The Evolution of Funding for Research and Its Effects on Healthcare

 

In an excellent four part series writers at Boston University document a disturbing trend in research in the United States.

For decades privately funded research of a more goal oriented design has outstripped publicly funded basic research in dollars spent.  In recent years there has been a decline in private funding, as well.  The result is that the landmark discoveries – discoveries like that of the Higgs boson – have been made thanks to foreign investors of foreign research teams.  Institutions like Boston University and MIT depend on public research funding to maintain their preeminent position in the world of academia.  Without funding institutions can no longer attract the best graduate students and they go elsewhere.  Graduate students are both inspiration for educators, and the machinery that makes research work.

Writers also point out that while publicly funded basic research has grown both in dollars and as a percentage of GDP, public funding for development has fallen, occasionally rising and then falling again.  Presumably, legislators feel that private industry should fund development.

 

Having read medical journals and attended seminars over a forty year period prior to my retirement the years ago, it became apparent that the entire landscape of medical research, publication, and dissemination of information had fundamentally changed.

Some things have not changed.  Educators in the Medical Sciences are pressured to do research, and to publish.  The deleterious effect of this pressure is that some of the best teachers are less interested in research, and the best researchers are often terrible educators.  Researchers advance.  Educator’s careers languish.  Research, though, gives an institution a position of eminence in a crowded and very competitive field. 

During the same time period there were fundamental changes in the way research was carried out and funded.  In the 1950s and 1960s there was an emphasis on research in basic science.  The thinking was that basic research had given us our greatest findings; findings that were often unexpected. Research conducted on one thing led to observations that had great benefit elsewhere.

As an example, techniques developed to preserve bacterial cultures so that they could be studied at a later time led to the development of freeze drying food.  Industry got a freebie due to basic research paid for by the public.  Industry is used to thinking on the short term, though, in terms of next quarters profits, and the pay-off from basic research is unpredictable and long-term in scope.

This article from the NIHgives good examples of basic research that provided important new techniques both in medicine and industry.  All of these advances came from asking questions like:

    “How do cells talk to each other?

    What controls gene activity?

    How do proteins shape themselves so they can work properly?

    Why should we care?”

The last question, the one in italics, turns out to be the most important question of all.

 

There have always been lawmakers who want to cut basic research funding.  In past decades they have derisively pointed to basic research and asked why we care how fruit flies attract each other making innuendoes about “fruit fly sex voyeurs”.  For the most part though, there is no glamour in basic research.  Lawmakers can’t point to funding and tell the public how they are going to be helped except in the most general, long-term, way.

As a spin-off of supply side economics – Reaganomics – there was a push to switch funding from the federal government to industry.  The results were predictable.  “Why should we care?” became the recurrent theme.  Concomitant with the conservative pull-back in public funding for economic reasons came the push by social conservatives to cut funding in areas that they deemed inappropriate.

 

One of the most contentious episodes in the battle for and against health research involved AIDS.  Because social conservatives in the early 1980s were opposed to sex education, contraceptive use, and any overt recognition of the existence of gays and lesbians, President Ronald Reagan – despite the fact that the AIDS epidemic practically began with his inauguration - did not even mention AIDS until 2 years after he took office.  This silence and lack of action continued even after his friend Rock Hudson died of AIDS complications.  Eventually public pressure forced him to take action and, while he at first said that he wanted research on AIDS, the budget passed at the time actually cut research funding.  The following excerpt from Wikipedia notes that after a number of years of denial, Reagan took the action needed to fund research.

“Supporters of Reagan past and present have pointed out the fact that he declared in the aforementioned September 1985 press conference that he wanted from Congress massive government research effort against AIDS similar to one President Nixon had overseen against cancer. Reagan said, "It's been one of the top priorities with us, and over the last 4 years, and including what we have in the budget for '86, it will amount to over a half a billion dollars that we have provided for research on AIDS in addition to what I'm sure other medical groups are doing." He also remarked, "Yes, there's no question about the seriousness of this and the need to find an answer." Annual AIDS related funding was $44 million in 1983, 2 years after he took office, and was $1.6 billion in 1988, an increase of over 1000 percent.[89][90][91]

In fact, in 1988 Reagan made a radio address on the importance of scientific research, acknowledging its importance:

“The remarkable thing is that although basic research does not begin with a particular practical goal, when you look at the results over the years, it ends up being one of the most practical things government does….We cannot know where scientific research will lead. The consequences and spin-offs are unknown and unknowable until they happen. In research, as Albert Einstein once said, imagination is more important than knowledge. We can travel wherever the eye of our imagination can see. But one thing is certain: If we don't explore, others will, and we'll fall behind. This is why I've urged Congress to devote more money to research.”

