Biomedical Research: Changes and Opportunities

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 24 ¦ Number 4 · Summer 1981 BIOMEDICAL RESEARCH: CHANGES AND OPPORTUNITIES SIR MACFARLANE BURNET* I am deeply honoured to be invited to present a W. S. Paley Lecture in the very centre of American medicine, and I am very conscious of my limitations in doing so. There are great gaps in my comprehension of the complexities that lie on the borderlines of medicine and the other aspects of our social structure. On the other hand, I have a good medical degree, and it is just possible that I could have been a good doctor. Nothing before or since seemed quite so important or satisfying as my year's internship at the Melbourne Hospital in 1922-1923. But apart from a brief stint as a ship's surgeon on a cargo boat to England, I have had no further personal responsibility as a physician. Yet in some ways, to have been engaged in research on a theme not too distant from medicine for more than 50 years from 1923 to 1978 gave me an opportunity to watch with a little detachment how the whole pattern of medicine changed over that wonderful half-century. But for as long as I can remember I have been more interested in the biological rather than the clinical potentialities of what nowadays we call biomedical research . I confess that for the first 20 years I was rather naively eager to provide, in addition, something that would be of clear human benefit—to prevent polio was one outstanding ambition!—but what I really wanted was to seek and occasionally find some new thread to be woven into the developing fabric of biological science. Sixth William S. Paley Lecture on Science and Society, Cornell Medical Center, New York, May 15, 1980.»Former director, Walter and Eliza Hall Institute, professor emeritus of experimental medicine, University of Melbourne, Parkville, Victoria 3052, Australia. Present address: 48 Monomeath Avenue, Canterbury, Victoria 3126, Australia.©1981 by The University of Chicago. 0031-5982/81/2404-0234$01.00 Perspectives in Biology andMedicine · Summer 1981 | 511 So I want to look at some of the more philosophical aspects of medicine and human biology from the point of view of one who is primarily interested in research. By research, I mean all those types of scholarly work which have contributed to the progressive clarification of our understanding of any aspect of the universe. Most of what I have to say in this lecture concerns medical research, and in line with my own interests deals almost exclusively with research directed toward understanding the etiology of disease. During the great days when the agents responsible for many important infectious diseases were being isolated and studied, an understanding of etiology usually led fairly directly to a means of prevention. To prevent most of the diseases we see today is much more difficult, and in the light of that change I want to discuss what we should have as our research objectives in the biomedical field in the immediate future. I shall therefore start with a brief consideration of how the major causes of disease and death have changed in the last 100 years and look at our major unsolved problems from what is perhaps a very personal and slighdy heretical viewpoint that puts unusual emphasis on genetic factors and insists that human biology and medicine are part of the universe—and that the whole endeavor of science to produce a consistent picture of the universe and the integration within it of life and human thought and behavior must progressively impinge on the understanding of human medical and social difficulties. First, then, a thumbnail sketch of the present frontiers of understanding as they apply to human disease. The Patterns ofHuman Disease and Disability The 50 years from 1920 onward that spanned most of my adult life were specially noteworthy for their success in understanding and dealing with disease and disability resulting from what one can call "the impact of the environment." The diseases that result from environmental impact are (1) those due to infection or infestation by viruses, microorganisms, and parasites; (2) the various types of traumatic damage by physical agents and their sequelae; and...