Lean Look For Medical Research

April 05, 1994|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- Medical research is booming these days, pouring out discoveries in genetics, drugs, and other fields that hold great promise for preventing and healing disease.

But the financial underpinnings of this enterprise are increasingly shaky, and provide good reason to wonder about the long-term health of the health sciences.

The scientific community, and in particular its medical wing, excels at sending out financial distress calls, regardless of the weather. The reason is plain enough:

Each advance in science reveals new paths to explore. This has always been the case, but super-powerful research equipment has accelerated the tempo of scientific progress. As the body of knowledge increases, so does the roster of tantalizing problems to be explored.

Money thus becomes the essential ingredient. For three decades, plenty of it flowed into medical laboratories throughout the country via government funding for the National Institutes of Health.

But like much else in government in recent years, NIH has collided with austerity, and has essentially been living on a fixed income. Money is available for fewer and fewer of the research projects that NIH's expert reviewers deem scientifically meritorious.

In what now look like the good old days, back in the 1960s and 1970s, some 40-to-50 percent of highly ranked scientists got money for their projects. The figure is now down to 25-to-30 percent.

Strict grading is generally regarded as beneficial in research, but researchers commonly complain that there's no discernible difference between many of the winners and losers in the competition for scarce funds.

Well, times are tough elsewhere, too. But the fright settling over medical research has origins beyond government-wide austerity. The various health-reform plans now circulating on Capitol Hill say little or nothing about medical research.

In response to anguished appeals from medical schools -- which are the home base for a great deal of health research -- the White House has given vague assurances of sensitive treatment. But specifics are yet to come.

NIH has found little but disappointment in the two budgets that Clinton has submitted to Congress since taking office.

The first, presented in February 1993, focused on the crucial fields of AIDS and breast cancer, but at the price of reducing funds for research on many other diseases. Congress, as usual, sweetened up the medical-research budget, and the expectation was that it would do so again in response to Clinton's latest spending plan for NIH.

But the politics of medical research were thrown into uncertainty late last month with the death of Rep. William Natcher, D-Ky., who had lovingly presided over NIH budgets during the preceding 15 years.

As chairman of the subcommittee that votes money for the agency, Natcher reliably delivered funds for NIH, and came to be a revered figure in the research community. Now nearing completion, the newest building on the NIH campus, in Bethesda, has borne his name since groundbreaking.

Mr. Natcher's counterpart in the Senate, Tom Harkin, D-Ia., is also an enthusiast for medical research, but does not wield the influence of the late Kentuckian.

Senator Harkin, in collaboration with Sen. Mark Hatfield, R-Ore., has a bright idea for reinforcing the finances of medical research -- a small monthly tax tied to every insurance policy under whatever health insurance plan, if any, Congress finally adopts.

The cost, perhaps a couple of dollars a month, would be negligible. The impact, however, would be of mammoth importance, adding $5 billion or $6 billion a year to the finances of medical research.

The Harkin-Hatfield plan, unfortunately, has aroused only minor interest in Congress and less than that in the White House, which flees from anything titled or resembling a tax.

Surveys of public opinion invariably put medical research at or near the top of the list of government activities that should be expanded. However, politics, obsessed with frugality, seems indifferent to the fraying of the nation's great medical science establishment.

Maybe "Wolf!" was cried too often. But that's no reason to ignore the real problems of a precious national asset.

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

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