Investigator-initiated research: a necessity or a luxury?
John Ruedy, MD, CM
Clin Invest Med 1997;20(6):405-6.
Dr. Ruedy is professor of medicine and pharmacology and dean of the Faculty of Medicine, Dalhousie University, Halifax, NS.
Reprint requests to: Dr. Stuart M. MacLeod, St. Joseph's Hospital, 50 Charlton Ave. E, Hamilton ON L8N 4A6
The tyranny of debt, the corporatization of medicine, the globalization of information sources, "disintermediation" and populism were prominent among the current influences on medical education, health care and health research identified at the Annual Meeting of the Association of Canadian Medical Colleges, the Association of Canadian Teaching Hospitals and the Canadian Association for Medical Education. The goal of the meeting was not only to address external forces affecting medicine but to develop plans for how to take advantage of our changing social environment.
It was concluded that the Canadian public has accepted the overriding importance of eliminating the operating deficits of our governments and that there is little to suggest that societal attitudes toward the reduction of the public debt will change when this goal is achieved. This tyranny of debt has dominated all policy decisions dependent upon government funding for the last 5 years. Since health care and education constitute the largest part of government expenditures, it is a revelation to no one that health care, research and education have had to adapt rapidly to this changed fiscal environment. Partly in response to the decrease in government support, a shift has occurred in medicine toward increased private sector funding, with market forces influencing the agenda. This corporatization of medicine has enticed academic medicine to include business opportunities in development plans, whether in marketing education, health services or research expertise. Other, possibly more permanent, changes are occurring in societal attitudes and values. Easy access to attractively presented information, largely through the electronic media, is creating a more informed, although not necessarily a more educated, public. This has supported a simultaneous populist surge. Expertise is increasingly regarded by the public as elitism that cannot be trusted. The most knowledgeable authority is no longer necessarily regarded as the most influential interpreter of sophisticated data, including scientific information. At the meeting, Diane Francis referred to this phenomenon as "disintermediation," a term new to most of the audience.
Research, and particularly investigator-initiated or curiosity-driven inquiry, is not immune to these forces. There has been an obvious decline in the priority government agencies place on funding basic biomedical research in this country over the last decade. While the budgets of the US National Institutes of Health grew by 60% since 1990, and those of the Medical Research Councils of the United Kingdom and Australia increased by approximately 40%, that of the Medical Research Council of Canada declined by 10%! 1 In the 10 years from 1986 to 1995 the proportion of research funding in Canada's medical schools supporting research in basic science departments decreased from 40.8% to 35.4% of total research funding.2,3 Private-sector funding of research studies, which are frequently directed by the agenda of the funding source, increased from 3.6% to 15.5% of total research support in our medical schools, and in the Atlantic region this shift has been more dramatic, rising from 4% in 1986 to 37% of all reported research funding in 1995.2,3
In an address in 1993 entitled, "Investigator-initiated research.Will it become a luxury?", Robert Weinberg made an eloquent plea for continuing support of basic scientific, curiosity-driven research. He expressed serious concern about the shift of resources away from discovery-oriented research toward applied research.4 He cited advances in our understanding of human breast cancer, which have come from a better understanding of the mechanisms of cell growth and the reasons that cancer cells grow uncontrollably. Some of the key elements have flowed from disparate research findings, including studies of rat brain tumours, of the development of the vulva in a hermaphroditic worm, of the development of the retina of the fruit fly, and of a virus causing warts in cows, rather than from programmatically targeted breast cancer research. All basic scientists can provide other examples of how our advances in knowledge depend on the capability of our basic scientists to pursue their inquisitiveness through research.
The demonstrable lack of priority given to basic scientific research in our medical schools and funding sources is perplexing and surprising to scientists, since it is occurring when advances in our understanding of biology are being made at an ever-increasing rate. It is a concern to those of us who see bright, young students discouraged from pursuing a career in research and for those who are early in their research careers and must face almost overwhelming odds in achieving secure research funding. The survival of our basic science faculty may also be vulnerable to current changes in the undergraduate medical curriculum. Earlier clinical experiences and problem-based tutorial curricula can exclude basic scientists, who may be uncomfortable with the clinical questions raised by students. Financially hard-pressed universities may question the need for as many basic scientists if the health sciences curricula are less obviously dependent on their participation.
What can be done to ensure that curiosity-driven fundamental medical research is accepted in Canada as a necessity and not a luxury? First, we require much stronger conviction of this need and greater leadership in the academic community. We must not allow the "expansion" of research support from the commercial sector or for health outcomes research, nor the much-needed infrastructure funding through the Canada Foundation for Innovation, to camouflage the decline in support for fundamental research. Without a change in attitude and in support for basic research we will find ourselves like an orchestra playing music in a well-appointed concert hall but without composers (to expand on a metaphor coined at the meeting by Jean Gray). Basic scientists must actively contribute not only to curriculum reform but to the teaching of revised curricula. This may require leadership from deans of medicine.
It is evident from the discussions in Halifax that our challenge extends beyond the tyranny of debt if we want to save basic research in our academic centres. We must also effectively address the influences of the current wave of populism and "disintermediation." This effort can be assisted by our taking every opportunity to proselytize. All basic scientists and all of us concerned with science must seize every chance to educate the public and the decision-makers. Convincing fiscal arguments can be made for basic science research in a knowledge-based economy. More important is the fact that the quality of the knowledge that we generate, the health care that we provide and the abilities of the students who follow us depend upon it.
References
- McAllister J. A cold wind blows through Canada's research funding. Nature Med 1996;2:1290-1.
- Association of Canadian Medical Colleges. Canadian medical education statistics. Ottawa: The Association; 1988. p. 86.
- Association of Canadian Medical Colleges. Canadian medical education statistics. Ottawa: The Association; 1996. p. 131.
- Weinberg RA. You can't get there from here: the tortuous road to basic research. Acad Med 1994;69:441-4.
