Recent rumors of looming cuts to the National Health and Medical Research Council budget have jump-started a much-needed national discussion about health and medical research policy in Australia.
Unfortunately, so far the argument has largely missed the point in two important ways. First, participants are obsessed with profit rather than progress. Second, advocates are arguing over the amount of medical research, rather than the quality of that research.
1. Profit = health?
Why do countries use public money to support medical research?
Much of the debate in recent days would suggest that the primary aim is to prop up the pharmaceutical and medical technology industries, thereby spurring economic growth and global competitiveness.
An editorial in The Age went so far as to claim that “rich countries invest heavily in health research not just because they can but because their wealth depends on it.”
Many others have pointed to the potential job losses and other negative economic impacts that might result from major funding cuts.
In short, the argument goes, publicly funded research leads to private profit.
But wait a second… does profit lead to better health? Wealth and health may be connected (though the connection is far from straightforward). But if the medical research establishment’s only means of improving health is via wealth creation, then we are in a very sorry situation.
The explicit motivation for medical research is better health outcomes. The NHMRC’s own mission statement is about health, not economic growth. It claims to be “Working to build a healthy Australia.”
Similarly, the US National Institutes of Health (NIH) aim to “enhance health, lengthen life, and reduce the burdens of illness and disability.”
Neither of these organisations has economic profit as a central feature of its mission. If Australia’s medical research investment is doing what it is supposed to do, there should be a much clearer and more direct connection between medical science and health outcomes.
Regardless of its merit, the profit argument completely misses the point of medical research funding.
By downplaying their core mission in favor of economic arguments, scientists and other advocates are playing a dangerous game.
Do they really want to compete with the full range of policy alternatives that could also be effective in creating jobs and raising GDP?
2. Medical research = better health?
Some are arguing that a $400 million cut would spell disaster for health in Australia. But what about the reverse scenario? Would adding $400 million dramatically improve health? How about $4 billion? Or $40 billion?
It seems intuitive that a larger government investment in health and medical research would yield better health outcomes for the country, but in reality this connection is very difficult to demonstrate.
For example, the US has long outspent every other country on medical research by any measure (e.g. raw total, per capita, % GDP, etc), yet it lags behind other developed countries in many important health outcomes, including life expectancy.
Meanwhile, Australia does far better than the US in those same categories, despite spending much less on medical research.
This suggests that at the macro level, a country’s budget for medical research says very little about the health of its population.
Bhaven Sampat, an economist and expert on health and innovation policy, reviewed various attempts to show that science funded by the NIH is directly responsible for improved outcomes and concluded: “there is little econometric evidence [that] NIH-funded basic research has played an important role in improvement in health outcomes over the past half-century.”
This does not mean, he points out, that such a relationship does not exist, but “clearly, more work is needed on this front.”
As the US example painfully demonstrates, increasing research budgets are not enough to ensure better health. To build a lasting case for medical research funding in Australia, advocates will need to do a few things:
explain how the investment promotes better health;
back that up with solid evidence; and
demonstrate that the research enterprise can respond effectively to the needs of the health system, rather than simply pursuing scientific opportunity.
Doing so requires focusing on quality, not just quantity, and avoiding the alluring but irrelevant “profit-equals-progress” assumption.
Nobody disputes the idea that the government should fund medical research. But in these times of tightening budgets, some might protest the idea that medical research is somehow more deserving of your tax dollars than, say, actual medicine, national security, early childhood education, or crime prevention.
To show that medical research is somehow more important than everything else would require a pretty compelling argument.
Further Reading:
Sampat, Bhaven N. (2009) “The Dismal Science, The Crown Jewel and the Endless Frontier: An Economist’s Perspective on the NIH” in D. Foray, ed., The New Economics of Technology Policy. Edward Elgar
Crow, Michael M. (2011) “Time to rethink the NIH.” Nature. 471, 569-571.
Some of Ryan’s blog posts on health research policy can be accessed here.
Do you agree that profit should not be used to justify medical research funding?
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Comments (12)
David Beins
(logged in via Facebook)
Another way to look at it is to assume there is such a thing as medical research which leads to wealth creation and medical research which improves health, that it is possible to distinguish between the two, and that the latter should be funded preferentially. But research by its very nature is uncertain, so the arguement inevitably falls down. Perhaps what is really needed are robust criteria to predict those projects likely to succeed irrespective of intended benefit, then fund those. Surely governments would have a hard time justifying cutbacks to successful research whatever the beneficial outcome?
