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SUBMISSION TO THE HEALTH AND MEDICAL RESEARCH REVIEW
23 June 1998

Australia's place in health and medical research

The Academy suggests that a primary goal of the Review should be to set policies which maintain Australia’s prominence in international medical research. Australia contributes 2.5% of the world's medical research publications and four out of five of Australia's Nobel Prizes, were awarded to medical researchers (Burnet, Eccles, Florey and Doherty).

Australia's support for medical research

The present high quality and international standing of medical research in Australia owes much to earlier policy initiatives which provided a seamless funding structure for work from the most fundamental through to clinical and industrial research.

In the Scoreboard 1997(1) report a notable feature is that six out of the top ten firms undertaking R&D in Australia are in the biotechnology, pharmaceutical and medical area. Many very high R&D-intensity companies come from ventures based around fundamental new discoveries. Companies are willing to invest heavily in R&D to be part of industries which will expand rapidly. As Johnson & Johnson Research Pty Ltd has stated

"the most important reason why Johnson & Johnson set up a world wide R&D centre in Australia is because Australia has excellent medical institutes and research centres."

Advances in medical science are the result of active collaboration among universities, hospitals and research institutes, government, industry and more recently, Cooperative Research Centres. These interactions are vital and future policy must deliver strength in each sector.

The Academy believes that there is further scope for combining Australia’s research strength and industrial capacity towards improving public health and the national economy. This contrasts with the proposed increase in U.S. budget by 50% for the N.I.H. over the next five years, and 8.4% increase in funding for the National Institutes of Health to US $14.8billion. Similarly, the Canadian Medical Research Council support will increase by 14% in 1998 and these increases will continue through to 2004. These changes coincide with pronounced insecurity in the Australian university sector which may be fragile. Coordination of higher education research policy and medical research policy is desirable. In its recommendations to Government for the future funding base of the NH&MRC , the Academy recommends that the Review analyse and exemplify the value of medical research both as a scholarly enterprise and as a significant driver of industry and the economy.

Universities

There has been a strong record in Australia of effective and productive medical research within the universities. With the emergence of increasing numbers of medical research institutes, often dedicated to a particular area of medical research, it is important to emphasise the value of individual investigator-driven research, based within the universities, as providing a broad base of activity from which new specialties may grow. This research often involves collaborative groups of investigators across university departments, hospitals and industry.

There is a potential problem developing for university-based research since the current 25% of NH&MRC funds going to universities does not leverage (for example on a dollar for dollar basis) supplementary income from other sources. It appears that such leverage is possible for hospitals and some institutes from their own resources. Universities may not be able to compete and as pressure to block-fund more of the institutes builds this problem may become acute.

Since the access to graduate students from either science or medical faculties for PhD and MD programs is crucial for the recruitment of future distinguished medical researchers, this evolving disparity in research opportunity may be of strategic concern. The opportunity for undergraduate students to take a year-long break from their medical course to undertake a research year (a B.Med. Science Honours year) in one of their lecturers' laboratories is often a crucial experience, inducing many top medical students to go on to research-based careers.

University-based research is a cost-effective form of medical research for funding bodies such as the NH&MRC because substantial components of the cost are covered by other sources, in particular the universities. Thus, the Chief Investigator's salary, much of the infrastructure support and some of the research personnel (in particular, Honours students and graduate students) do not constitute a charge on limited NH&MRC funds. In contrast, for institute-based research, the salaries of investigators and most of the infrastructure costs must be borne by NH&MRC block-grant funding or other sources.

The goal should be to achieve a balance between university and hospital-based research (i.e. basic and clinical). Both are essential. Hospital research should be reviewed and organised on the same financial basis as university science and subject to similar peer review.

Recommendation

• The Review should recommend ways in which a desirable balance of funding should be struck so as to encourage university-based research and post-graduate training as well as providing a more diversified funding basis for medical research institutes.

Research Institutes

The great research institutes of Australia such as the Walter and Eliza Hall Institute and the John Curtin School of Medical Research are now joined by a growing number of medical research institutes with a greater or lesser degree of targeted research. Many are attached to major hospitals and universities. As these new institutes are created, their relationship to the NH&MRC may progress from a requirement for project-grant funding to a condition where they seek block-grant funding.

Recommendation

• The Academy recommends that the evolution of this situation be carefully examined by the Review to avoid the disappearance of individual project grants, as has happened in the Medical Research Council of the United Kingdom.

