tag:theconversation.com,2011:/africa/topics/medical-research-future-fund-10406/articlesMedical research Future fund – The Conversation2020-12-01T19:07:49Ztag:theconversation.com,2011:article/1450222020-12-01T19:07:49Z2020-12-01T19:07:49ZCOVID has left Australia’s biomedical research sector gasping for air<figure><img src="https://images.theconversation.com/files/364612/original/file-20201020-23-z6hb5m.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5162%2C3441&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While COVID-19 has highlighted the value of medical research, it has unfortunately also seriously disrupted it. Lack of funding is driving members of Australia’s once-vibrant virology research community out of the sector, and forcing early-career researchers to turn to fundraising or philanthropy amid intense competition for federal government grants.</p>
<p>This disruption disproportionately affects early- and mid-career researchers (EMCRs) and laboratory-based scientists, especially women (who typically also <a href="https://blogs.lse.ac.uk/covid19/2020/06/05/homeschooling-during-lockdown-will-deepen-inequality/">shoulder the bulk</a> of caring and home-schooling responsibilities).</p>
<p>In Australia, national funding of medical research happens mainly via the <a href="https://www.nhmrc.gov.au/">National Health and Medical Research Council</a>. Over the past ten years there has been <a href="https://www.nhmrc.gov.au/funding/data-research/outcomes-funding-rounds">near stagnant investment</a>, leading to a decline in funding in real terms. In 2019, the average success rates across the main NHMRC Ideas and Investigator Grant schemes was just 11.9%.</p>
<h2>Stagnant investment, plummeting morale</h2>
<p>Morale in the sector has <a href="https://www.afr.com/policy/health-and-education/funding-for-basic-research-disappears-in-a-wave-of-populism-20190620-p51zhj">plummeted</a> and we have lost <a href="https://www.theguardian.com/science/2020/oct/26/one-in-five-australian-scientists-planning-to-leave-survey-shows">talented researchers</a> to the United States, Europe and Asia, prompting leading universities to <a href="https://go8.edu.au/in-the-media-group-of-eight-warns-of-brain-drain-with-7000-jobs-set-to-go">warn of a brain drain</a>.</p>
<p>Eureka Prize-winning cancer biologist <a href="https://www.facebook.com/watch/?v=618261328871953">Darren Saunders</a> and clinical geneticist <a href="https://campusmorningmail.com.au/news/luke-hesson-left-research-and-found-a-better-life">Luke Hesson</a> have both decided to leave academia altogether. The full-time medical research workforce <a href="https://asmr.org.au/wp-content/uploads/2019/04/2019-Factsheet.pdf">declined by 20%</a> between 2012 and 2017.</p>
<h2>How did we get here?</h2>
<p>In 2018, following extensive consultation, the NHMRC funding scheme was overhauled with major objectives to encourage innovation across the sector, reduce the burden on applicants and reviewers, and improve success rates of EMCRs.</p>
<p>In the first two years of this new scheme, the success rates for EMCR Investigator Grants (EL1-2) was <a href="https://www.nhmrc.gov.au/funding/data-research/outcomes-funding-rounds">just 11.7% (250 of 2,133 applications)</a>.</p>
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Read more:
<a href="https://theconversation.com/the-nhmrc-program-grant-overhaul-will-it-change-the-medical-research-landscape-in-australia-78343">The NHMRC program grant overhaul: will it change the medical research landscape in Australia?</a>
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<p>Schemes specifically designed to develop emerging talent are also receiving dwindling support. In 2017 the NHMRC awarded 181 “early career and career development fellowships”; by 2020 that figure had fallen to 122.</p>
<p>The 2019 success rate for <a href="https://www.nhmrc.gov.au/funding/find-funding/ideas-grants">NHMRC Ideas Grants</a> scheme (which sustains fundamental research, including on vaccines) in Australia was <a href="https://www.nhmrc.gov.au/funding/data-research/outcomes-funding-rounds">only 11.1%</a>, despite almost three times as many applications being ranked as “fundable” by expert peer reviewers.</p>
<h2>Onus on universities</h2>
<p>With such low success rates, it has fallen to universities to prop up their research departments and laboratories.</p>
<p>If these trends continue, Australia stands to lose an entire generation of medical researchers. This prompted the <a href="https://www.mtpconnect.org.au/Company?Action=Profile&Company_id=336">Association of Australian Medical Research Institutes</a> in August to <a href="https://www.google.com/url?q=https://aamri.org.au/news-events/media-releases/aamris-budget-priority-secure-the-future-of-australias-next-generation-of-talent/&sa=D&ust=1603167068994000&usg=AOvVaw3XblOaN8f6hXiUz0TPn37Y">call for</a> the government to fund 300 new fellowships for EMCRs through the federal budget. </p>
<p>AAMRI president Jonathan Carapetis said the lack of grants and fellowships has forced EMCRs to rely on philanthropy or fundraising to support their research, adding:</p>
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<p>…due to the economic downturn resulting from COVID-19 the holes in this imperfect system have turned into chasms. These are the researchers who have finished their PhDs, are testing hypotheses on what causes different diseases, developing new treatments and vaccines… Our EMCRs are tomorrow’s scientific leaders, and without action to support them we will lose them.</p>
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<p>This call, however, was not heeded in the recent federal budget, which contained <a href="https://twitter.com/TheASMR1/status/1320889480778108928">no new money for biomedical research</a>.</p>
<h2>Funding the future?</h2>
<p>The federal government’s Medical Research Future Fund (MRFF) was <a href="https://www.health.gov.au/initiatives-and-programs/medical-research-future-fund/about-the-mrff">established in 2015</a> and began dispensing funds in 2017. As the MRFF website <a href="https://www.health.gov.au/initiatives-and-programs/medical-research-future-fund/about-the-mrff">explains</a>, the government uses some of the net interest from the A$20 billion fund to pay for medical research. This year it will disperse around A$650 million.</p>
<p>The MRFF represented a major and very welcome funding boost to Australia’s health and medical research sector.</p>
<p>But the combined NHMRC and MRFF budget still only represents 0.53% of the <a href="https://asmr.org.au/wp-content/uploads/2019/05/ASMRPositionDocument_2019.pdf">total health expenditure in the federal budget</a>.</p>
<p>This is a fraction of the 3% of health expenditure that would bring Australia’s health and medical research spending into line with <a href="https://asmr.org.au/wp-content/uploads/2019/05/ASMRPositionDocument_2019.pdf">other OECD countries</a>. An increase to 3% of health expenditure would generate <a href="https://asmr.org.au/wp-content/uploads/2019/05/ASMRPositionDocument_2019.pdf">A$58 billion in health and economic benefits</a>, according to a Deloitte Access Economics report commissioned by the Australian Society for Medical Research.</p>
<p>The MRFF has recently come under scrutiny as it emerged during Senate estimates that <a href="https://asmr.org.au/wp-content/uploads/2020/08/MRFF-Audit.pdf">up to 65% of funds were distributed without peer review</a>.</p>
<p>What’s more, researchers who narrowly missed out on the incredibly competitive NHMRC Investigator funding cannot apply to the MRFF unless they are a clinical researcher, meaning fundamental biomedical researchers engaged in translational research, but without a medical degree, <a href="https://www.health.gov.au/initiatives-and-programs/clinician-researchers-initiative">miss out</a>.</p>
<h2>Without investment, advances are not possible</h2>
<p>In the post-COVID era, a robust health and medical research sector is essential to lead the discoveries and innovations that will fuel our long-term economic recovery. </p>
<p>The <a href="https://narf.org.au/">National Association of Research Fellows</a> (a peak body representing biomedical researchers; the authors of this article are on the NARF Executive) is calling for:</p>
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<li><p>at least a doubling of federal funds into the Australian health and medical research sector </p></li>
<li><p>transparent, 360-degree oversight of the targeted calls for expression of interest and allocation of funds from the MRFF with involvement of NHMRC peer review. </p></li>
<li><p>strictly equal support for clinical and fundamental biomedical research.</p></li>
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<p>This investment would position Australia as an international leader in health and medical research. Without better support for the sector, advances in patient treatment and care are simply not possible.</p>
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Read more:
<a href="https://theconversation.com/more-than-10-000-job-losses-billions-in-lost-revenue-coronavirus-will-hit-australias-research-capacity-harder-than-the-gfc-138210">More than 10,000 job losses, billions in lost revenue: coronavirus will hit Australia's research capacity harder than the GFC</a>
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<p><em><strong>Editor’s note</strong>: This article references figures tabled in Senate Estimates in March 2020 showing only <a href="https://asmr.org.au/wp-content/uploads/2020/08/MRFF-Audit.pdf">35% of MRFF grants</a> were awarded via a competitive process. It has since been brought to our attention that more recent data are now available, and this figure has now <a href="https://www.health.gov.au/summary-of-mrff-grant-recipients">risen to 73%</a> as of December 2, 2020.</em></p>
<p><em>The article also previously stated Darren Saunders and Luke Hesson have left science altogether. They have in fact decided to continue their scientific research careers outside academia.</em></p><img src="https://counter.theconversation.com/content/145022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gina Ravenscroft receives funding from the NHMRC, and is WA representative of the National Association of Research Fellows of NHMRC.</span></em></p><p class="fine-print"><em><span>Elizabeth Gardiner receives funding from the NHMRC and the ARC, and is treasurer of the National Association of Research Fellows of NHMRC. </span></em></p>While COVID-19 has highlighted the invaluable nature of medical research, it has unfortunately also seriously disrupted it. In Australia, the sector now teeters on the brink of collapse.Gina Ravenscroft, Research Fellow, The University of Western AustraliaElizabeth E. Gardiner, Professor, John Curtin School of Medical Research, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/604522016-06-07T00:52:43Z2016-06-07T00:52:43ZWhere could Australia genuinely innovate?<figure><img src="https://images.theconversation.com/files/125291/original/image-20160606-25999-wnq0h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia could capitalise on its sun-drenched landscape to innovate in renewable energy.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There is a lot of talk about innovation these days, but are we really innovating in the areas where we could generate the most benefit for Australia and the world?</p>
