and larger than the phrase “liberal guilt” can capture. It goes beyond anything contained in routine editorial-page scolding in the mainstream media about the high cost of pharmaceuticals.

R&D is expensive, and companies should be rewarded for innovation; we know this. At the same time, a civilized society shouldn’t let people die because they’re not rich. Both statements are true. Game on, pundits.

At Post and Powell, in the center of Union Square, another homeless man hits me up for change. I don’t have any left. “Sorry,” I tell him. “God bless you,” he says, but at the moment I’m not sure.