Medical Research Funding

Alexander Berezin berezin at MCMAIL.CIS.MCMASTER.CA
Fri Dec 22 22:09:06 EST 1995



On 22 Dec 1995, Gregory R. Harriman wrote:

> In article
> <Pine.SOL.3.91.951221182728.7806A-100000 at mcmail.CIS.McMaster.CA>,
> berezin at MCMAIL.CIS.MCMASTER.CA (Alexander Berezin) wrote:
> 
> > Now let me pose another question: this is about the source 
> > of NIH budget and the assumption (in one of the previous
> > posters) that Government should give even more money for
> > biomedical research. ... and here I am puzzled ..... Why it
> > (USA Government) should fund medical research at first 
> > place ?
> > 
> > Americans largely against government-run medicine. All attemps
> > so far (Clinton and prior) in this direction were rejected as 
> > (aparently) smelling red, or whatever. Fine, no objections - this 
> > is your democratic consensus as a mature nation - you don't want 
> > anything to do with with socialistically-directed reforms in 
> > medicine and keep insisting on free-market operated medicine.          
> > 
> > So far, so good ... But then, I am afraid you loose the consistency 
> > in saying, ..." yes, but ... medical RESEARCH is the responsibility 
> > of the Government (primarily through NIH)" ... and here I have to
> > stop and ask you WHY. If your market-operated medicine is unwilling 
> > to provide funding for medical research (at least at the level you 
> > claim it should be), then why your Government should ? (After
> > all isn't democratically elected Government reflects the will
> > of the people electing it ?).
> > 
> > I admit, I may misunderstand something and perhaps you
> > have a sensible answer to my question - so please post your 
> > comments explaining why your Government has a duty to fund
> > NIH at first place.
> 
> 
>      You shouldn't be puzzled.  Even a nation that believes in free
> markets readily accepts that government can and should perform certain
> functions.  Very few people in the United States (except perhaps some
> extreme libertarians) would assert that government has no role to play and
> therefore should be done away with entirely.  
> 
>      Obviously, the federal government performs some important, even vital
> functions, including national defense, building infrastructure (highways,
> dams, etc.) and even regulating societal activities (including businesses,
> stock markets, environmental protection, etc.).  Such government activity
> is important for the well-being of the country.  
> 
>      It's also probably safe to say that most people in the U.S. believe
> government funding of basic research is a valuable and beneficial
> activity, for the very reasons explained in previous posts.  As an
> example, businesses by-and-large are interested in pursuing activities
> which will lead to short-term benefits accruing to the company. 
> Businesses are not likely to provide direct funding or support for
> societal activities which although having substantial potential for
> benefit in the long run, are risky, may not "pay-off" for many years, and
> would not be proprietary (ie. other businesses or individuals could use
> and benefit from the activity).  
> 
>      Therefore, this type of activity (ie. basic research) is best funded
> by societal institutions which are separate from private business (ie.
> federal and state governments and private foundations).
> 
>      Incidentally, your posting suggests you have the misconception that
> research and the practice of "clinical" medicine are the same thing.  They
> are not!  

BEREZIN:
I have no problem with this. And I understand what you say above 
whyit is government which should support basic research, etc (in
a way, my previous posting was somewhat provocative, as I have 
anticipated more-or-less the answer you just gave).

However, everything is a matter of a proportion. And taking that 
general or "untargetted" fundamental research can benefit the 
society "at large", reasonable equity and proportion between the 
areas have to be maintaned. At this point, biomedical research
takes disproportionally high share of funds. You may say this
is because "it is the most important for the public interest".
I may dispute this: for example, sociological studies for the
crime prevention are perhaps not less socially important for
the American society at this point. And as I have argued earlier, 
the major source of inefficiency of American medical reseerch is 
that there is too much money in it rather than too little. This 
results in all perils of grantsmanship feods, grant-to-grant 
mentality, 'empire building' and other pathologies we all 
know about.

I suggest that BASIC research of all kinds (incl. biomedical)
be supported on equal footing with other areas through the
single source - National Endowment for Sciences and Arts.
(after all, medicine was "art" in ancient times). This will
provide long needed restrain for strengthening and focusing
of fundamental medical research towards real problems rather 
than solving numerous gargantuan pseudo-problems. 

> The pursuit of basic research, whether in universities, private
> institutes or even pharmaceutical companies, is not the same thing as the
> practice of clinical medicine in hospitals and by physicians.  Thus,
> whether Americans prefer free-market or socialized medicine should have
> little to do with whether they support government-funded basic research. 
> 
> 
> Greg Harriman
> 
> 



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