<p>What is clear is that the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/8415.0">decline in mining revenue</a>, the <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1415/Quick_Guides/Manufacturing">elimination of manufacturing jobs</a> and climate-dependent uncertainties in <a href="http://www.farminstitute.org.au/ag-forum/australian-agriculture-productivity-stall">agricultural productivity</a> mean Australia’s future prosperity cannot depend on endlessly repeating the past.</p>
<p>The decline of coal and, indeed, all fossil fuel exports is inevitable if nation states are to comply with the <a href="https://theconversation.com/the-paris-climate-agreement-at-a-glance-50465">Paris agreement</a>. That won’t happen overnight, but the pace of change will inevitably accelerate as a more concerned and aware younger generation seizes political control.</p>
<p>Future prospects for our greatest single tourism asset, the <a href="https://theconversation.com/au/topics/great-barrier-reef">Great Barrier Reef</a> seem increasingly dim. The <a href="https://theconversation.com/au/topics/coral-bleaching">bleaching</a> that’s killing the corals is a direct consequence of ocean warming. </p>
<p>With 0.3% of the world’s population, we produce around 1.4% of the world’s greenhouse gas emissions (and that’s excluding the emissions from our coal exports). But the fact remains that there’s relatively little Australia can do to protect the long-term health of the reef.</p>
<p>We could act to limit agricultural runoff. And, thinking innovatively, we might research if it’s possible to engineer or transplant more heat resistant corals. But apart from the technical challenges, any long-term success will depend on how hot the seas eventually become.</p>
<p>If we’re thinking about places where a country like ours with a small population can hope to innovate in ways that generate new technologies and more jobs, the area with the greatest potential is renewable energy.</p>
<h2>Playing to our strengths</h2>
<p>We live on the world’s largest solar collector. How do we exploit that to serve our own energy needs and, beyond that to develop a clean energy export industry? One possibility is to produce an <a href="http://www.hans-josef-fell.de/content/index.php/dokumente/documents-in-foreign-languages/743-english-asia-pacific-super-grid/file">Asia-Pacific solar “super grid”</a>, with Australia exporting solar energy to our neighbours.</p>
<p>Given that we have massive solar resources, and assuming a <a href="http://www.scientificamerican.com/article/carbon-pollution-costs-more-than-u-s-government-estimates/">realistic global price for carbon</a> (say A$100/ton levied on everything from energy generation to transport), Australia would become a highly desirable place to site activities that require a lot of energy. An obvious, immediate application is to host global data centres.</p>
<p>We also have a strong record of innovation in the medical area, with the new <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mrff">Medical Research Future Fund</a> being tangible evidence that this is recognised at the political level. </p>
<p>Vaccines, such as <a href="https://theconversation.com/four-things-you-should-know-about-hpv-vaccinations-15178">Gardasil</a>, and devices such as the <a href="https://theconversation.com/five-australian-medical-stories-everyone-should-know-27581">ResMed sleep mask</a> and the <a href="http://www.cochlear.com/wps/wcm/connect/au/home/understand/hearing-and-hl/hl-treatments/cochlear-implant">bionic ear</a> have been major dollar earners, although each hasn’t necessarily created many domestic jobs.</p>
<p>Given our increasing ethnic diversity and our centrally organised national health system, Australia is a great place to do clinical trials that will be acceptable to the emerging powerhouses, such as China, in drug discovery and development.</p>
<p>And we have established great models for networking university and research institute talent across the nation. </p>
<p>Sometimes, I fear our politicians take too narrow a view of medical research. They fail to grasp that the Australian Research Council and CSIRO-funded chemists, physicists, mathematicians and so forth are centrally important to this enterprise, although that is understood by those who administer the funding agencies. And cutting research support funds to universities is a major regressive step. </p>
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<a href="https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125456/original/image-20160607-31933-zqh402.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Australia has a long history of innovation in agriculture, including through the CSIRO.</span>
<span class="attribution"><span class="source">Willem van Aken/CSIRO</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Research prosperity</h2>
<p>That said, a great deal of innovation has nothing to do with the formal research sector. Innovation in areas such as design, visual imagery, fashion, surfboards, bicycles and so forth is based on the insight and energy of inventors and entrepreneurs. </p>
<p>That’s also true, to some extent, for innovation in engineering and architecture, although developing novel solutions is likely to benefit from regulations and/or investment strategies that mandate, for instance, energy efficiency and “greening”.</p>
<p>Government definitely has a part to play here. If we look at Silicon Valley, for example, an enormous amount of support has been supplied by US Department of Defence and Department of Energy grants. </p>
<p>CSIRO chief Larry Marshall’s strategy to take the institution down a more entrepreneurial road is understandable. What is regrettable, though, is that there has been no real political commitment to continuing the “public good” (and long-term economic good) science that has been a major focus for CSIRO and should, perhaps, find another home.</p>
<p>One option would be to establish a new National Institute for Earth Systems Science that incorporates some of the CSIRO activities that are slated for cuts. </p>
<p>If we don’t understand what is happening with the climate, tides, soils, water, biodiversity and so forth, we limit our capacity to innovate in response to environmental stress. We also risk making very bad political decisions about where to invest for future development and to mitigate the effects of climate change. </p>
<p>Surely Australia should be the great laboratory for water conservation and dry land agriculture. That won’t happen if we compromise the necessary science.</p>
<h2>Finding the advantage</h2>
<p>As a research scientist, the principle I’ve always adopted is to align with selective advantage. That means collaborating with talented people (especially those at close range with different expertise) and tackling issues where there is real need. </p>
<p>The big questions are: what are our selective advantages as a nation? And how do we exploit them?</p>
<p>Although there are signs of erosion, one great advantage we still have is that we live in a socially progressive and generally tolerant society with a strong record in science, education and the arts. </p>
<p>So, although governments can help get the settings right and provide some resources, genuine innovation depends on the actions of smart, courageous and determined entrepreneurs.</p>
<p>Where the US prospers, it’s because it has outstanding tertiary educational institutions that produce such people, it invests in science and technology and it recruits talent from across the world. </p>
<p>That’s one place where we can take a lesson from their book. Although, when it comes to social policy, other centres of innovation such as Scandinavia and Germany seem to be more relevant to us. </p>
<p>Innovators want to live in places that are safe, decent, have affordable education, and value personal freedom, bold ideas and creativity. What we are as a culture is a major component of our selective advantage, and we need to preserve that distinctiveness.</p><img src="https://counter.theconversation.com/content/60452/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter C. Doherty is at the University of Melbourne Medical School, where he is part of an NHMRC Program Grant investigating immunity to the influenza viruses. He serves as Board Chair for the ARC Centre of Excellence for Climate Systems Science, and the ARC COE for on Convergent Bio-Nano Science and Technology. He is a founding member of the Board of TheConversation.</span></em></p>There are several areas where Australia could be a world leader in innovation. If we can identify them and focus our efforts there, we could generate some genuine benefits here and abroad.Peter C. Doherty, Laureate Professor, The Peter Doherty Institute for Infection and ImmunityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/578102016-04-21T01:14:22Z2016-04-21T01:14:22ZHow to pick Australia’s health and medical research priorities<figure><img src="https://images.theconversation.com/files/119202/original/image-20160419-5284-2t98xa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The highest-quality research is much more likely to be impactful research.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-274678289/stock-photo-scientist-working-at-the-laboratory.html?src=tN5S2elFShEsBMnqNMsDGg-1-42">Guschenkova/Shutterstock</a></span></figcaption></figure><p>Earlier this month, Health Minister Sussan Ley announced the <a href="http://www.afr.com/news/sussan-ley-to-unveil-new-medical-research-future-fund-advisory-board-20160403-gnx9o9">board of the Australian Medical Research Future Fund</a> (MRFF). It is led by <a href="https://theconversation.com/profiles/ian-frazer-10030">Professor Ian Frazer</a>, one of Australia’s most innovative and successful researchers who developed the highly successful human papillomavirus (HPV) vaccine that protects against cervical cancer. </p>
<p>The MRFF was originally announced in the Abbott government’s 2014 budget and aimed to have around A$1 billion to spend each year.</p>
<p>The board will establish the fund’s research priorities. But how should they choose? Two main approaches are possible: prioritising a health problem and prioritising quality and impact. </p>
<p>Prioritising a health condition is tempting for governments. No-one would argue against the strongest possible worldwide research effort on any area of ill health, whether it’s to defeat, say, dementia, breast cancer or diabetes. </p>
