International Campaign for Establishment and Development of Oncology Centers (ICEDOC)

Future directions

The Fourth Way

A proposal for a brain storming thinking. A vision for a Fourth Way.
By: Ahmed Elzawawy &

Our trials for searching for solutions for the problem of shortage of essential cancer drugs and biosimilars led us for broader scope and thoughts for many other problems and policies that have underlying economic elements in the world. That what Ahmed Elzawawy in 2013 and 2015 coined as “The Fourth Way” as a proposal for flexible brain storming thinking. article

Among multiple factors, the main obvious cause for the shortage of essential cancer medications and drugs generics in The USA is economic and particularly the lack of incentives for production. More scientific explorations and studies are needed. The aim should be toward the economical sustainability and affordability of better value cancer care and not whether the drug is brand or generics. Despite that this was our starting point and still our main issue of work as a clinical oncologist, but this led to see things more globally.

Searching for solutions for a problem with complexities like the shortage of essential cancer medications and drugs generics in the USA opens broader view for the underlying matters in the USA and the world. Hence, this could give a clue and a model for other issues in the world and in all aspects of problems and policies that have economic elements.

The floating choices for any economic system along the last two centuries lie in a predetermined way for the whole policy and economic issues for a given country. It could be fixed around:

a) We let the market work freely (Unlimited Liberalism and the historical older form of capitalism).
b) Or complete public-governmental- control and ownership.( The historical Marxism) .
c) Or Variable forms of a third way in between.
We think that it is the time to make reflections and to propose The Fourth Way.

The pre-Socratic philosopher Heraclitus was correct when he asserted “Change is the only constant”.

It was thought that there is nothing common between Liberalism and conservatism and they’ll never meet. After decades of Communism “Liberal conservatism” is recalled in Russia from the early 19th century Russians Philosophers and politicians like Vekhi, Pyotr Stolypin, Boris Chicherin , Vladimir Solovyov and Pyotr Struve. A modern Russian author A.V. Vasilenko summed up this school of thought, writing that despite of the paradox “Without a strong state, liberal reforms are impossible”. The British academic Richard Sakwa describes it as a unique synthesis of liberalism and conservatism embodied together as appeared in the article of Professor Paul Robinson in the American Conservative in April, 2012

In the other hand, it seems that the notions of liberals markets and economy of today as well as all the older systems and economic ideologies of State over control would change.

In the book “Librating the Heroic Spirit of Business. Conscious Capitalism,” edited by Mackey and Sisodia, Harvard Business Review Press. Boston, Massachusetts, 2013 , Howard Schultz , President and CEO of Starbucks expressed how the companies could balance between the profitability and their social roles and how they could serve better a variety of stakeholders. Yet few leaders have inherent understanding of how to do it. Conscious capitalism is the registered trade name of a nonprofit organization in the USA.

With the third and fourth revolutions in science and the flood of informatics and the flow of communications, we think that the new generation becomes less attached to the historical or fixed ideologies and they show enormous flexibilities in tackling different issues.

Our proposed The Fourth Way, see that the next generation would see a newer flexible system and freedom of thoughts that could be a newer liberalism aiming for the better of all. It would consider the human aspects, continuous evolution, and the increase -as most as possible- of the numbers of winners in a scientific way. ( & )

As an application in of the Fourth way the field of oncology; economic sustainability of better value cancer care and moon shots progress in science are hoped.

We summarize our proposal of The Fourth Way as

1) First, not be limited by any predetermined economic policy or theory.
2) Identification of your goals, aims and objectives.
3) Strategies that reflect open thoughts and the hopes.
4) To adopt flexible tactics, to use what is available from the revolution of informatics and innovative ideas that could realize our goals, and to consider -in realistic way- the interests and the motivation of stakeholders. Science is the way.
5) To be human beings centered, hence, to consider quality of life, the social and economic dignity and the hopes and expectations of the human beings.
6) Everything should be legal and scientific and to consider the humanitarian aspects.
7) To consider how to make economic sustainability for any solution or a policy.
8) There are places under the sun for all; hence it is a win-win scientific approach for all stakeholders and to maintain economic and scientific progress.

In everything, destructive challenges against each other or omitting realistic and legitimate incentives are not a long term solutions, but using minds smartly and probably our proposed concept of “The Fourth Way” could give insight not only for the problem of shortage of availability of essential cancer drugs in The USA, but also a general vision for thinking for economic policies in the world.

When we face multi-complicated problems in the world, then it is a time to think out of the box and globally that if we want to go out effectively of different crises.
This could be one the positive aspects in the controversy and negative aspects about globalization.

I never claim that I have the full wisdom or the absolute right vision. These are not within the known the human composition!

After all, it is a personal proposal. Hence, all should feel free to modify or to support and to diffuse to all whom you like to receive.

Once again, as I stated before about the Win-Win scientific initiative , despite of the humanitarian motivation, it is completely scientific initiative that calls for more researches, scientific evidences and innovative studies.
Kindest regards to all in our world.
Professor Ahmed Elzawawy, MD &

Citations for the Fourth Way:

- Elzawawy A, Kerr D. (2013) Variation in the availability of cancer drug generics in the United States of America. Ann Oncol 24 (suppl 5):v17-v22

- Elzawawy A (2015) The Shortage of Essential Cancer Drugs and Generics in the United States of America: Global Brain Storming Directions for the World. Int J Cancer Clin Res 2(2): 016. article

-Ahmed Elzawawy and Wilfred Ngwa (eds). Approaching global oncology: The win-win model”. IOP publishing Ltd, Bristol, UK , June 2022