Public Expectations and Funding of Biomedical Research

FACTORS AFFECTING RESEARCH SUPPORT AND CAREER DECISIONS IN CLINICAL INVESTIGATION Public Expectations and Funding ofBiomedical Research EDWARD H. KASS* Many assumptions, stated and unstated, underlie most discussions of funding for biomedical research. One of these is that in the recent past the explosive increase in the amount of money available for biomedical research led to a point at which we were reasonably funded, but with the development of more difficult economic circumstances we must now experience an inevitable adjustment. As is often the case, adjustments carry with them changing perceptions, some of which suggest that perhaps we did not spend our money wisely in the past. Other perceptions suggest that perhaps we did not communicate adequately with the general public from whom the money ultimately must come. Still other perceptions suggest that perhaps we have had too much money anyway, and that it would be at least as productive to support a smaller number of carefully chosen investigators who would carry us as far ahead in the advancement of knowledge as would a much larger group in which they are simply enmeshed. There are even those among us who, while not wishing to state so openly, regard much of the research that has been conducted as being a diversion and suggest that most of the money directed toward biomedical research might be better diverted toward the delivery of medical care and the training of a different brand of physician from that which is now being turned out by most of our medical schools. These, and many other points of view, can be elicited from almost any reading of the public press; from almost any discussion of any size among biomedical investigators, teachers, or providers ofhealth *Department of Medicine, Harvard Medical School, and Director, Channing Laboratory , Peter Bent Brigham Hospital, Affiliated Hospitals Center, 180 Longwood Avenue, Boston, Massachusetts 02118.© 1980 by The University of Chicago. 0031-5982/80/2322-1054$01.00. S44 I Edward H. Kass ¦ Funding ofBiomedical Research care; and can easily be elicited in almost any discussion with our students . Although all these points ofview have a certainjustice to them, in that they grapple with perceived needs and deficiencies, it does not follow that all of them have equal value in the creation of public policy. It is not possible, in these brief presentations, to develop all the steps in the analysis of the different points of view and in the creation of a present stance. Accordingly, a few more general statements must suffice as background to a small number of conclusions. The emergence of the scientific method as a means for solving a large number of biomedical problems as well as other problems in science had its roots in a changing awareness and changing technology, making possible changing perceptions of the nature of our world and of the universe around us and causing deep rifts and uncertainties with the system of beliefs that had existed before scientific exploration became a part of our daily existence. However, we recognize that much of the growth of science was supported by rulers of nations who had the foresight to understand that by supporting scientists such as astronomers, physicists, metallurgists, chemists, and many others their own expanding ambitions would be furthered. Large astronomical observatories, representing big science for their times, thusjustified their relatively large budgets by the demonstrations of the value of their observations in providing better nautical charts and better understanding of the bases for exploration and trade with other lands. Those nations and rulers that recognized the value of science more quickly than the others reaped economic benefits which were rapidly translated into social orders that, in their various ways, made use of their advanced technical knowledge for furtherance of their economic and other advantages. Of course, there were political leaders who respected the sheer power of the intellectual process, and the search for knowledge as an objective unto itselfwas always respected in certain quarters. But the dominant mode accounting for the support of research in the physical sciences tended to be enlightened selfinterest . In the biomedical sciences, there was great benefit from the intellectual excitement and new directions of thought that were being explored in the physical sciences...