<p>But it is a poor way to get the most benefit for Australia. Even devoting all of the Australian MRFF to a single disease would represent only a tiny increase in the worldwide research effort (perhaps by 1-2%). This is unlikely to make much difference, no matter how large the burden of the disease on individuals and societies. </p>
<p>There are exceptions. These include uniquely or predominantly Australian issues such as the health of our First Peoples, or research to make our unique health system work better for the patient and the taxpayer. </p>
<p>So it’s much wiser to prioritise quality and impact. The highest-quality research is much more likely to be impactful research. Poor-quality research, no matter how important the problem being investigated is, is a waste of money. </p>
<p>We should expect the MRFF to make two broad impacts – better health and health care, and improved national prosperity. </p>
<p>First, then, the MRFF should support research that is needed to more rapidly improve health care (which, incidentally, is one of our largest industries). Australian universities have some high-quality research centres that could, with increased funds, contribute quickly to this.</p>
<p>Second, lots of great discoveries are made by Australians. To have an impact on national prosperity, including high-quality manufacturing and jobs, the MRFF should strengthen, stimulate and accelerate the pathways from discovery to a robust Australian innovative industry sector in biotech, IT, financing, devices, consulting and more. </p>
<p>However, some things need to change. </p>
<p>Australian medical research is too fragmented. We have more than three dozen universities and their associated hospitals and more than five dozen separate medical research institutes, some of which are very small. Some hospital campuses contain several separate independent institutes as well as university clinical departments and research centres. </p>
<p>There is much duplication of research resources and services, and little co-ordination.</p>
<p>In the second decade of the 21st century, visionary, breakthrough research is characterised by collaboration of biomedical research and the life sciences with physics, engineering, chemistry, IT and mathematics. </p>
<p>To tackle the really difficult issues, such as reducing the individual and financial costs of chronic diseases, we also need high-quality social sciences, economics, policy research and entrepreneurship. </p>
<p>These international trends will require a much more open and collaborative Australian research effort, internationally focused. </p>
<p>Gaining national wealth through innovation will likewise require a major leap in collaboration with researchers in other disciplines, drawing on their skills and experience, and especially with industry big and small, here and overseas. After decades of talking about innovation being essential to our futures, there is still little interaction between universities and industry. </p>
<p>Small institutions with few resources and a narrow research focus are likely to struggle to contribute. It should not be a MRFF priority to prop them up. </p>
<p>The MRFF will need to fix its eyes firmly on what is best for Australia’s health and prosperity. This involves maximising ambitious, collaborative, frontier research at top international levels and accelerating the research findings into increased wealth and health for Australia. </p>
<p>But we need to keep in mind that innovative ideas and the greatest successes come from talented driven individuals, not the priorities of committees and boards.</p><img src="https://counter.theconversation.com/content/57810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Warwick Anderson was the Chief Executive Officer of the National Health and medical Research Council of Australia (NHMRC) from 2006 to March 2015. He is a Vice-Chancellor’s Professorial Fellow at Monash University and Secretary-General of the Human Frontier Science Program Organisation.
Warwick Anderson était le Chief Executive Officer du National Health and Medical Research Council d’Australie, 2006 – mars 2015. Il est maintenant un Vice-Chancellor’s Professorial Fellow a Monash University et le Secretary-General de l’Human Frontier Science Program Organisation.</span></em></p>The MRFF should prioritise the chances of making major advances in knowledge and the chances of research having an impact on Australian health and wealth.Warwick Anderson, Secretary-General, International Human Frontier Science Program Organisation; Vice-Chancellor’s Professorial Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/436222015-06-25T20:20:35Z2015-06-25T20:20:35ZOne bright idea that could transform innovation in Australia<figure><img src="https://images.theconversation.com/files/86219/original/image-20150624-824-13ho0bn.jpg?ixlib=rb-1.1.0&rect=333%2C17%2C1207%2C1143&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Connecting researchers to industry and investment is a great idea.</span> <span class="attribution"><span class="source">Caleb Roenigk/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>When it comes to fostering innovation and the commercialisation of world class research, there is something the United States has that we lack. We ought to learn from the successes of the US in this area, and emulate one program they have pioneered to give our own innovative industries a much needed kick start.</p>
<p>For dozens of Australian researchers returning to the country after working in the US, the lack of an equivalent to the US’s Small Business Innovation Research (<a href="https://www.sbir.gov/">SBIR</a>) scheme here reflects a major hole in our innovation ecosystem. </p>
<p><a href="http://www.manufacturing.gatech.edu/people/charles-wessner">Charles Wessner</a>, Professor at Georgetown University and director of the Global Innovation Policy unit, says the SBIR scheme triggered a fundamental shift in attitudes in American universities when it was introduced in 1982.</p>
<p>According to Wessner, before SBIR, the Dean of a faculty would ask young academics how many publications were going to come out of their latest piece of research.</p>
<p>Thirty years on, the Dean is now asking whether the research can be converted into a product or service, and whether they should spin it out of the university to access SBIR funding. It has been a profound change of mindset, says Wessner.</p>
<h2>Simple but effective</h2>
<p>The Small Business Innovation Research (SBIR) scheme is a fairly simple design that hasn’t changed much since its introduction. US government agencies, which undertake more than US$100 million worth of R&D outside the agency, are required to allocate 2.8% of their R&D budget to these programs. Currently, eleven federal agencies participate in the program.</p>
<p>Each agency takes an active role in calling for R&D – “solicitations” is the term used in the US, and with a completely straight face – for areas of concern to them. For example, the US Department of Agriculture this year is calling for projects in ten areas. They are unsurprising fields, like “aquaculture” and “biofuels and biobased products”, but with a bit more specificity under them. </p>
<p>Any small business (one to 500 employees) can then bid to undertake projects against those solicitations. The <a href="http://www.usda.gov/wps/portal/usda/usdahome">US Department of Agriculture</a> issues solicitations once a year, receives about 500 applications for “Phase 1” projects (those up to US$100,000 over up to eight months) and funds about 15 to 20% of them. If a project is success at Phase 1, they can apply for a Phase II award, which can be up to US$500,000 over two years. Some departments have further, larger Phase III stages, although the USDA doesn’t.</p>
<p>For the Department of Defense <a href="http://www.defense.gov/">DoD</a>, 2.8% of its extramural R&D spend is a <a href="http://www.aaas.org/sites/default/files/Function_1.jpg">very large amount of money</a> indeed. Moreover, if the Department of Defense is soliciting proposals for new work, it is very likely it’ll become the first customer of that small business if the project is successful. </p>
<p>The DoD already has a stake in the product, and is thinking about how it might work in its own ecosystem. Given the extreme complexity of military procurement procedures, having the DoD already staked in your product is a major advantage to a new company. </p>
<p>Carry on Phase II and then Phase III funding, sometimes in multiple series, are available in much larger amounts from the bigger agencies, and can run to tens of millions of dollars.</p>
<p>Don’t imagine that means all SBIR projects are short-term or lack scientific challenges. The US Navy uses about 1.4 billion tonnes of fuel annually, and the head of its energy program, Captain Jim Goudreau, said climate change transcends politics when you are talking about that much fuel. </p>
<p>He pointed out that the US military is already affected by climate change in many practical ways, like having less available live fire practice days each year in California. And as he said at the <a href="http://www.techconnectworld.com/World2015/">TechConnect World</a> audience in Washington last week, the Navy is contracting for materiel to be delivered in 2040, which needs to be effective into the 2070s and 2080s. So it needs to cope with a changing climate.</p>
<h2>Pull and push</h2>
<p>At the TechConnect meeting in Washington last week, there were literally dozens of US federal groups talking to the science and business community about their innovation needs. Big departments, like Defense and Energy, are represented by many specialised teams seeking out companies to work for them. </p>
<p>It is “customer pull” in its rawest form. The science community is here in big numbers offering new technologies to the market. When “science push” and “customer pull” mix, then the chances of successful innovation rise to a new level.</p>
<p>At the same time in Philadelphia, the gigantic annual biotechnology conference, <a href="http://convention.bio.org/">BIO</a>, was underway with more than 15,000 participants from across the globe. The two big US science funding agencies – the National Science Foundation (<a href="http://www.nsf.gov/">NSF</a>) and the National Institutes of Health (<a href="http://www.nih.gov/">NIH</a>) were there in force helping their SBIR companies meet up with big pharma and other collaborators to bring technologies to market. </p>
<p>It’s like a science festival writ large, but also in extreme detail, as companies search for new opportunities from the vast American research community.</p>
<h2>Could it work in Australia?</h2>
<p>The recent joint paper from Ian Macfarlane and Christopher Pyne, “<a href="https://education.gov.au/news/discussion-paper-boosting-commercial-returns-research-released">Boosting Commercialisation of Research</a>”, floated the idea that Australia needs an “SBIR-like” scheme. The Academy of Technological Sciences and Engineering (<a href="https://www.atse.org.au/">ATSE</a>) has often pointed out that the lack of such a scheme is a gaping hole in the Australian innovation ecosystem.</p>
