Medical Scientists Are Wary

March 29, 1994|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- Hidden in the dust of battle over health-care reform is the unsettled question of how medical research relates to the popular twin goals of better care for all, coupled with restraints on spending.

The two are not necessarily a harmonious pair, since new methods of diagnosis and healing often turn out to be extraordinarily expensive -- and not necessarily as effective as their enthusiastic sponsors proclaim.

In today's hot competition for paying patients, however, hospitals must provide doctors with the latest technologies offered by tirelessly inventive manufacturers; otherwise, they'll take their patients elsewhere. The result is a kind of medi cal arms race that shows up in the glittering, beeping and flashing equipment that characterizes the modern hospital. From relatively simple electronic monitoring devices in patients' rooms, to multi-million-dollar diagnostic machines, today's houses of healing comprise great assemblages of fast-evolving medical machines coupled with innovative surgical techniques and bio-engineered drugs. New is in, regard- less of whether it's really better or makes sense financially.

As a result, technological sophistication is a potent factor in the buoyancy of health-care spending, even during the current long stretch of low-level inflation in the rest of the economy.

But there's more to the relationship between research and health-care spending than glitzy equipment. Underlying the impressive hardware of space-age doctoring is a vast supportive enterprise in basic biomedical research, most of it conducted in medical schools and hospitals with government research grants. Federal money for research amounts to some $11 billion a year. The pharmaceutical industry says it spends at least that much of its own money on turning basic scientific knowledge into drugs.

With bountiful money, talent and profit-seeking going into medical research, it's plain that innovation is a powerful factor in health costs. Sure, sometimes it reduces spending, as in the classic case of polio vaccine canceling the need for iron lungs. But many medical technologies are both expensive and limited in effectiveness. Heart, liver and lung transplants are examples of high-priced miracles that often produce limited results in quality of life and longevity.

Research got a brush-off in the Clintons' initial approach to health-care planning, with none of the chiefs or specialists from the government's own bastion of medical science, the National Institutes of Health, invited onto Hillary Rodham Clinton's health-reform task force. The Health Security Act that the president sent to Congress last fall said little about research. And where it did fleetingly address that topic, the focus was on preventing disease, rather than treating it.

The president coupled these neglects of research for cures with skimpy budgets for the NIH, thus causing emotional turmoil in the distinguished ranks of medical science. The managers of the research enterprise strongly feel it needs a lot more money each year to finance a new crop of young scientists and to advance vigorously along the frontiers of knowledge. The Clinton treatment inspired speculations that the president and his wife were cool to research because they regarded it as contrary to health-care economy.

Sen. Tom Harkin, D-Iowa, one of the great friends of medical research, took up the cause of science and proposed a ''tax'' on each insurance policy under universal health care to create a special fund for medical research. Wary of any tax, the administration has not responded to the Harkin proposal. But in February, Mrs. Clinton made a special visit to the National Institutes of Health and assured an audience there that the administration is keen for basic medical research and will strongly support it.

The reality, however, is that President Clinton's budget proposal for next year barely keeps the institutes in step with inflation. Mrs. Clinton's audience responded politely to her address. But these scientists understand budgets and numbers and cannot help but wonder what the administration's true sentiments are toward the role of medical research in health-care reform.

The indications so far are that the Clintons and company consider research part of the problem, rather than central to the solution. The same goes for other formulas for health insurance. No wonder medical scientists are wary of health-care reform.

Daniel S. Greenberg is editor and publisher of Science & Government Report, a Washington newsletter.

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