TCS Daily


Trickle Down Solutions

By Henry I. Miller - April 16, 2003 12:00 AM

Gerald Keusch, the director of the Fogarty International Center at the NIH, and Carol Medlin of the University of California, San Francisco observed recently in a commentary in the journal Nature that health R&D has been officially designated a "global public good" by the World Health Organization's Commission on Macroeconomics and Health (CMH). In order to promote this good, the two authors suggested the creation of a virtual "global health-research network" that would consist of "several of the world's leading medical research councils in a voluntary, independent but coordinated collaborative effort."

This project is like a mollusk that hasn't yet found its rock. And although the United Nations would seem to be a perfect attachment site for a mollusk - huge, ponderous, undynamic - a major problem with that would be, in the words of Keusch and Medlin, "to keep the network coordinated, functional and focused on science rather than becoming a politically correct, all-inclusive, but dysfunctional, tool for development."

And although they enumerate some of difficulties that such an undertaking would present, the authors leave unresolved the pivotal issue: namely, that the logical outcome of their observation that "competition, an essential element to ensure excellence, can be focused on coming up with new knowledge in the shortest time frame, and not on which country or agency announces the discovery," would be, inevitably, the vast majority of funding going to laboratories in the United States, Japan, Germany, France and Britain. Not that there is anything wrong with this result, given that competition for research funding is, or should be, a meritocracy.

Arguably, therefore, in lieu of creating some sort of centralized, international mechanism intended to avoid the further segregation of what has been called the "two worlds of science" - that is, the richer and poorer countries, respectively - the larger public and private sources of funding in the major industrialized countries could simply agree to redirect more of their resources to the problems of less-developed countries, as the Rockefeller Foundation has done by supporting the development of gene-spliced crops (such as vitamin A-rich "Golden Rice") that can address nutritional deficiencies.

The funders could coordinate their work via e-mail, and the $1.5 billion proposed by the WHO's Commission on Macroeconomics and Health "to initiate serious discussion," could be used for actually performing health research, instead of for discussing it.

In the absence of centralized coordination, there may, of course, be some redundancy, but as long as laboratories compete for funding through an "investigator-initiated, peer-reviewed, merit-based research support system" - which Keusch and Medlin acknowledge promotes the "best science" - that will engender healthy competition.

If health research is to be treated as a "public good," it must be approached in a serious and intellectually honest way. It must be administered dispassionately and efficiently, and in a manner that does not shrink from the reality that cures for the public health ills of less-developed countries may be most efficiently delivered by "trickling down" from the high-powered research machines of the wealthier countries.

Dr. Henry Miller, a physician and molecular biologist, is a fellow at the Hoover Institution. He was the director of the FDA's Office of Biotechnology from 1989-1993.
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