Currently, publishing findings related to climate science has created the same sort of belief related controversies that existed during the Reagan era.

 

Funding for government funded developmental research as a percentage of total R&D peaked in 1963 and has fallen steadily since as industry funded applied research has increased.

Businesses apparently understand the value of basic research, but look for gains over a shorter term than is afforded by basic research.  Additionally, many businesses are interested in keeping the results of research secret in order to gain an edge over competitors.  The result of this private research is that only positive results get published and negative results get stuck in a drawer.

A number of individuals have commented on the public benefit of open scientific research.  In publicly funded basic research all results get published.  The negative effect of proprietary research is that money and time are wasted as one researcher investigates some area that another researcher has already studied and found to lack benefit.

To change the publication behavior of researchers the system of rewards has to change. 

Funding for medical research for the past 20-30 years has increasingly come from pharmaceutical companies.  There are several problems with this.  Research is goal oriented, and researchers are pressured to structure their projects so that the funder benefits financially.  Pressure is applied to keep results secret so that only the company knows findings.  In some cases, there has been pressure to exaggerate positive outcomes and hide negative outcomes, particularly in drug trials. 

A less obvious effect of the switch to privately funded developmental healthcare research is that continuing medical education programs often bring in the researchers whose work was funded by a pharmaceutical company to talk about the diagnosis and treatment of some medical condition. The cost of bringing those researchers to speak is covered by the drug company to some extent provided that the drug company’s product is touted.  The result is a form of insidious deceit.

In a recent blog about TED talks that call for open science in healthcare the reasons why open science does not exist are explored.

Excerpts from Madeline Morris Blog:

--------------------------

Dr. Ben Goldacre asks why medical researchers seem to publish only positive results of pharmaceutical testing, instead of openly sharing both good and bad results. (Wouldn’t you want to know everything possible about a drug you’re about to take?)

Michael Nielsen uses his TEDx talk to explore how an open industry may lead to more rapid and efficient solving of today’s most difficult scientific problems.  His conclusion: “Any publicly funded science should be open science.”

Jay Bradner’s talk serves as a personal report from the front lines of the fight against cancer — and the possibilities of open science. After discovering an important compound for cancer research, Bradner and his team decided to ask: “What would happen if we were as open and honest at the earliest phase of discovery chemistry research as we could be?”

Ellen t’ Hoen describes in detail how the oppressive structure of medical patents prevents low-income patients from receiving the treatment they need to survive.

-----------------------------------------------

In the series of articles published by Boston University it was pointed out that in the second installment the point was made by Dr. Philip Auerswald  at George Mason University that collaborative research is now leading the way in innovation.  The process is much less linear than in the past where basic science findings led to various developmental research projects.  The findings and research projects are conducted in a more combinatorial process.  This process seems less at work in healthcare research than in other areas.

Views: 249

Comment by Workstudio on July 22, 2016 at 9:03am

Collaborative research is going to be around more from now on I would think, just like collaborative work, that's probably a good thing. Private funding is all right, but it is always going to be biased, pharmaceuticals keep focusing on what doesn't work, and get money for that, not many people are investigating what it means to be healthy, or how a healthy person works, or what works when that person is healthy. Research should stay as a public good, it ensures the commons gets covered, what is relevant to everyone in the community.

Comment by JMac1949 Today on July 22, 2016 at 10:36am

The problem with much research is that 85% of it might be regarded as failure.   Another 10% make produce successful but inapplicable results.  Less than 5% results in any kind of affordable or useful application in industry.  Classic example is quantum physics, but with patience and ingenuity some efforts produce astounding results such as IBM's research into nanotechnology and atomic memory operations:

2012 - IBM creates data storage at the atomic level

2016 - Smallest hard disk to date writes information atom by atom

BTW: IBM began physically arranging individual atoms with tunneling electron microscopes in the mid 1980's.

The DARPA and the US military is researching cyber bionic neural interfaces for weapons control so like Teflon we may soon have affordable personal computers that we can control and wear as beauty spot jewels that connect our brains directly to the internet:

Comment by Arthur James on July 22, 2016 at 10:46am

`

Whoo...

Lots to ponder

and assimilate

`

Google Blog?

` On Being '

`

Kristta Tipett

`

Interview with

Tectonic Plate

Geologist -

`

Xavier Le Pinchon

`

I spent One month in

India in ` 1973 post a

Sad` Deadly Earthquake.

Many Died... I learn some

Stuff - and Enjoyed `On 

Beings - Interview - I bet

You'll Enjoy too - (sigh)

Flashback -

I was informed the Earth

Shook because of Underground

Weapons Testing - A Pakistan

Physician was a Great Teacher.