<p>We do have some “customer pull” oriented schemes, though. The <a href="http://www.ruralrdc.com.au/Page/Home.aspx">Rural R&D Corporations</a> definitely fall into this category, as do many of the Cooperative Research Centres (<a href="http://www.business.gov.au/grants-and-assistance/Collaboration/CRC/Pages/default.aspx">CRCs</a>). </p>
<p>The government’s response to the recent “<a href="http://www.business.gov.au/grants-and-assistance/Collaboration/CRC/CRC-Programme-Review/Pages/default.aspx">Miles Review</a>” of the CRC program was to push CRCs to be even more industry-led. </p>
<p>Industry leadership is the mantra for the new <a href="http://www.business.gov.au/advice-and-support/IndustryGrowthCentres/Pages/default.aspx">Industry Growth Centres</a>, but they are not going to be funding very much research. The ARC’s <a href="http://www.arc.gov.au/ncgp/lp/lp_default.htm">Linkage Projects</a> and the newer <a href="http://www.arc.gov.au/ncgp/itrp/centres_default.htm">Industrial Transformation Training Centres</a> as well as the NHMRC’s <a href="https://www.nhmrc.gov.au/grants-funding/apply-funding/partnerships-better-health/partnerships-centres">Partnership Centres</a> are each attempts to have push more of the nation’s R&D investment into more market-facing efforts.</p>
<p>But none of these schemes are aimed at boosting innovation from small businesses. Or at least, not exclusively so. They are often encouraged to do so, and make sporadic attempts to improve their small business engagement, but it is clearly a weak spot in the Australian innovation context. </p>
<p>Small businesses that are trying to expand with innovative technologies constantly struggle to raise funds at early stages of development.</p>
<h2>Bridging the gap</h2>
<p>SBIR is not of itself a scheme for collaboration; the small businesses involved can undertake all the R&D themselves. But the experience in the US is that SBIR fosters collaboration as high technology start-ups seek to source expertise from universities and other research agencies. </p>
<p>Universities immediately increased their rate of spinning out companies on implementation of the scheme in 1982. The SBIR funding attracts further seed and venture capital funding, bridging that “valley of death” between early research funding and the business becoming self-sustaining. </p>
<p>Ultimately, many of the small businesses get bought out by large companies, particularly in the defence and pharmaceutical areas, where massive ongoing investment is needed to introduce new products.</p>
<p>There’s no doubt that an SBIR scheme would fill a major innovation gap in Australia, and no doubt we could make the necessary administrative arrangements. But for an SBIR scheme to truly succeed in Australia, there would be a few hurdles that I’d suggest must be overcome before we spent the first dollar. I call these the “Fair Dinkumness” tests to ensure an Australian flavour.</p>
<h3>Fair Dinkumness test 1</h3>
<p>Would there be true political support? </p>
<p>Unless a scheme enjoyed bipartisan support, there would be no point in introducing one. With one of the shortest electoral cycles in the world, Australia is at a major disadvantage in terms of stable policy in relation to innovation. </p>
<p>If the political support is there, then an SBIR scheme would need a significant investment of new money. Scrounging money off another under-funded program would simply be setting both up to fail. It takes some time for industry to become confident with new schemes and start to invest in a meaningful way. We’d need a real commitment.</p>
<h3>Fair Dinkumness test 2</h3>
<p>Would there be true bureaucratic support? </p>
<p>SBIR in the US works because it is a procurement scheme as well as an R&D scheme. The bureaucracy would need to seriously commit to using the scheme to improve its own departmental knowledge or services. </p>
<p>That means a solicited report to the Department of Environment on management of an endangered species would need to be implemented, not just sent to the library. That means the Army would need to buy the better boots from an Australian small business. </p>
<p>This is perhaps a bigger mindset change than either the politicians or the business community, and would need to be monitored closely, even if there was initial high level support. </p>
<p>For a small country such as Australia, it is often easiest to take the pathway of least risk – so Senate Estimates would need to cut bureaucrats some slack for backing Australian inventiveness too.</p>
<h3>Fair Dinkumness test 3</h3>
<p>Would Australian business truly back it? </p>
<p>If small businesses are formed just to access SBIR money, and want to survive on providing some research to government, then we are no better off. If peak industry bodies view the money as simply an entitlement for their members, then nothing new will happen. </p>
<p>The whole point of giving a big innovative boost to small businesses is to turn them into high-growth businesses. Existing bigger businesses would need to accept that they won’t be able to access the scheme, and they might even be faced with competition from those that do become successful innovators. An SBIR scheme by its very nature involves giving a leg-up to the new players in town, and the incumbent players need to accept that situation.</p>
<p>If the federal government did undertake to create an SBIR-like scheme in Australia, it would easily be the biggest reform of the innovation ecosystem in the country since the Hawke government’s raft of “Clever Country” policies. </p>
<p>It may not be the size of the <a href="https://theconversation.com/au/topics/medical-research-future-fund">Medical Research Future Fund</a> as that scheme grows, but it is significantly more complex to implement. There is no doubt the government wants business and research agencies to come together much more closely. An SBIR scheme would be a massive step in that direction.</p><img src="https://counter.theconversation.com/content/43622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Peacock is the Chief Executive of the Cooperative Research Centres Association, which advocates on behalf of CRCs. He also receives funding from The Winston Churchill Memorial Trust, sponsored by Monash University. He has previously received funding from the Australian Research Council Linkage Program; the Grains R&D Corporation, Australian Wool Innovation, Meat and Livestock Australia, Australian Pork Limited, CSIRO, and the Cooperative Research Centres Program.</span></em></p>If we want to boost innovation in this country, we should emulate a scheme that has proven highly successful in the United States.Tony Peacock, Adjunct professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/421882015-05-26T22:24:04Z2015-05-26T22:24:04ZAAS President: Science needs support to build a better Australia<figure><img src="https://images.theconversation.com/files/82827/original/image-20150525-32578-1kfb35j.jpg?ixlib=rb-1.1.0&rect=89%2C248%2C1751%2C1197&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia has a long history of first class science.</span> <span class="attribution"><a class="source" href="http://www.scienceimage.csiro.au/tag/In-the-lab/i/4698/technician-in-csiro-laboratories/large">Willem van Aken/CSIRO</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>A shift has occurred in the past year in the way the Australian public, politicians and business talk about science. Scientists are no longer considered to be “<a href="http://www.theguardian.com/world/2014/sep/11/scientists-angry-about-ian-macfarlanes-precious-petals-remark">precious petals</a>”. We are being taken seriously. We are being heard.</p>
<p>At the end of last year we welcomed the <a href="https://theconversation.com/shaping-2015-the-challenge-for-australias-new-science-minister-36588">reinstatement</a> of the word “Science” into the portfolio of the <a href="http://www.minister.industry.gov.au/ministers/macfarlane">Minister of Industry and Science</a>. It seems like a small thing, but it’s symbolically significant. And it was followed by further indications from the government that it is listening to science. </p>
<p>The three key federal government portfolios of Industry and Science, Health, and Education and Training all speak to important pillars for the scientific community. And we are pleased that these three Ministers join the Prime Minister, the Chief Scientist and others at the <a href="http://www.chiefscientist.gov.au/2015/04/commonwealth-science-council-2/">Commonwealth Science Council</a>. </p>
<p>It’s a council that has five Australian Academy of Science Fellows as members and has already met twice this year. We are heartened at the interest that the Prime Minister has shown in this body. </p>
<p>The Government has also committed to working with the council and the <a href="https://theconversation.com/profiles/ian-chubb-5153">Chief Scientist</a> to develop a <a href="https://theconversation.com/why-a-national-science-strategy-is-good-for-australia-40254">science strategy</a>, and will be consulting broadly with the sector over the coming months. This is important for Australian science and research, and I encourage every researcher and science organisation with an interest in Australia’s scientific future to provide considered input into the consultation.</p>
<p>In March, Science Minister Ian Macfarlane made a positive, respectful and forward-looking <a href="http://www.minister.industry.gov.au/ministers/macfarlane/speeches/address-science-meets-parliament">speech</a> at <a href="http://scienceandtechnologyaustralia.org.au/science-meets-parliament/">Science Meets Parliament</a>, in which he made it clear that he believes science is fundamental to our national prosperity, and that our scientific institutions have the capacity to provide a strong platform upon which to build the Australia of the future.</p>
<p>We are making headway. The political narrative about science is starting to shift.</p>
<h2>Turning talk into action</h2>
<p>In the <a href="https://theconversation.com/au/topics/federal-budget-2015">Federal Budget</a> handed down two weeks ago, there was a welcome <a href="https://theconversation.com/budget-brief-how-does-science-and-research-funding-fare-41434">reprieve for science funding</a> in the coming financial year. However, there are still forecast cuts of around A$290 million to key Australian science and research programs that will take effect in the financial year 2016-17.</p>
<p>Despite immediate relief for NCRIS and an ongoing commitment to establish a Medical Research Future Fund, overall funding for science in Australia will <a href="https://theconversation.com/australian-science-is-no-better-off-after-the-2015-budget-41827">continue to decline</a>. </p>
<p>Unfortunately NCRIS has been funded through significant reductions in block grants to researchers in universities. This is like taking engines off the jumbo jet.
