Medical Funding Dialogue

Alexander Berezin berezin at MCMAIL.CIS.MCMASTER.CA
Sat Dec 23 18:45:27 EST 1995



On 23 Dec 1995, Gregory R. Harriman wrote:

> In article
> <Pine.SOL.3.91.951222213838.22580C-100000 at mcmail.CIS.McMaster.CA>,
> berezin at MCMAIL.CIS.MCMASTER.CA (Alexander Berezin) wrote:
> 
> Stuff deleted.

(BEREZIN): 
> > 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. 

(HARRIMAN): 
>      Reasonable people can disagree about which priorities are more
> important and which should receive more funding.  However, your
> unsubstantiated statement that "biomedical research takes a
> disproportionally (sic) high share of funds" must be challenged.  

> First how did you decide that this funding is disproportionately 
> high?  Based on what criteria?  How about providing some numbers 
> and evidence.  

BEREZIN:
My ground-level demarcation criteria to tell if the area is
overfuned is to look at the employment and reward structure in it.
Take some scholarly areas where there is clearly very liitle money
(like, say, medieval history or paleonthology). People go to these
areas usually well aware of personal limitations and certainly
not to 'get rich'. They go thre because this is where their heart 
is. And scientists in these areas almost invariably do all the work 
themselves. 

Not so for Big Biomedical Research (BBR). Reward structure is
such that empire building, emplyment of cheap research labor and
grantsmansip is the primarily way of life. If you don't play it,
you are (almost always) kicked out. Why this all happen ?
Becasuse people are getting enough money to became sub-employers
and in many cases buy themselves out. So, its not the matter
of total budget ($ 11 billions, or whaeever) but the 
disrtibution and reward system which is in place.   

I don't deny that most medical resaerch requires technician(s).
However, anything beyond 1 technicain and 1 grad. student per
prof is almost invariably a sign of overfunding and LOSS (not
increase) of the efficiency. (personally, I know many examples). 

(HARRIMAN):

> While I
> certainly agree that the U.S. has some serious social problems to deal
> with, the inference that biomedical research funding is somehow preventing
> the solution of these problems is ludicrous.  

BEREZIN:
I am not saying this, although I do believe that many potentially
very bright minds which could be instrumental in solving many other
acute problems, are unnecessarily tied-up (usually for life-time)
in many dead-end BBR areas.

(HARRIMAN):
> The entire proposed NIH
> budget for 1996 is a little over $11 billion.  This is out of an entire
> federal U.S. budget of roughly $1.5 trillion.  Biomedical research funding
> is a tiny fraction of the entire federal budget.  The government could
> easily find other areas of the budget (such as defense and entitlements
> which are the majority of the budget) from which to could get $10-11
> billion to fund other programs if that was felt to be necessary.

BEREZIN:
It is not that I am saying that cutting this $ 11 billions and using 
savings elsewhere is the PRIME issue (its significance is non-zero, but 
secondary - see above).

What I am saying is that present funding structure makes BBR
much less efficent than if the budget be REDUCED by the factor
of several and there will be clear limitations imposed on the 
size of research groups and budget per researcher. Such Spartan 
measures will raise the total efficiency of BBR because:

 (1) it will be no longer a place to catch for the personal
 fortune and many people who should not be there at first 
 place will not enter the system. Only truly dedicated 
 enthusiasts will remain, same as in the science of the past.

 (2) people will largely work themselves, and this means
  more careful choice of priorities, more thinking and 
  much more personal creativity (you can't be too creative 
  having group of 10 people - all your creativity goes for
  grantsmanship).     

(HARRIMAN):
> 
>      Further, it can be argued that basic biomedical research is one of
> the more cost-effective utilizations of tax dollars.  

BEREZIN:
This is highly questionable. For a good consulting fee I can
equally strongly argue on either side of this statement.

(HARRIMAN):
> For example,
> $billions are being spent (both publicly and privately) every year to
> treat the million or so HIV-infected people in the U.S.  In addition,
> $billions and $billions are being spent every year on treating people with
> various infectious diseases (sexually-transmitted diseases, tuberculosis,
> influenza, etc, etc).  

> If effective vaccines can be developed against even
> a few of these diseases, society will save a lot of money in the long
> run.  

BEREZIN:
Here we unfortunately again hit a contentious argument. It is
all a matter of faith. Will BBR come up with vaccine from AIDS,
cancer, etc we don't know. As I have read somewhere, the chances
that cures will be found in some small scale (perhaps, even
third world) labs are equally good. After all, in physics
you have termonuclear establishement which for the last 50 years
worked on controlled thero-nuclear synthesis, spend HALF A
TRILLION dollars on it and the results are essentially none.


(HARRIMAN):

> Smallpox used to be a major killer throughout the world and it cost
> tremendous amounts of money in terms of morbidity and mortality.  This
> virus does not even exist any more, except in two government laboratories
> in the U.S. and Russia.  That is the result of successful vaccination
> against smallpox.  

BEREZIN:
I am not an expert, but not at all certain that this has much
to do with a type of BBR-biomedical research. First successful
vactinations, as you know, where developed by Louis Paster who
was sole scientist (not "BBR" like). 

(HARRIMAN):
> I'm not even discussing the really big diseases, such
> as heart disease and cancer.  Research in these areas has the 
> potential to
> be very cost-effective in the long term.

BEREZIN:
I would say, that "faith healing" or alternative therapies
have at least as good chances to succeed than BBR (perhaps,
likely better).

(HARRIMAN):
> 
>      While one may or may not agree that biomedical research has lived up
> to its promise (and I'd be happy to debate that with you), one can't
> rationally argue that success in biomedical research would ultimately be
> highly cost-effective and beneficial for society.

BEREZIN:
If you are prepred to broaden the base (e.g. including preventive
along with curative) and make the process researcher-centered
(rather than funding-centered), than our dialogue may indeed
show promiss of constructiveness.

(BEREZIN): 
> > 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.
>
> Sorry, but I don't agree with this.  See above.  
> 
> > 
> > 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. 

(HARRIMAN): 
>      Maybe you live in a part of the world where heart disease, strokes,
> breast cancer, lung cancer, AIDS, etc are pseudo-problems.  I'm sure a lot
> of people would like to know where that is.

BEREZIN:
I am not saying these are pseudo-problems. But APPROACH to these
(real) problems based on (reductionistic) BBR-model may well be.
> 
> Greg Harriman
> 
> 



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