Medical Funding Dialogue

Gregory R. Harriman gregoryh at bcm.tmc.edu
Sun Dec 24 13:13:34 EST 1995


In article
<Pine.SOL.3.91.951223174106.29911A-100000 at mcmail.CIS.McMaster.CA>,
berezin at MCMAIL.CIS.MCMASTER.CA (Alexander Berezin) wrote:

> 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:
     You appear to have such a limited knowledge of biomedical research,
yet such strong biases against it, that it is difficult to carry on a
meaninful discussion.  Are there a _few_ biomedical scientists with large
labs and remarkable amounts of funding?  Yes.  Is this wrong?  No, not
necessarily.  Many of them are successful because they have consistently
demonstrated the ability to generate important, creative and valid ideas
which they have proceeded to prove.  This advances our knowledge of
medicine and has been to the benefit of society.  I don't see anything
wrong with this.  When one analyzes your statements, your complaint simply
seems to be they are too successful.  Sorry, but I don't buy the argument
that just because someone is successful, rich, powerful or whatever, they
are necessarily bad or evil.  Just to keep the record straight, I am
definitely not one of these big, "fat cat" biomedical researchers.

     Are there some people in research who have exploited the system or
gotten there by means other than based on creativity, hard work, etc? 
Undoubtedly!  I'm sure many of us could come up with the name of at least
one person who falls into that category.  But, this flaw is not limited to
biomedical research.  Similar individuals can be found in every area of
research.  For that matter, there are always some individuals in any
societal institution (university, business, government, medicine, you name
it) who act unethically or illegally.  You don't have to condemn the whole
institution (ie. biomedical research) just because there are a few bad
apples.  What needs to be done is to ensure that adequate processes are in
place to expose and deal with such people.

     As an aside, I find it remarkable, given the fact that you are not a
biomedical researcher, that you feel you have the necessary wisdom to
decide how many technicians or grad students a professor doing biomedical
research needs to carry on his/her research.
 
> 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:
     Your last statement is arguable, but even if you were right, isn't it
their choice to make regarding what area of research they pursue?  Maybe
they are doing it because they are fascinated by the research.  Even if
they don't make a lot of money and don't get the Nobel prize, maybe they
enjoy what they are doing.  If not, they can always change what they are
doing.  You have a very paternalistic attitude about what you think is
best for other people.  

     Besides, who's to say what is a dead-end in biomedical research. 
It's possible that if you were around in the 1950s, you would have looked
at the people doing obscure research on bacterial enzymes that chop up DNA
and pronounced that this is not "solving many other acute problems" in
medicine.  Little would you (or anyone else at the time) have known that
such research on restriction enzymes was instrumental in the development
of the fields of molecular biology, molecular genetics and gene therapy. 
You can't predict or dictate which research or discovery is going to be
fundamentally important in the future.

>BEREZIN:
> 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:
     This is one of the most ridiculous statements (ie. 'no longer a place
to catch for the personal fortune") I have ever heard!  Somehow you
believe that because significant amounts of money are provided in
biomedical research grants, that means it all goes into the pocket of the
principal investigator.  Again, your lack of knowledge about biomedical
research is profound, yet you feel compelled to make grandiose
pronouncements about what is wrong with biomedical research.  The money in
biomedical research grants goes to pay technician, grad student and
post-doc salaries/stipends, lab suppplies, animal housing/maintenance
costs and yes, the principal investigator's salary.  You might find it
interesting to know that M.D.s who work in biomedical research at academic
institutions could readily go out into private practice in the U.S. (even
under managed care) and make a lot more $ than they do in academics.  It's
certainly not the "personal fortune" that one gets in biomedical research
that keeps us here.  It's because we enjoy doing research and exploring,
discovering and advancing scientific knowledge. 
 
Stuff deleted.

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

HARRIMAN:
     I'm not sure how to respond to this, except to say that I know you're
not a biomedical researcher, but I was always under the impression you are
a scientist.
 
> >(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.

HARRIMAN:
     I'm perfectly willing to broaden the discussion to include preventive
medicine.  However, the discussion was never narrowed to begin with.  I
previously discussed vaccines, which are by definition preventive
medicine.  Here's another example.  Over the last year or so two genes
BRCA1 and BRCA2 have been identified and cloned.  Mutations in these genes
are responsible for 5-10% of all breast cancer in women.  In these
instances the mutations are inherited and the female offspring will be at
great risk of developing breast cancer as adults.  Breast cancer is one of
the major cancers causing large numbers of deaths every year, and even
5-10% of this is a large number (I'm afraid I don't have the exact
numbers).  Because these genes have now been discovered, we can screen
people from families with a history of breast cancer.  If individuals are
found to have inherited the mutated form of BRCA1 or BRCA2, their doctor
will know they are at great risk for developing breast cancer. 
Consequently, the person at risk can be followed very carefully, with
exams and mammograms, in order to detect breast cancer at an early stage. 
Some women might even want to consider prophylactic mastectomies if the
risk is great enough, but that would be an individual choice.  So here's
an example of how your "Big Biomedical Research" has done something which
is advancing preventive medicine.  I can give you other examples if you
are still having difficulty with this.


Greg Harriman



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