I regret that I am unable to give the draft Position Paper on Biomedical Research the kind of attention it warrants and also
regret not being able to get these comments to you earlier. I am involved in a series of all day meetings for four
days at the Smithsonian.
Here, nevertheless, are some comments.
In item 5 under challenges, and dispersed throughout, there is an emphasis which I think should be somewhat altered. The argument
that support of fundamental research should not be diminished to provide for applied work would be more forceful if more explicit
attention were given to additional mechanisms for fostering the applied work. One possibility is to suggest explicitly that
applied work is more fruitfully left to private rather than public support because market provides the best incentives and
drives what will actually be applied. I myself
would, however, want to add that the government can do much to provide incentives for the applied work. If it is preferred
by others to argue for government support of applied work (but not at the expense of fundamental work) then mechanisms should
be suggested. At this point, however, I do not think that the statement will be readily acceptable if it fails to discuss
the issue of applied research, including clinical research. Moreover, the statement is likely to garner wider support within
the biomedical community if it recognizes that applied research is an important part of the whole picture. There is no point
in causing further fractures between basic and clinical researchers at this point. Perhaps it should also be pointed out that
incentives for basic scientists to try to move their findings into applications are also helpful.
Perhaps what I just tried to say can be summarized by suggesting that the document does not deal directly with some thorny
issues. Another such issue is the question of acceptance of new genetic techniques by the public, the whole area that is
generally referred to as "ethical" considerations. The discussion of agricultural applications also omits reference
to these problems, yet they are real and pesky and will not go away easily. Perhaps this could be dealt with under public
Somewhere, in the "Challenges" section, the idea of cost sharing between the government and research institutions
should be introduced. This will lay the ground work for the recommendation on indirect costs.
In item 2 under "Challenges" there should be some mention of the fact that enormous sums have indeed been spent for
infrastructure, but by special legislative action in response to lobbying by particular institutions. This year the number
is, I think, close to $700 million. This would lay the ground for Recommendation #8.
Item #3 under "The Promise . . . ", about health care costs, does not document its statements. For instance, many
people can see in their own bills that there are serious new costs related to new diagnostic procedures. Are there any data
that can be referred to that actually show how the high diagnostic costs pay off in lower costs for treatment? Do we really
know that the new treatments will be inexpensive, for example, in cancer? New treatments for heart disease are highly effective,
but they are also costly. I am not sure that, in spite of the examples
given, the case is well made.
I'm not sure this all makes sense, as I've had to write without any time for real reflection, but perhaps there are
a few ideas that will strengthen the document.
Maxine F. Singer
[Dictated by Dr. Singer; signed faxed and mailed in her absence]