Who determines priorities in funding medical research?

Is medical research is already adequately funded? AAP

Expected cuts in health and medical research in the May Federal budget have led to a predicable backlash from vested interests.

We are informed that any cuts will detrimentally affect standards of healthcare and new areas of research. However, many of the most pressing human problems require social and environmental change not biomedical intervention.

Currently, arguably too much public money is spent on fruitless medical research. Many millions of dollars of public funding are devoted to research in areas such as stem cell research, with no evidence that this is a good use of resources.

There has been little debate on how research funding priorities are determined, whether research is likely to deliver what is promised, and who will benefit from resulting innovations.

In Australia and many other countries, the research policy agenda has been captured by powerful vested interests, particularly science groups, universities, and the biotechnology and pharmaceutical industries.

These groups stand to benefit financially and in terms of status from undertaking such research, and have made extensive use of PR and various media to help engender support for new fields of research.

Governments, too, are keen to reap the expected economic benefits from research, including savings in healthcare costs which are rapidly growing.

According to Trends in Health and Medical Research Funding (April, 2009), National Health and Medical (NH&MRC) research increased nearly five-fold between 1995 and 2009: from $177 million to $632 million.

During this time, NH&MRC funding also increased as a proportion of total Commonwealth Government science and innovation funding. Medical researchers also receive substantial funding from multinational companies, the philanthropy sector, and groups such as Cancer Council Australia and Prostate Cancer Foundation of Australia.

Some of this funding would be better spent on exploring the kinds of social and economic support needed by those who are already ill or disabled or on preventive interventions that are known to work.

The search for technological fixes has created a cargo cult mentality where individuals and communities begin to believe that all problems can be resolved through more research and more tests and treatments.

This has helped fuel the rise in healthcare expenditure and heightened the public’s expectations that that they should have ready access to new medical technologies. This situation is neither desirable nor sustainable.

What is urgently needed is a re-orienting of our conceptions of ‘health’ and priorities in healthcare. As the World Health Organisation has long pointed out, health is more than a fixed biophysical state established through biomedical intervention but comprises physical, social and psychological wellbeing.

Access to basic resources, such as shelter, food, and clean water and the achievement of economic and political security and social support are essential.

A truly democratic society would allow scope for all groups to have a say in determining research funding priorities. This would include those who are usually excluded from public debate, including the poor and marginalised who are most effected by budget decisions especially cuts to basic services but who are unable to organise to advance their position.

Unfortunately, such groups, which include the homeless, the unemployed, and unpaid and under-paid carers are least likely to have the resources and the skills to lobby and present their case.

To be clear, I should emphasise that I am not arguing against medical research. Some areas of research may be of great value, such as certain life-saving and life-enhancing treatments, including vaccines, anti-malarial treatments, and HIV drugs.

However, the current position, where we are called upon to simply take it on trust that investment in research will deliver the benefits that are claimed and that those who are leading the charge for such research should simply be trusted is both misguided and undemocratic.