To do science, you need excellent scientists to make the best use of top quality infrastructure; it can’t be one or the other. NCRIS needs a long-term sustainable funding model that addresses both ends of this equation.</p>
<p>The Minister for Industry and Science and the Prime Minister say they want science to play a greater role with industry, and yet in this budget there was A$30 million cut from the <a href="http://www.business.gov.au/grants-and-assistance/collaboration/crc/Pages/default.aspx">Cooperative Research Centres</a>, which are specifically designed to help improve collaboration with business and help generate jobs from research and development. It will be important to consider an alternative model to promote academia-industry engagement.</p>
<p>While there are forecast selective cuts there have also been selective increases – for the <a href="http://www.synchrotron.org.au/">Synchrotron</a>, Australian Nuclear Science and Technology Organisation (<a href="http://www.ansto.gov.au/">ANSTO</a>), <a href="https://theconversation.com/budget-brief-how-does-science-and-research-funding-fare-41434">Antarctic research and medical research into exotic tropical diseases</a> – and we look forward to seeing those increases sustained into the future. </p>
<p>We’re also pleased that there will be a <a href="http://www.arc.gov.au/ncgp/futurefel/future_default.htm">Future Fellowships</a> scheme this year, albeit with just 50 fellowships on offer. It’s a good start for this important initiative to support and retain some our best and brightest young researchers, and we will continue to advocate for the programme to be restored to its former scale.</p>
<p>As the <a href="https://theconversation.com/au/topics/mining-boom">mining boom slows</a>, this should be a time of growth in science funding. We should be preparing Australia to build a knowledge economy so that we do not simply survive but thrive in an increasingly competitive world.</p>
<p>We should be supporting our world-class research infrastructure, and our world-class and emerging researchers, to create new knowledge and innovation. And we should be supporting scientists and industry to forge strong links to translate this innovation into economic growth and security.</p>
<p>This is a challenge for politics, yes. But it’s also a challenge for the science sector.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82829/original/image-20150525-32575-y39uo6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CSIRO scientists deploy the CTD instrument from the Southern Surveyor to monitor the distribution and variation of water temperature, salinity and density.</span>
<span class="attribution"><a class="source" href="http://www.scienceimage.csiro.au/tag/in-the-field/i/10807/deploying-the-ctd-instrument-from-the-rv-southern-surveyor/">Bob Beattie/CSIRO</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Building a strong voice</h2>
<p>On the domestic front we must continue to persuade the Australian community of the importance of science as a major cultural contributor and a driver to national prosperity through wealth creation and improved productivity.</p>
<p>We must continue to focus on education, working with young people who will inevitably become the decision makers of the future. We must continue to build strong support, professional development, and mentorship for early- and mid-career researchers – such as that provided by the <a href="https://www.science.org.au/emcr-forum">Early- and Mid-Career Researchers Forum</a>, which grows from strength to strength.</p>
<p>And we must convince the community not only of the value of science as a discipline, but also as a provider of informed and trained minds who can meaningfully contribute to the workforce in many different areas from those directly related to their scientific training.</p>
<p>A major challenge facing the research community is to develop a profitable engagement with industry. There are many ways in which this can be realised, but common to all must be an acceptance that each party should benefit from this kind of engagement. </p>
<p>Here in Australia there are very few large companies engaged in fundamental and applied research. Much activity is carried out in small and medium enterprises (SMEs), which will invariably have limited capacity to fund collaborative research.</p>
<p>The solution to this must be seen as a task of government, which will inevitably reap the dividend in the taxation of increased earnings arising from the success of these small companies.</p>
<p>Just as we support the notion of a <a href="http://www.researchaustralia.org/mrff/mrff">Medical Research Future Fund</a>, so would we support industry engagement, through the Cooperative Research Centres and other mechanisms. It is, of course, important that this kind of engagement is not supported at the expense of our capacity for curiosity-driven research that is inevitably the wellspring of many translatable research discoveries. </p>
<p>All the evidence suggests that government is willing to engage constructively with scientists, and particularly Fellows of the Australian Academy of Science. </p>
<p>We have also gained the support of the President of the <a href="http://www.bca.com.au/">Business Council of Australia</a>, who is a <a href="http://www.bca.com.au/about-us/our-board">Fellow of the Academy</a> and a passionate advocate for STEM education and research infrastructure. </p>
<p>Ministers take note of the opinions expressed by the Academy, as demonstrated by the recent campaign to preserve <a href="https://theconversation.com/au/topics/ncris">NCRIS</a>. We are now regularly consulted when policy is being formulated, but there is much more to do to reach the stage where government routinely both consults and listens to us, and builds on our contribution. </p>
<p>For example, the absence of a holistic Australian international research collaborations strategy is becoming an embarrassment. Traditionally, Australia has been recognised as a significant player in the international scientific arena through its participation in many activities. Historically it has been well recognised that if we are not seen internationally, we will slip from the minds of those with whom we wish to engage. </p>
<p>It is on the base of strong historical opportunities that Australia plays such a prominent role in the international scientific community. We supply Presidents, office-bearers and committee members to a vast array of international scientific unions and societies, and hundreds of Australian scientists participate in their research programs. Our high profile abroad makes us respected international partners and we are chosen because we have a reputation for delivering good value in a research collaboration. </p>
<p>It is with these goals in mind that we seek to remind government that we can help in matters of science for diplomacy as well as science for the benefit of sharing information and capacity building. The Academy believes in the value of scientific collaborations that transcend political and religious beliefs and contribute to the peaceful co-existence of nations. </p>
<h2>Looking ahead</h2>
<p>It is up to all scientists to speak to power when it’s warranted. To become involved in educating and mentoring the next generation. To speak to the media and ensure that science has a voice in the public sphere.</p>
<p>We are improving well-being. We are helping to prepare this nation, and the world, for an uncertain future. We are strengthening our economy. We are nurturing our international connections. We are innovating.</p>
<p>Together we are making a difference. We are working towards a better informed, more capable, more agile Australia.</p>
<hr>
<p><em>This is an edited transcript of the speech given by Professor Andrew Holmes, President of the Australian Academy of Science, delivered at the Science at the Shine Dome 2015.</em></p><img src="https://counter.theconversation.com/content/42188/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Holmes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australian scientists are listened to by government and business, but must do more to ensure their advice and work contributes to a stronger future for Australia.Andrew Holmes, President of the Australian Academy of Science, CSIRO Fellow & Laureate Professor of Chemistry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/353112014-12-10T02:30:46Z2014-12-10T02:30:46ZBack to the future with Coalition attacks on Medicare bulk billing<p>In the government’s latest “scraping away the barnacles” of unpopular and blocked policies, prime minister Tony Abbott and health minister Peter Dutton have announced they’re abandoning the plan to have doctors charge a $7 co-payment for consultations. Facing a massive backlash from both the medical profession and the public, the budget measure was facing almost certain defeat in the Senate.</p>
<p>Abbott and Dutton have outlined an “optional” co-payment, which makes doctors responsible for charging it. It reduces the rebate doctors receive for treating patients by $5 and freezes it until July 2018. General practitioners can pass on this cut by charging patients who do not have health-care (concession) cards and are aged over 16. </p>
<p>Both versions of the co-payment policy are just the latest stoush in long battle over bulk billing, which lies at the centre of Medicare, and the scope of universal health coverage in Australia. Bulk billing – where general practitioners bill Medicare directly without charging patients upfront fees – has, in fact, played an unusually prominent role in Australian health policy conflicts. </p>
<p>“Free” access to the gatekeeper role of general practice enraged conservative critics of Medicare from the start. At the same time, defenders of Medicare treat it as a line in the sand; any attack on bulk billing is equated with an assault on Australia’s public health system.</p>
<h2>A doomed policy</h2>
<p>The original policy, announced in the <a href="http://www.budget.gov.au/2014-15/content/glossy/health/download/Health.pdf">May budget</a>, was complicated and poorly explained. Here’s a brief summary of what it entailed. </p>
<p>From July 1, 2015, previously bulk-billed patients would pay $7 towards the cost of standard medical consultations and out-of-hospital pathology and imaging services. Some patients – including children under 16 and health-care card holders (low-income earners and pensioners) – would be exempt from the co-payment after their first ten visits in a calender year. </p>
<p>In effect, the structure of bulk billing would remain intact. Doctors could still bill Medicare directly, but their patients would have to pay the $7 co-payment. If they charged the full amount, general practitioners would receive an additional $2 in the rebate from the government. The other $5 raised by the co-payment would go into a Medical Research Future Fund, which would start disbursing the interest it garnered after it had collected $20 billion.</p>
<p>The policy was <a href="https://www.mja.com.au/journal/2014/200/7/copayments-general-practice-visits">attacked from all sides</a>. Defenders of Medicare saw it as another round in the Coalition’s attempts to undermine universal coverage. And the Australian Medical Association (AMA) – long ambivalent about bulk billing – criticised the complexity of the arrangements, and demanded the exclusion of vulnerable people. </p>
