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Bioscience and the Citizen
Science and politics do not mix! I was brought up on this aphorism and I can remember how comforting it was to realise that the ivory towers of academia were so far removed from the squalid hurly-burly of political manipulations.
It is, of course, and always was, arrant nonsense. It has become increasingly nonsensical since Galileo's time and surely it was laid to rest with the bombs at Hiroshima and Nagasaki. It has developed new nuances, such as that while military and industrial science may have heavy political overtones, at least medical and biological sciences are still pure. But these ideas are just as nonsensical as the notion that nuclear fission has nothing to do with politics. Even the most abstract of all biological studies, molecular biology, which is largely responsible for the present explosion in biomedical research world wide, is a highly political subject.
In my capacity as Director of Biomedical Sciences I am particularly concerned that rapid advancements in this field should be matched by an increased political and public awareness of how it works and where it is leading. What I would like to address is how biomedical scientists are becoming politically involved and why, indeed, they should.
The cost of health -- running the hospitals, paying the doctors, nurses and ancillary workers, purchasing medicines and so on -- is about 6% of the total wealth generated in New Zealand. However, the overall expenditure on health research and development is about $21 million or about 0.024% of total wealth generated. So there is a huge difference between our health effort and our total health cost. Similar differentials also occur in most Westernised countries.
How much should we be spending on health research, especially in areas like molecular biology which often address the more basic questions of biomedicine? Whenever this question is asked about biological research, people raise the question of "relevance" -- what society will get back for what it spends.
Obviously the cost of providing health services is nothing like the total cost to the country of illness in loss of earnings, social security claims, loss of productivity and other factors. If we can be guided by a computation for the UK, the overall cost of ill-health is about four to five times the direct cost to the health service. That results in the staggering statistic that more than 25% of the total gross national product can be accounted for in coping with ill-health in our population. Viewed from this perspective, it is probably the single most costly item on our social balance sheet.
We are rapidly reaching the limits of what society can pay for in direct medical care. To improve, we will have to accumulate more wealth or to cut down the number of people who fall ill, the time they are incapacitated and the cost of the treatment -- none of this at the cost of reducing standards.
A calculation made some years ago suggested that if we were to apply all possible public health measures and the best standards of diagnosis and treatment to all the people in the US or UK, we could probably reduce mortality by about one-third. Most of this would be achieved by one single measure -- the banning of cigarette smoking -- and the rest would be achieved at enormous cost. Despite recent progress, the only way to reduce ill-health further is going to be by innovative research aimed at understanding and preventing or curing disease.
Why is so little spent on medical research in relation to health costs? That niggardliness is worldwide and derives from two fundamental psychological considerations. The first is that people have always lived with death and disease, and are therefore accustomed to adopting a fatalistic attitude towards them.
The second reason is that medical research is international in nature, whereas activities like the export industry or defence are intensely national. Because medical research results are freely disseminated among scientists, many governments feel that they can afford to parasitise the efforts of others. However, while basic biomedical knowledge is still freely exchanged world-wide, anything with the slightest whiff of applicability or commercial value is immediately patented by the discovering organisation. So future access to the benefits of this knowledge could be at a price.
While it is entirely proper that the application of scientific discoveries should be subject to democratic control, to set limits to scientific understanding could be as destructive to democratic freedoms and prospects as censorship in the arts and the media.
It is a common fallacy that all publicly supported research is directed at a practical end (for example, a cure for AIDS) when the truth is more often that solutions are only recognised because of antecedent research aimed at quite different questions. AIDS is a good example. Without the freely given support for immunological research in the sixties, we might now be largely ignorant of the true nature of the AIDS syndrome.
Most well-conceived research does not start with ends but with questions that are experimentally testable. The hope is that the resulting new knowledge will be helpful, but the principal drive is to understand the intricacies of nature.
And yet the public may say "if only we had known how this research would turn out, we would have banned it", which is close to proscribing any research if the results cannot be seen in advance -- a perfect recipe for the most trivial science. There are two categories of public unacceptability that I have frequently encountered.
There is a common view that we have found out enough about the world already and that we can afford to cut back on scientific research, especially of the basic kind. That is, the science most likely to produce a range of new options that could be of inestimable value in grappling with future problems.
There are two reasons why we should reject this notion in biomedical research. There are still many diseases which cause human suffering and contribute to health costs for which there is no effective treatment or cure. We need to know more. The second reason stems from the question "Why should we bother with science if it cannot help ameliorate the human condition now?"
The best answer is that science is simply what is known, and the only alternative is ignorance. To stop wanting to know would seem to deny the basic human instinct of curiosity that has contributed to our success and survival as a species.
This stems from the notion that it is wrong to tinker with nature. Humans have manipulated the genes of plants and animals by conventional breeding for thousands of years. However, attempts to speed up this process or to introduce new genes into a species have often aroused public disquiet.
The media are fond of lifting the lid of Pandora's Box to reveal all manner of extreme scenarios. Often all the helpless scientist can say is "in theory it is possible, but in practice it is highly unlikely to happen". The public impression is therefore of a laissez-faire attitude towards this kind of work, and they naturally become apprehensive.
However, the scientific community has been highly responsible from the beginning. In the mid-seventies, I was one of a handful of people in the UK doing gene cloning when a year-long moritorium was imposed on all such experiments worldwide. This ban arose from scientists themselves, who wanted time to assess carefully the long-term implications of what they had just discovered.
What they came up with was a set of guidelines which protected scientists and public alike, and which have stood the test of time ever since. This process of self-initiated debate leading to statutory control has been repeated for other areas of public concern -- for example, embryo manipulation.
These examples show that scientists are capable of confronting moral implications and value judgements and becoming the leaders of change rather than the followers. This sort of involvement needs to happen for all aspects of science that raise social concerns.
As science has grown, so has the ignorance of those that do not know about it. I believe it is a fear of not knowing that is behind much lay misgiving and antipathy.
In the universities, success has historically been achieved in specialisation in narrow subdisciplines. Science students who depart from the mainstream to pursue careers in business or policy-making are sometimes frowned upon.
Thus begins the vicious circle -- bright students do not see science as a way to reach positions of leadership, and science suffers because those in leadership positions have little experience in science. There is a danger that debates about the future of science become frustrating exchanges between the scientifically illiterate and the politically clueless.
In the end the greatest threat to the future existence of biomedical research as we now know it may not be the scientific illiteracy of the public, but the political illiteracy of the scientist.
Professor Stewart Gilmour is Director of Biomedical Technology at the University of Auckland.
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