Proposed medical research fund is unfair and unethical

The policy is imbalanced because it imposes burdens on the poor to provide benefits to the rich. flickr: mikeleary83, CC BY-NC-ND

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). But whether creating this fund is ethical is another matter.

The medical research future fund will save money by significant disinvestment in preventative and public health measures and by the introduction of a $7 co-payment for GP visits.

On the face of it, this is a significantly regressive move. The evidence on co-payments, for instance, suggests they’ll disproportionately impact the socially disadvantaged, leading people to avoid treatment until health conditions worsen and need more serious treatment, including hospitalisation.

While the benefits of new medical research are likely to disproportionately accrue to the socially and economically advantaged.

A fundamental imbalance

People who are well off live longer, as evidence regarding the social determinants of health 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.

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.

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.

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.

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”.

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.

A better way?

Could the policy be ethically justified, if reshaped? Only if it adopts a number of relatively uncommon funding priorities and principles.

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.

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.

  • The existence of this fund isn’t used as an excuse to cut back research funding in other areas.

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.

Ideally, the new money will be distributed by the existing structure, perhaps with some tweaking of their priorities.

  • The funding criteria aim at reducing disadvantage as well as reducing waste and costs, rather than at creating shiny new and expensive treatments.

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.

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.

  • The government implements and listens to good quality research even if it goes against its ideology.

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:

policy ideas that keep being killed by evidence, but nonetheless shamble relentlessly forward, essentially because they suit a political agenda.

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 no evidence that co-payments will help to eliminate ununecessary GP visits.