<p>Australia already has one of the <a href="http://www.publish.csiro.au/paper/AH14087.htm">largest and most complex set of co-payments</a> for medical services in the developed world. Proponents of a “price signal” for health seemed ignorant of the bewildering array of price signals already faced by anyone with a serious and continuing illness. </p>
<p>And no one, including the government, has proffered any modelling to justify the claim that a co-payment would make the system more efficient, rather than just add to the existing obstacle course. </p>
<p>Even the medical research community seemed either bemused and embarrassed by the linking of the co-payment to a new Medical Research Future Fund. This move, which seemed calculated to divide medical groups, confused the government’s message that the measure was part of its program of “budget repair”. </p>
<p>It was hard to find anyone with a good word to say about the policy. And its doom in the Senate seemed certain. </p>
<p>An official report released in September showing federal government spending on health <a href="http://www.aihw.gov.au/publication-detail/?id=60129548871">has been declining</a> – and will fall further with cuts in transfers to state hospital systems – made the justification for the change look even more fragile.</p>
<h2>Back to the future</h2>
<p>So how is the new policy likely to be received? The AMA has always been comfortable with co-payments, but not with cuts in the rebate. Its national president, Brian Owler, has described the announcement as a “<a href="https://ama.com.au/media/government%E2%80%99s-new-co-payment-model-%E2%80%98mixed-bag%E2%80%99">mixed bag</a>”. </p>
<p>The “optional” co-payment ends the administrative nightmare of charging concessional patients for just their first ten visits. It also removes proposed co-payments on pathology and other diagnostic tests.</p>
<p>But it remains a cost shift from the government to individuals, with doctors squeezed in the middle. It may have severe effects on the viability of practices in poorer areas where general practitioners may not feel they have the option of passing on the rebate cut. </p>
<p>The odd thing about this saga is that <a href="https://www.newsouthbooks.com.au/books/the-making-of-medicare/">we have been here before</a>. In 1996, the Howard government froze GP rebates. Over the next three years, this squeezed doctors’ incomes, which fell almost 20% in relation to average weekly earnings. </p>
<p>One result was a slow abandonment of bulk billing, not out of ideological hostility, but to maintain practice incomes. Bulk billing had been at a high of 80.6% of services in 1996, but fell to 68.5% in 2003-04. The shift was even greater in areas with fewer general practitioners, especially in remote and rural places.</p>
<p>A political backlash developed; the government faced hostile criticism from doctors, the AMA, and patients. The response was “A Fairer Medicare”, launched in April 2003. It brought in new subsidies for bulk billing in rural and remote areas and incentives for bulk billing health-care card holders. </p>
<p>Opponents argued it was nothing of the sort; health-care card holders were only a minority of those in need, and the policy continued to push general practitioners out of bulk billing. The Senate, controlled by Labor and the Greens, blocked “A Fairer Medicare”.</p>
<p>With a federal election looming, John Howard appointed Tony Abbott as the new Minister for Health, gave him an open cheque book and a mandate to remove bulk billing as an electoral issue. </p>
<p>“Medicare Plus” restored the level of all general practitioner rebates, with extra incentives (which remain in place) to bulk bill children and pensioners. The restoration led to a return of bulk billing. And by 2006, it was back to 78% of services. Tony Abbott used these bulk billing figures to proclaim himself “Medicare’s greatest friend”.</p>
<p>Will the latest changes meet the fate of “A Fairer Medicare”? The Abbott government’s changes will be introduced by regulation, avoiding an immediate Parliamentary vote. But they can be reversed by a Senate vote when Parliament reconvenes in early 2015. </p>
<p>The exclusion of some low-income groups and children may make the new policy more palatable to the cross-benchers who will decide its fate. But the freeze of the rebate and long-term pressure to abandon bulk billing mean neither general practitioners nor many of their patients will be appeased.</p><img src="https://counter.theconversation.com/content/35311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jim Gillespie receives research funding from NHMRC and WentWest/ Western Sydney Partners in Recovery.</span></em></p>In the government’s latest “scraping away the barnacles” of unpopular and blocked policies, prime minister Tony Abbott and health minister Peter Dutton have announced they’re abandoning the plan to have…Jim Gillespie, Deputy Director, Menzies Centre for Health Policy & Associate Professor in Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/271752014-05-28T05:04:01Z2014-05-28T05:04:01ZFunding health research: a win-win alternative to co-payments<figure><img src="https://images.theconversation.com/files/49440/original/p8bjgn7f-1401084112.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The $14 billion derived annually from tobacco and alcohol tax is already a pretty good bucket from which to fund health and medical research.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/reinis/3926296348/sizes/o/">Reinis Taidras/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>One of the most criticised components of the federal budget has been the <a href="https://theconversation.com/federal-budget-2014-health-experts-react-26577">proposed $7 co-payment</a> for GP visits and some medical tests. But there’s a healthy way the treasurer can have his cake and eat it too.</p>
<p>While the main debate has focused on the co-payments plan, it would be a pity if its love child, a substantial boost for health and medical research, disappeared from the equation.</p>
<p>There are other ways the government could provide all the funding promised for research and more – along with a standing ovation from health groups.</p>
<h2>Chorus of criticism</h2>
<p>Criticisms of co-payments have included that, whether for treatment or <a href="http://www.canberratimes.com.au/act-news/copayment-could-see-vaccination-rates-plummet-20140527-zrpkm.html">important preventive services</a>, they will <a href="https://theconversation.com/federal-budget-2014-health-experts-react-26577">deter people</a> who most need to visit GPs from doing so; they will <a href="https://ama.com.au/media/health-budget-full-pain-patients">reduce services to the aged</a>; they will <a href="http://www.abc.net.au/pm/content/2014/s4009259.htm">undermine the principles of Medicare</a>; the plan will turn doctors into <a href="http://blogs.crikey.com.au/croakey/2014/05/14/budget-2014-the-good-the-bad-and-the-ugly-but-mostly-the-ugly/">de facto tax collectors</a>; and it will all be <a href="https://ama.com.au/media/ama-transcript-ama-president-dr-steve-hambleton-abc-news-radio-tanya-nolan-16-may-2014">expensive and complex to administer</a>. </p>
<p>The intended sweetener was the government’s announcement that money from co-payments would go into a <a href="https://theconversation.com/proposed-medical-research-fund-is-unfair-and-unethical-26740">new medical research future fund</a>.</p>
<p>Health researchers are as keen as anyone else to attract more funding, but as <a href="https://theconversation.com/profiles/fiona-stanley-16277/profile_bio">Professor Fiona Stanley</a> (one of just four researchers recognised in treasurer Joe Hockey’s budget speech) commented, <a href="http://www.theaustralian.com.au/national-affairs/budget-2014/future-fund-both-curse-and-blessing/story-fnmbxudx-1226920693712#">not at the expense</a> of “the sickest, most marginalised, the poorest”.</p>
<h2>Positive steps</h2>
<p>To its credit, the government has maintained support for tobacco control, including plain packaging and a commitment to continuing funding for much-needed media campaigns.</p>
<p>A few months ago, it was praised by health groups for <a href="http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fems%2Fr5172_ems_78ed6212-03a3-4669-9947-c3fc17c8b5e0%22">implementing the first of four</a> successive 12.5% annual increases in tobacco excise (along with an improved approach to indexation). </p>
<p>Its rationale included emphasis on the need to “provide real health benefits” and to “move towards international best practice in the pricing of tobacco products”.</p>
<p>Increasing tobacco taxes is popular, especially if the funds are applied to worthy health purposes; the <a href="http://www.budget.gov.au/2014-15/content/bp1/html/bp1_bst5-03.htm">government estimates</a> it will derive $7.85 billion from tobacco taxes this year alone. Combined revenues from tobacco and alcohol taxes bring in some $13.8 billion.</p>
<h2>Crying out for reform</h2>
<p>The <a href="http://taxreview.treasury.gov.au/Content/Content.aspx?doc=html/home.htm">Australia’s Future Tax System Review</a> concluded that Australia’s alcohol tax system was incoherent" and recommended long-overdue reform. </p>
<p>The most obvious change is abolition of the [Wine Equalisation Tax (WET)](https://www.ato.gov.au/Business/Activity-statements/Wine-equalisation-tax-(WET), which discriminates in favour of cheap wine. The WET enables sale of products with high alcohol content at dirt-cheap prices. </p>
<p>Ending it would end the sale and promotion of cheap and nasty products and help to make major inroads into a wide range of alcohol harms. This simple measure alone should bring the government an estimated $500 million a year.</p>
<p>There’s massive community concern about the harms of alcohol. Only <a href="http://mcaay.org.au/assets/publications/market-research-reports/amr-omnibus_6qs_17062013_smaller-file.pdf">17% of respondents to an online survey</a> believed that governments are doing enough to address alcohol problems.</p>
<h2>A fourfold win</h2>
<p>When the treasurer told us with stars in his eyes that new research might find cures for cancer and heart disease, he might not have been aware of overwhelming evidence that reducing smoking would do more than any other single measure to reduce cancer and heart disease.</p>
<p>The money from tobacco and alcohol taxes is already a pretty good bucket from which to fund health and medical research. Tobacco excise increases alone would cover all the proposed funding for medical research – with enough left over to fund a mass of further initiatives. </p>
<p>A further modest increase in tobacco tax or an abolition of the WET would make this a financially painless process for the government. It could get all the benefits of increasing our medical research capacity without the downsides of introducing an unpopular co-payment scheme that will keep researchers (and ultimately reporters) busy charting its damaging impacts over time.</p>