Michael J. Lew
(Senior Lecturer, Pharmacology at University of Melbourne)
I agree that private profit is a poor motive for public spending on medical research, and I agree with Tim van Gelder that the investment quality of medical research may not be exceptional measured against alternatives such as preventive health. However, to my mind, they are not the most important issues relating to the proposal to reduce NHMRC funding. Instead, we might focus on the fact that ad hoc changes to the NHMRC funding set in train long-term changes in the careers of scientists and the structures of universities and research institutions (changes that are often irreversible), on the fact that the government feels the need to reduce funding of 'soft targets' like the NHMRC because of a failure to withstand self-interested lobbying and public bullying by major industries, and on the fact that governments try to balance the budget in response to the false assumption that all public debt is bad.
Ryan Meyer
(Visiting Fellow at University of Melbourne)
Thanks all, for reading the article and providing these thoughtful comments.
David Beins – You are absolutely right that there is inherent uncertainty in the potential outcomes of scientific research. But then you seem to conclude from this that outcomes-focused decision making about science funding is impossible. This defies common sense.
To take a crude hypothetical, if you had $1 million to spend on cancer research, and had to choose between awarding it to an excellent geologist, or a top-notch…
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Ian Musgrave
(logged in via Twitter)
And what if you had a choice between a health economist, an epidemiologist, and a biochemist? Here the choice is less obvious, but depending on your specific goals with respect to specific manifestations of cancer as a problem for society (Finding cures? Reducing socioeconomic disparities? Lowering the cost of existing treatment options?), you could make very reasonable arguments for one over the others.
The NH&MRC funds all those activities, by cutting funding to the NH&MRC you taken all…
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Ian Musgrave
(logged in via Twitter)
blockquote fail, the first paragraph is Ryans. And spelling fails in the remaining paragraphs.
Ian Musgrave
(logged in via Twitter)
First lets put the expenditure on research into perspective. The total health budget for 2010-2011 is $130 billion, total NH&MRC funding is $750 Million, ie around 0.6% of total health expenditure. The proposed cuts would cripple Australian medical research without doing anything significant to health expenditure.
Biomedical research returns between 2-5 times the amount invested in it (depending on the sector), but this is not so much "profit" as returns due to increases in well being and reduced…
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Vanessa
(logged in via Twitter)
The Exceptional Returns report (2008) estimates that for every dollar invested in health and medical research, $2.17 is saved in healthcare costs. Sounds like a pretty good investment of government money to me.
Tim van Gelder
(logged in via Twitter)
That's only a "prima facie" good investment. What you're after is the best investment, so you'd need to compare the savings in health care costs from research investment with other relevant alternatives, such as investing the same amount in basic preventative care, better dental care, etc.. I don't actually know the figures but have a hunch you'd find medical research would struggle to compete on this metric.
Ian Musgrave
(logged in via Twitter)
Where do you think preventative care comes from? Gardasil, which will protect women from developing cervical cancer, was developed using Medical Research funding. Relenza, which can prevent spread of pandemic flu was similarly developed through Medical Research Funding. The Men's Health initiative and the various healthy ageing research programs which are designed to provide preventative outcomes are all funded by the NH&MRC and all will suffer from these cuts.
Also, again realise that NH&MRC funding is around 0.6% of all health funding. By cutting research funding you are throwing away future improvements for extremely marginal changes in current expenditure.
amanda lawler
(logged in via Twitter)
Definitely Tim - and what about alternative therapies - what sort of savings would they equate to? I think they need to be more recognised....have written about this to...
http://www.principals.com.au/blogs/heroes-and-villians/if-this-is-quack-then-im-hooked
Michael J. Biercuk
(Senior Lecturer in the School of Physics at University of Sydney)
Well argued.
The fact that a movement called "evidence based medicine" exists suggests that not all medical research is actually producing positive outcomes for health. Reevaluation of priorities is quite reasonable in this sector. If a health-outcomes-based argument can be made to support the level of investment, then that position should be adopted.
I think scientists in medical research should be particularly wary of economic arguments. In addition to the points made above, their use also dilutes the "moral" underpinnings of research aiming to improve health.
Adrian Barnett
(Associate Professor of Public Health at Queensland University of Technology)
There's very little fat to cut from the current NHMRC system. Every year I see exciting and viable projects go unfunded. In the last few years I've been involved in studies that aimed to prevent needlestick injuries and improve lung transplant outcomes. Both were rated highly by the reviewers, but were unsuccessful. We had the expertise and staff to run these studies. If they were funded we would at this moment be digesting and publishing new information that could save lives or improve the quality…
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