TIME: Almanac 1993/TIME Almanac 1993.iso/time/121790/1217510.000

Text File | 1992-08-28 | 7.7 KB | 187 lines

                                                                                INTERVIEW, Page 20

The Growing Crisis In Medical Science


LEON ROSENBERG, dean of the Yale Medical School, says the
world's best research system is collapsing and President Bush
should fix it

By DICK THOMPSON and 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.