<p>Indeed, it would be a win-win-win-win-win: meet the commitment to fund more health and medical research; improve the health of the community; bring added benefits to disadvantaged groups rather than put them at further risk; attract praise and support from health groups; and no public pain. </p>
<p>What more could any government want?</p><img src="https://counter.theconversation.com/content/27175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Daube does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One of the most criticised components of the federal budget has been the proposed $7 co-payment for GP visits and some medical tests. But there’s a healthy way the treasurer can have his cake and eat it…Mike Daube, Professor of Health Policy, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/267402014-05-18T20:08:25Z2014-05-18T20:08:25ZProposed medical research fund is unfair and unethical<figure><img src="https://images.theconversation.com/files/48701/original/mqbrph2j-1400216545.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The policy is imbalanced because it imposes burdens on the poor to provide benefits to the rich.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mikeleary83/2222244131/sizes/l">flickr: mikeleary83</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Medical research is a significant winner in the federal budget: we’re told, (<a href="http://www.theguardian.com/world/2014/may/14/factcheck-the-worlds-biggest-medical-research-endowment-fund">probably falsely</a>), that the government will establish the largest medical research fund in the world ($20 billion by 2023). But whether creating this fund is ethical is another matter. </p>
<p>The medical research future fund will save money by <a href="http://theconversation.com/why-the-federal-budget-is-bad-for-health-and-worse-for-society-26451">significant disinvestment in preventative and public health</a> measures and by the introduction of a $7 co-payment for GP visits. </p>
<p>On the face of it, this is a significantly regressive move. <a href="http://theconversation.com/save-now-spend-later-why-co-payments-for-gp-visits-are-a-bad-idea-25823">The evidence on co-payments</a>, for instance, suggests they’ll disproportionately <a href="http://theconversation.com/why-the-federal-budget-is-bad-for-health-and-worse-for-society-26451">impact the socially disadvantaged</a>, leading people to avoid treatment until health conditions worsen and need more serious treatment, including hospitalisation.</p>
<p>While the benefits of new medical research are likely to disproportionately accrue to the socially and economically advantaged.</p>
<h2>A fundamental imbalance</h2>
<p>People who are well off live longer, as <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/oatsih-healthplan-toc%7Edeterminants">evidence regarding the social determinants of health</a> shows, and medical research is very much an investment in the future. The average new medicine takes at least 10 to 15 years to bring to market, so the longest-lived are most likely to benefit from medical research. </p>
<p>What’s more, new medical research is only going to benefit those who can access it, and the increasing trend towards privatisation in the Australian health-care system suggests access will be the domain of the wealthy. </p>
<p>Finally, medical research, as a whole, tends to be skewed towards the interests of those who are well off. This is typically referred to as the 90/10 gap: 90% of the money spent on medical research is spent on conditions primarily impacting on the richest 10% of the global population. </p>
<p>To be fair, the majority of Australians, including many of those who are socially disadvantaged, fall within that richest 10%. But the most severely disadvantaged Australians do not.</p>
<p>So, on the face of it, this policy is not ethically justified because it imposes burdens on the poor to provide benefits for the rich. This grossly violates any plausible conception of fairness, and, in this case, hardly represents the typical Liberal credo of “user pays”. </p>
<p>Indeed, the policy may not even be economically sound, since cuts to preventative health now can lead to significant health-care costs in the future. And the economic value of new medical research, while potentially great, is nonetheless uncertain.</p>
<h2>A better way?</h2>
<p>Could the policy be ethically justified, if reshaped? Only if it adopts a number of relatively uncommon funding priorities and principles.</p>
<ul>
<li><a href="http://theconversation.com/better-ways-to-spend-the-medical-research-future-fund-26685">Health research rather than medical research</a>.</li>
</ul>
<p>Given what we know about the benefits of public health and preventative measures, it would be unfortunate to focus research exclusively on medical research rather than more broadly on health research. </p>
<p>Of course, if the provision of public health and preventative care is scaled back as significantly as this budget suggests, then this may be a moot point since the government would lack the capacity to implement the results of such research.</p>
<ul>
<li>The existence of this fund isn’t used as an excuse to cut back research funding in other areas.</li>
</ul>
<p>We already have a National Medical and Health Research Council (NHMRC), so one hopes both that there will be no duplication, and that the existence of this new fund won’t be used as a reason to cut funding to the NHMRC. </p>
<p>Ideally, the new money will be distributed by the existing structure, perhaps with some tweaking of their priorities.</p>
<ul>
<li>The funding criteria aim at reducing disadvantage as well as reducing waste and costs, rather than at creating shiny new and expensive treatments.</li>
</ul>
<p>If we’re all in this together, then our research priorities ought not be those that benefit only the well off. Rather, they should focus on those who are worst off. </p>
<p>We should prioritise research that addresses the health impacts of social disadvantage and poverty. Likewise, the more efficient we can make the delivery of existing health-care services, the better off we all will be.</p>
<ul>
<li>The government implements and listens to good quality research even if it goes against its ideology.</li>
</ul>
<p>If new research is going to be of genuine benefit, then it has to be taken seriously and implemented by the government. Health is too important to be hijacked by what the US economist Paul Krugman refers to as zombie ideas: </p>
<blockquote>
<p>policy ideas that keep being killed by evidence, but nonetheless shamble relentlessly forward, essentially because they suit a political agenda.</p>
</blockquote>
<p>Unfortunately, there’s little hope of any of these priorities being adopted, partly because the supposed benefits of the co-payments amount to precisely one of these zombie ideas; there’s next to <a href="https://theconversation.com/australias-unsustainable-health-spending-is-a-myth-26393">no evidence that co-payments will help to eliminate ununecessary GP visits</a>.</p><img src="https://counter.theconversation.com/content/26740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>There are no conflicts of interests </span></em></p>Medical research is a significant winner in the federal budget: we’re told, (probably falsely), that the government will establish the largest medical research fund in the world ($20 billion by 2023…David Hunter, Associate Professor of Medical Ethics, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/266852014-05-15T04:53:01Z2014-05-15T04:53:01ZBetter ways to spend the medical research future fund<p>One of the few real surprises in the budget was the creation of medical research future fund, to be partly funded by the introduction of a $7 GP co-payment. This injection of money provides an opportunity think strategically about role and direction of Australia’s medical research effort. </p>
<p>To be invested and managed by the Future Fund Board of Guardians, all estimated savings from health expenditure announced in Tuesday’s budget flow into the fund until it reaches $20 billion. It will also include $1 billion of uncommitted money in the existing health and hospital fund.</p>
<p>Establishment is subject to legislation passing through parliament and capital and ongoing gains will be preserved in perpetuity. Net earnings will fund medical research priorities the following year, including through the National Health and Medical Research Council (NMHRC).</p>
<p>While further details are relatively scant, the <a href="http://www.financeminister.gov.au/media/2014/mr_2014-45.html">Department of Finance indicates</a> it will fund research across a wide spectrum including:</p>
<blockquote>
<p>illness prevention and promote early intervention, reducing health costs while improving health outcomes and delivering better quality of life. </p>
</blockquote>
<p>What this does not mention is any research into health system changes. When it comes to improving the health-care system, what’s needed is research that addresses issues that are relevant to current or future policy debates.</p>
<h2>Missing research</h2>
<p>But Australia seems better at writing reports about the potential for undertaking health services-focused research than actually doing the work.</p>
<p>Health services research was a central part of the <a href="http://www.mckeonreview.org.au/">2013 Strategic Review of Health and Medical Research</a> (McKeon Review), and has been called for in the <a href="http://www.pc.gov.au/__data/assets/pdf_file/0008/128438/annual-report-2012-13.pdf">2012-13 Productivity Commission Annual Report</a>, which argues “[p]olicy-making based on good evidence is central to improving community living standards.” </p>
<p>It was also mentioned in the recent <a href="http://www.ncoa.gov.au/report/phase-one/part-b/9-1-principal-bodies.html">National Commission of Audit report</a>, which said Australia needs to “embed health and medical research in the health system” in order to “improve patient outcomes and deliver efficiencies”. </p>
<p>These aspirations are a long way from the current focus of Australian medical research, which looks more at petri dishes than patients. The most commonly used word in the <a href="http://nhmrc.gov.au/grants/research-funding-statistics-and-data/research-achievements">synposes of grants</a> given by the NHMRC from 2004 to 2012, for instance, is “cells”, which reflects its strong biomedical focus.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=551&fit=crop&dpr=1 600w, https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=551&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=551&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=693&fit=crop&dpr=1 754w, https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=693&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/48541/original/t7836vd7-1400112122.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=693&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most commonly words in the synopses of grants given by the NHMRC.</span>
<span class="attribution"><span class="source">Adrian Barnett</span></span>
</figcaption>
</figure>
<p>Most of the NHMRC-funded medical research institutes, over 40% of project grants and the majority of fellowships funding flow to basic science. Health services research constitutes less than 10% of overall funding. </p>