~

I still see Squashed Children...

Stone Walls that were Gravity

Lain Shook like a Baby Cradle.

A 4.6- Richer QUAKE shook

Beams and Stone Walls...

Many Agrarians Died at 4:3o Am.

\`\~'

sad 

Memory

`cc`

`

Comment by Arthur James on July 22, 2016 at 10:49am

`

oops

`

1993

I just left

the VAMC

painful FED

VET Counseling

` gig ` First News

Reports ? 60,000

People may have 

died? Vietnam's

Black Granite Wall

came to my Mind

`

Memory...

I staid one

month as a

Volunteer...

Burial Duty

``cc``

gasp

sigh

`

Kilarri

Marastra 

State,

India

`

Comment by Rodney Roe on July 22, 2016 at 10:52am

Two really exciting technological developments have been the construction of graphene - a one molecule thick carbon fabric that is a lightning fast electricity conductor and 2D molybdenum disulfide (MoS2) that may enable walls to become lights.  How to manufacture either of these at a cost that is affordable is the current enigma, but the answer may come from "out of the blue" as a spin-off from some other research.

To think, I sold my IBM a few years ago :-)

Comment by Rodney Roe on July 22, 2016 at 11:02am

Art, thanks.  Seeing natural - and man made - disasters first hand is hardly describable.  I spent a couple of weeks in New Orleans post-Katrina restoring homes.  The memory of blocks and blocks of bare foundations with an occasional bent and broken home still sitting askew is hard to appreciate without being there.

This doesn't seem to relate except that many of the best researchers now come from places like India and Pakistan.

Comment by nerd cred on July 22, 2016 at 12:03pm

Bravo bravo bravo bravo.

And yet, still last night Trump is still promising to flush out government waste as a means to budget cutting. As if every presidential candidate since at least Carter hasn't done the same.

But I thought publicly funded science was required to be open.

Come to think of it, in the past 10 or so years some complicated laws or regulations were put in place for profit-sharing in public institutions, like Universities. I have that in my memory as affecting to private funders only (because I was working in privately funded research at the time) but maybe federal, too.

Most VA hospitals, BTW, have non-profits connected with them to administer private research funding and, as I saw it, evade as many federal regulations as possible. It seems necessary to retain docs, many of which are also university faculty members.

Comment by Arthur James on July 22, 2016 at 12:16pm

`

RODNEY ROE...

`

APOLoGY...

thanks for

Understanding...

`

I visited the local

64- Acre Indian Spring

Lake. If I am viewed 

Suspiciously by the State

K-9   Dog Unit State

Nice Police Officer who is

a new ` K-9 ` Dog Unit

Officer as I gather Geese

Feathers from Canadian 

Geese.... I quickly Mention

`

Martin Gallery ( Retired ) K-9

C&O ` Officer - FED - and a

Vietnam Veteran with the 

Highest Security Cleaner?

no

Clearance

`

He was assigned

to Protect ` Camp

David, Thurmont,

Maryland - Martin

Gallery told me stuff

I VOWED to never dare

Utter - ref::, Camp David.

`

He was a ` FED 'K-9' Officer.

I Never Ever reveal ` Secrets.

`

I told the State K-9- State 

Officer I knew `Martin Gallery.

That helped... ` Then, I was a

Viewed  as ... ` Suspicious as

I goatherd? huh? `  tease...

I was Suspicious Gathering the

Canadian Goose Duck Feathers.

I* give to Grandchildren and my

Guest House 3- Children Sons of

Lazed? Farm Helpers. I find Box

Turtles, Feathers, and they are

my Social Life - I no tell the K-9

Unit what I heard - (Rumors) ref:,

`

Thurmont

Camp David,

Maryland.

`

Some stuff

We Be Wiske?

No Sip That!

`

Carry some

Secrets to

Our? grave

hole. Aye.

`

I was not viewed 

as a Sispicious

Feather Picker-

Upper after I

mentioned `

Vietnam

Retired 

K-9-

FED

`

Nice

Martin 

Gallery.

`

I no

Tell

Secrets.

`

I'll read `gin

off line. I happy 

I visited Lake 

and Be viewed

as a Suspicious

Feather Picker.

`

off-line

read and

private

notes

`cc`

`

Comment by koshersalaami on July 22, 2016 at 3:24pm
Ending waste dates from way before Carter
Comment by Rodney Roe on July 22, 2016 at 4:34pm
I think it started in the 60s. I can certainly remember complaints in the early 70s about $200.00 hammers.

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