Medical Funding Dialogue
Ferland Louis H.
ferlandl at ERE.UMontreal.CA
Sun Dec 24 03:01:45 EST 1995
On 23 Dec 1995, Alexander Berezin wrote:
> Date: 23 Dec 1995 15:45:27 -0800
> From: Alexander Berezin <berezin at mcmail.cis.mcmaster.ca>
> To: bioforum at net.bio.net
> Subject: Medical Funding Dialogue
> 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.
> > > 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.
> > 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.
> 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
Some of us in this walk of life also do this because we believe it is
interesting and worthy. How dare you judge ME? Besides, had it been money
I was after, I would CERTAINLY NOT have chosen research!
> 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).
WHAT??? You are completely out to lunch, Alex. Better not write so soon
after Xmas parties in the future.
> > 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.
> 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.
> > 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.
> 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.
Again how dare you question my dedication and enthousiasm! They are just
about ALL I have to live on! The science of the past, by the way,
progressed much slower than we do today and the (obvious) main reason is
the amount of total effort we collectively put into our research.
> (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
A good grant application stems from a good idea. Grantsmanship is a very
good place where to put one's creativity, not making buffers.
> > Further, it can be argued that basic biomedical research is one of
> > the more cost-effective utilizations of tax dollars.
> This is highly questionable. For a good consulting fee I can
> equally strongly argue on either side of this statement.
> > 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.
> 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.
You forget about the mass action law, my friend. Small labs can and do
develop brilliant ideas and produce superb results, but I have no
indication and no reason to believe that they have a better PROPORTION of
good shots than larger labs. Those with the most imagination and who work
the hardest come up with the most innovative ideas and are the
trendsetters; some of those work alone while some others head an army of
post-docs, graduate students and technicians. Only, those with larger
labs tend to get there faster (to my great dismay every time I get
scoooped; I have a small lab)
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.
> > 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.
> 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).
> > 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.
> I would say, that "faith healing" or alternative therapies
> have at least as good chances to succeed than BBR (perhaps,
> likely better).
GREAT GOD! This one isn't even worthy of a comment.
> > 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.
> 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.
> > > 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.
> > 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.
> I am not saying these are pseudo-problems. But APPROACH to these
> (real) problems based on (reductionistic) BBR-model may well be.
> > Greg Harriman
Dr. Louis H. Ferland
Centre de Recherche, Hotel-Dieu de Montreal
Dept de Nutrition, Universite de Montreal
Phone: (514) 843-2757 FAX: (514) 843-2719
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