<h2>Evidence-free health policy debate</h2>
<p>Take the recent debate on the merits of introducing a co-payment for GP visits. It’s hard to know its potential impact on use, particularly among those on lower incomes. And to what degree it may transfer costs to other sectors, for instance, by people going to hospital emergency departments instead. Surely, it’s evidence on these factors that should frame and inform any policy debate. </p>
<p>The <a href="http://www.budget.gov.au/2014-15/content/bp2/html/bp2_expense-14.htm">introduction of a $7 co-payment in the budget</a> provides the opportunity to evaluate impact, but that would require research involving information collection from a representative sample of Australians and using administrative data to see how health-care usage changes.</p>
<p>Getting this type of research funded through the existing NHMRC grant funding system is problematic. Its investigator-initiated funding model requires researchers to apply to undertake research, rather than the NHMRC commissioning important topics to work on. </p>
<p>Pragmatic research designs that address important questions don’t often fair well in its grant evaluation processes. Even if the research does receive NHMRC funding, the earliest such a project could commence would be in early 2016, precluding any opportunity to collect data before and after the introduction of the co-payment in July 2015. </p>
<h2>An evidence-based alternative</h2>
<p>You don’t have to look far for a vision of better funding system for health services and systems research in Australia. It was one of the major themes of the <a href="http://www.mckeonreview.org.au/">McKeon review</a>, which focused on better aligning research to deliver health-system impact. </p>
<p>The review suggested funding health services research by setting aside a proportion of existing funds by:</p>
<p>• quarantining a proportion of NHMRC research for “top-down strategic research”</p>
<p>• establishing an influential institute of health services research and</p>
<p>• boosting fellowships targeted at disciplines that undertake health services research.</p>
<p>If this had been implemented, an institute of health services research or the NHMRC could already be commissioning the collection of special studies to examine the impact of the GP co-payment. Unfortunately, few of the McKeon recommendations have been put into practice to date.</p>
<p>Only a small fraction of the medical research future fund would be required to kick start a systematic research effort aimed at improving key aspects of our health system. Surely, some of the funds from all Australians who will be paying the GP co-payment should be used to study its effects and thereby help directly improve our health care system.</p><img src="https://counter.theconversation.com/content/26685/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Clarke receives funding from National Health and Medical Research Council and would potentially benefit from additional funding devoted to health services research.</span></em></p><p class="fine-print"><em><span>Adrian Barnett receives funding from the National Health and Medical Research Council. As a health and medical researcher he may receive future income from the proposed Research Future Fund.</span></em></p><p class="fine-print"><em><span>Danielle Herbert receives funding from NHMRC.</span></em></p><p class="fine-print"><em><span>Nicholas Graves receives funding from ARC, NHMRC, NIHR & Queensland Government</span></em></p>One of the few real surprises in the budget was the creation of medical research future fund, to be partly funded by the introduction of a $7 GP co-payment. This injection of money provides an opportunity…Philip Clarke, Professor of Public Health, The University of MelbourneAdrian Barnett, Associate Professor of Public Health, Queensland University of TechnologyDanielle Herbert, Researcher, Queensland University of TechnologyNicholas Graves, Professor of Health Economics, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/266822014-05-14T03:02:12Z2014-05-14T03:02:12ZNo matter how you fund it, medical research is a good investment<p>The federal government has announced a $20 billion medical research future fund, which is expected to distribute $1 billion to research by 2022-23, doubling its direct medical research funding. The announcement was the biggest surprise of the budget.</p>
<p>Douglas Hilton is director of Walter and Eliza Hall Institute. He played a lead role in the Discoveries Need Dollars campaign that successfully lobbied against proposed cuts to medical funding by the Labor government in 2011. </p>
<hr>
<p><strong>Was this a surprise?</strong></p>
<p>Over the last 18 months or so there have been indications from the current government when it was in opposition, and when it was elected that medical research was a priority. Andrew Robb mentioned it a number of times in the <a href="https://theconversation.com/in-conversation-with-andrew-robb-research-must-back-our-strengths-10958">interview I did for The Conversation</a> last year, and Tony Abbott, in his budget reply speech last year as opposition leader mentioned medical research in the first 15 seconds of his speech.</p>
<p>But really, the three things that have happened are Discoveries Need Dollars, which highlighted the fact the community is highly supportive of health and medical research; it does a lot for the community and the community really supports it so there’s really a good synergy there.</p>
<p>The second was push for <a href="https://theconversation.com/mckeon-review-we-need-to-integrate-research-and-health-services-9742">the McKeon Review</a> (<a href="http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf">Strategic Review of Health and Medical Research</a>). I think Simon McKeon needs to get a lot of credit for this budget announcement.</p>
<p>I think he put forward a remarkably cogent argument for the role of health and medical research in the Australian community, so that was essential. And of course, there’s been steady lobbying of government ever since. So I think it’s been those three platforms.</p>
<p><strong>The money will come from “budget savings” in the health sector via, among other things, a $7 co-payment fee for visits to general practitioners. Does the move to link it to research gag criticism of the co-payments?</strong></p>
<p>What it does show that the co-payments are going to be used for something that the community is highly supportive of. The community for many years has shown that it is a remarkable and generous support of medical research, so in that sense it probably sweetens the pill.</p>
<p><strong>Will this move effectively stop the other political parties from blocking the co-payment?</strong></p>
<p>I don’t know how the linking of the $20 billion medical research fund and Medicare co-payments is going to play out in the Senate. That’s a very interesting political issue.</p>
<p>Adam Bandt has been extremely supportive of health and medical research but the Greens as a party are opposed to co-payments. How these things are going to play is going to be very interesting.</p>
<p><strong>Will Labor or the Greens’ opposition to the move unleash a campaign like Discoveries Needs Dollars again?</strong></p>
<p>I think that was the right campaign for that moment in time. I can’t imagine us taking researchers out onto the streets for that sort of a political battle.</p>
<p>I’m in Washington, I haven’t spoken to Adam Bandt or Bill Shorten or Catherine King. I think it will be interesting to hear what Bill Shorten says in his Budget reply speech. That’s the next point where we’ll get some understanding.</p>
<p><strong>The issue remains that it’s at the expense of primary care.</strong></p>
<p>There’s obviously debate from the Left and from the Right about how to improve the efficiency of the health-care system. The question is politically whether you think a $7 co-payment for GP visits is the way to do it. </p>
<p>Some commentators will think it is a good way to add discipline to the health-care system, others won’t. It’s a political judgement.</p>
<p>There will be a group of vulnerable Australians for whom the $7 co-payment will be an issue. Clearly, if you’re on $180,000 or whatever the current definition of being wealthy is, the $7 co-payment is not make a difference one way or another.</p>
<p>But I guess the broader question is how does one create a health system that’s continuously improving, allows the community access to the new drugs that they want to access through the Pharmaceutical Benefits Scheme but is sustainable. That to me is one of the national grand challenges.</p>
<p>The government is thinking about this grand challenge, which I think is a good thing. We can debate whether its way of achieving it is right.</p>
<p><strong>When there’s been talk of extra medical funding there’s been grumbling from some scientists saying “let’s not forget basic science”…</strong></p>
<p>The NHMRC really has three pillars and I think the beauty of this is that we can hope all three pillars will be boosted. The NHMRC does fund a lot of basic biology, with a medical research flavour to it and the hope is more of this will be supported in the future. </p>
<p>It clearly also supports clinical and translational research and it also supports preventative health research, health systems research and population research. So my view would be there’s an opportunity for strategic growth in all those areas.</p>
<p>Medical research is clearly the first cab off the rank for this government. In my dealings with the government, I believe it understands that research generally is important to creating a productive economy and the sort of society that we want live in as Australians. </p>
<p>Let’s judge the government’s performance on research at the end of its first term, not part way in.</p><img src="https://counter.theconversation.com/content/26682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Douglas Hilton works for the Walter And Eliza Hall Institute Of Medical Research and The University Of Melbourne, and is president-elect of the Association of Australian Medical Research Institutes. He advises a range of medical research institutes, collaborates with CSL and founded and owns shares in the privately owned company, Murigen Therapeutics. Doug was the director of CRC Growth Factors, and the Walter and Eliza Hall Institute receives funding from CRCs including the HEARing-CRC, and Cancer Therapeutics CRC. Doug receives funding from the NHMRC, the Australian Research Council, CSL, National Collaborative Research Infrastructure Strategy (NCRIS), National Institute of Health (USA), CSIRO via the Science and Industry Endowment Fund, and various philanthropic trusts and foundations.
</span></em></p>The federal government has announced a $20 billion medical research future fund, which is expected to distribute $1 billion to research by 2022-23, doubling its direct medical research funding. The announcement…Douglas Hilton, Director, Walter and Eliza Hall Institute & Professor of Medical Biology , Walter and Eliza Hall InstituteLicensed as Creative Commons – attribution, no derivatives.