The Growing Crisis

By DICK THOMPSON Leon Rosenberg

Q. You keep saying the nation's health-research program is "burning." Certainly that's excessive.

A. It's not an overstatement to say the country's structure for the support of biomedical research is burning. The problems are significant enough that if they are not attended to soon, the U.S. could lose its position as the world's leader in health-sciences research. I do not regret the use of the word burning. We have a national treasure here that's in some jeopardy.

Q. What is so disturbing?

A. There is more anguish in the ranks of scientists than we've had in 20 years. In academic institutions, young people are apprehensive about throwing in their lot with the field. Established investigators have become demoralized as a smaller and smaller fraction of their grant requests are funded. Institutional leaders see decay in the research facilities in which this research is carried out. And the entire enterprise suffers from the absence of any long-term strategic planning.

Q. What's the cause, in your view?

A. We have gotten to this situation because the leadership of the health- sciences research community has addressed the problems on a short-term, piecemeal basis, essentially looking at the problem only as long as the one- year budget cycle of Congress. That style of leadership has led to a virtual roller coaster of boom and bust. We are now suffering from a vacuum in national leadership for science in general and health science in particular.

Q. Recently Congress, in a harshly worded report, blamed scientists themselves for creating this chaos.

A. There is much truth in that House report. And there is an edge in the language that I have previously not seen from the House committee, and it is a reflection of the frustration that Congress feels with the leadership of the National Institutes of Health and with the leadership of biomedical research across the country.

Q. Is it correct that the problem isn't so much a vacuum of leadership as it is a political brawl for leadership -- among the supporters of the human genome project, the AIDS lobby, cancer researchers?

A. The scientific community is responsible in a major way for the paradoxes and dilemmas in which we find ourselves. The paradox is that this decay is occurring at a time when there are more opportunities than ever to ferret out the secrets of human biology and apply those secrets to the reduction of human suffering. The dilemma is that we must obtain more funding for the support of this effort in order to capitalize on those opportunities and improve the morale of the scientific community, while at the same time acknowledging that we have been generously supported for the past 40 years. Thus it is difficult to formulate a message that is not dead on arrival.

Q. Medical researchers have been pampered. Isn't it time to evaluate whether this investment has been wisely spent? The mortality rate for cancer has risen by 8% in the past 20 years. Doesn't that indicate a failure of return or an inappropriate investment?

A. Any serious economic assessment of health-sciences research will demonstrate that it has been remarkably cost effective. For example, the funds that were expended to develop the polio vaccine 30 years ago were quite small compared to the value derived from the virtual eradication of poliomyelitis. It has been calculated that if polio had not been prevented, the cost to the country in 1990 of caring for the millions of people with polio would exceed all the funds that have been spent by the NIH in the past 30 years. In 1955 essentially all children who developed acute leukemia died quickly with an enormous amount of suffering because of infections, because of anemia, because of bleeding tendencies. Today 70% of all children with acute leukemia are cured by combined chemotherapy programs. It is the best success story in the war on cancer that we have.

Q. In fact, it's an aberration, isn't it?

A. Yes it is.

Q. Significant improvements in the public health could be made with behavioral changes: smoking cessation and so on. Isn't there too little money going into what are high targets of opportunity?

A. You're touching on a crucial national problem, which is, What kind of a society do we demand to have? To place the responsibility for that on the health-science community is, I would say, unfair. The responsibility for that judgment rests with the entire country's priorities. Why do we undervalue the young? Why are our disadvantaged minorities so sick? Why is education in such horrendous shape in math and science? We live in a remarkably complicated society in which we have been incapable of having all our citizens share in the fruits of our national labors. But it would be remarkably shortsighted and illogical to say that the responsibility for that lies with those who generate new information. We must all accept the responsibility for the social problems that so much are the underlying causes for poor health and disease.

Q. What are the priorities of health-science researchers? Is it the extension of what they're doing, their own intellectual entertainment, or is it the improvement of public health? What's first?

A. It would be naive for me to say that the average working scientist has a broad societal perspective about his or her work. People go into science because they are inquisitive and because they believe that knowing more about our world will improve it. Our country has benefited enormously from the support of much unfocused basic research because in totally unexpected ways it has provided insights into medical problems that have been of enormous significance.

Q. Everyone would agree that it's in the country's interest to spend money on unfocused research, but given that we are in an era of limits, priorities are going to have to be set. What are your priorities?

A. My first priority is to create an environment in which talented young people choose careers in health-sciences research, because without them our future will be blighted. My second priority would be to fashion a system in which talented, more senior researchers could obtain stable funding for their best work. Those two priorities cannot be achieved without setting some limits and making difficult choices.

Q. O.K., so make some difficult choices. Is too much being spent on AIDS? Is the human genome project overfunded?

A. If it is impossible to increase significantly the federal budget for health-sciences research in the near future, then I would favor reducing funding for the human genome initiative and even for AIDS. I stand with the priorities I outlined, and I realize that means we can't have business as usual.

Q. How can we set national priorities?

A. We need a group of people brave enough to be willing to set down a point of view for the next five to ten years and then to develop a consensus that will replace the one-year-at-a-time haggling.

Q. How do you do that?

A. I would call upon the President to appoint a commission to develop policy guidelines for science in general and for biomedical research in particular. We haven't had a major policy statement in 50 years. Everything suggests not only that the time is right, but that the time demands such broad thinking.