October 13, 2005
I’m shocked, shocked, to find gambling going on in this place!
Where’s Louie when you need him? Or Rick for that matter? Or Ilsa? I know we’re not in Casablanca. And we sure aren’t in Kansas anymore either when it comes to academic medical research.
The people of the US have invested mightily in medical research. For at least the last 50 years massive tax investment through the National Institutes of Health and multiple other government agencies has been showered upon academicians and their medical centers.
How have these stewards of the public funds performed?
First, let’s allow that this investment has, along with that of the biotechnology, device and pharmaceutical industries, contributed to the technology underpinnings of our healthcare system and led to great advances in understanding the scientific basis of our health and in creating treatments that may prolong and improve our lives.
The questions are:
• Do public funds allocated really go for research?
• How much goes to the institution for general purposes as opposed to the research?
• Once granted do the funds go to the project funded or redirected?
• How is it determined who and what get funded?
There are basically two drivers for research: market-based and bureaucratic. Market-based is derived from customer need that acts as a type of demand signal. Creating a solution that meets the needs of the customer end-user in a large enough way to make it worthwhile to bring the solution to market results in the decisions to proceed with investments required to create the solution. The downside of having only market-based drivers is that some needs if small in number even if soluble may not be done. And basic research will only be done to the extent that it reasonably leads to a marketable solution. Investment risk will be undertaken under the right circumstances and the investments repaid if successful and customer need is met. Accountability is clear.
Bureaucratic research follows a central planning and control methodology. This allows knowledge for knowledge’s sake to be generated with no specific purpose in mind, though this doesn’t happen too often. Basic research and even applied research can have greater depth and breadth and much less focus. What the customer or end-user may want or need is far less relevant. Funding comes from public monies and is only an indirect check on the system. Accountability for meaningful output is less clear with researchers primarily rewarded for process. That is, this game is one of competing for a grant of money for a specific project and hence the output of the work is aimed at generating another grant. If meaningful results are also generated, this is a plus for all concerned but not required to stay in this business. Who and what projects receive grant money are decided by standardized processes which at the end are determined by committees or individuals complete with their personal biases, views, and priorities. Innovation may be slow to be recognized if it cannot be recognized as supporting the prevailing and conventional wisdom. Lack of focus and accountability may be perceived to lead to a lot of waste from the perspective of the tax payer expecting some return on the investment.
To read some journals like Science, the journal of the American Association for the Advancement of Science, one might think that funding for government research is in the toilet. There is constant wailing for more money, the multiple government research agencies being presented as so many baby birds unfed with their mouths open.
The September 22, 2005 Houston Chronicle, however, reports a doubling in medical research funding over the past decade to nearly $95 billion a year though the question of accountability was raised. Quoting a study which had been published in the Journal of the American Medical Association:
"If we're soon going to be spending $100 billion a year, we'd better have treatments that work over a long period of time against diseases that are important today and will be more important tomorrow," said Dr. Hamilton Moses III, co-author of the study and chairman of the Alerion Institute in North Garden, Va., which studies research policy.
“Moses and his colleagues found that the industry sponsors 57 percent of medical research and the National Institutes of Health pays for 28 percent. That proportion has not changed in the past decade.”
Another concern was raised in an August 16, 2005 article in the Wall Street Journal entitled "As Universities Get Billions in Grants, Some See Abuses" by Bernard Wysocki, Jr. This article reports upon the common practices of academic medical centers which if not illegal are at least highly questionable.
The sum of the story was as follows: “Kyriakie Sarafoglou had only worked at Cornell University's medical school…for a few months when she says she suspected something was amiss. Cornell had received a five-year, $23 million grant from the National Institutes of Health for a center conducting studies of children's diseases. But several research projects Cornell had said it would carry out existed only on paper. The money for the children's center was being used to treat many adults, and the center enrolled people as study subjects who didn't have the diseases being studied.”
As reported the school pretty much dismissed the allegations as business as usual. And indeed it is. A little gambling at Rick’s is okay as long as Strasser’s not in a snit. Taxpayers and indeed the government agencies slinging the money around often just assume that academic medical centers can be trusted to do the right thing. Perhaps it may be worth asking the question more often, “Do they?”
A case was brought against Cornell which they settled for $4.4 million. An unplanned expense to be sure, but not a bad cost of revenue for obtaining the $23 million. My advice, start asking the questions. Start demanding some accountability. The research establishment may be more rotten and corrupt than you think. That’s not news but what you learn could be shocking.