Recommendation

In considering the balance between different styles of basic medical research the Academy recommends that the review

1. maintain research strength at individual researcher level,
2. foster support for the formation of consortia between researchers in different academic departments of the same or neighbouring universities. Such consortia and their funding should have something like a five year time horizon and be encouraged to draw in supplementary external finance for their work,
3. develop the idea of NH&MRC “Centres” in universities along the lines of ARC Special Research Centres. The Academy is informed that there is further scope for increasing these units which would have a limited life and be re-absorbed back into the university structure at the end if not renewed. Such Centres may be able to attract considerable external funding.

Industry, the Cooperative Research Centres and taxation concessions

Overall, expenditure by industry and business on research and development in Australia is ranked 18th out of 24 OECD and Asian countries. Although in the medical area the ranking may be rather better, the Academy recommends that a diversified interface be sustained between the more basic research of universities and institutes and the industrial sector.

The Academy commends the Government’s recent decision to continue the CRC program and awaits with interest the details of the changes to the program. CRCs such as the CRC for Cochlear Implant, Speech and Hearing Research illustrate benefits which are not only private to the company but to the “public good”. For example, in Victoria young children with bionic ears are now assimilated into normal schools with savings to government of an estimated $40m. This is just one of half a dozen Centres in the biomedical area which similarly have linked commercial and "public good" outcomes.

Recommendation

• The Academy recommends that in making decisions about the future allocation of support for medical research, the broader community benefits are incorporated into the equation.

Improving the career path for medical research scientists, as a measure to attract and retain young scientists

Apart from the problem of attracting bright young people into a career in medical science, there are several problems at the university level that ought to be addressed. These include:

• remuneration in academic and research positions is poor, and, at junior levels,
• there are great uncertainties about career structure;
• for postdoctoral fellows, the short period (about 6 weeks) between the end of a grant funding period and the announcement of successful new grants is much too short to find alternative employment.

Recommendation

• The Academy recommends that a “fall back system” be instituted for fellowship grants of three to five years so that one year's warning of non-continuation of a grant can be given and that opportunities be provided for a new proposal to be put for consideration.

Opportunities for international exchange

Maintenance of Australia's full participation in international medical research is essential to ensure that developments overseas can be implemented in clinical practice.

The Australian Academy of Science recently published (1996) a Discussion Paper on 'The Impact of Australian Science' and the perceived decline in this impact at the international level.

The Academy is examining the opportunities and resources available for young researchers to acquire overseas experience and international networks and the findings should be available towards the end of 1998. Further evidence of this decline has come from a 1997 report by Sir Robert May in Science indicating that Australia has slipped from ninth to twelfth place, falling behind New Zealand and Norway, in the Science Citation Index (SCI) of scientific performance. Some of the factors that appear relevant to this declining impact include the following.

First, there appear to be too few Australian-funded opportunities for Australian medical researchers to engage in international post-doctoral or other study programs. For example, there is only a small number of postdoctoral fellowships available in schemes such as the NH&MRC's C.J. Martin Fellowship scheme and the Florey Fellowship scheme.

Second, there are too few opportunities for foreign scholars to undertake research in Australia, an important factor in Australian medical scientists being part of the international network of science and scholarship. Foreign scholars who do come here mostly provide their own funding. There is no Australian equivalent, for example, of the German Humboldt Foundation Fellowship scheme which funds over 500 foreign scholars each year to work in Germany. If there were an equivalent scheme here, it might be expected, on a pro-rata basis, to provide ~120 fellowships each year for foreign scholars to work in Australia.

Recommendation

• Ensure that opportunities for international exchange for Australian medical researchers are improved to ensure that we are properly integrated into the international scholarly network.

Restructuring of the funding mechanisms to improve certainty and continuity of support

Partial vs. full funding. The current attempts by NH&MRC to pull back to partial funding in an attempt to spread the dollar further are misguided. There is no "magic pudding" out there in industry to make up the shortfall for most researchers in many biomedical areas. Once the attempt to fund fully ends, many damaging consequences flow. Particularly important is the already heavy burden placed on universities which are unable to make up further shortfalls; the lack of additional funding to continuing NH&MRC (and indeed ARC) grants to cover salary increases are a case in point, with some continuing grants being now insufficient to cover even the salary component.

Although the culture of industry funding has never been a major component of Australian research, changes are occuring. Even though most of the relevant industries with respect to the biomedical area are multi-national with extensive research programs overseas, many multinationals want to diversify and outsource their research to other countries such as Australia.

The mechanisms involved in seeking grant support have become increasingly cumbersome and time-consuming, culminating in the quite unsatisfactory mode in which the 'Grant-Net' scheme was introduced for NH&MRC applications in 1998. There is need for the 'Grant-Net' scheme to be improved and for a straight-forward and efficient mode of grant submission to be available for the next round of applications in early 1999.

The Academy favours program grants of five years, and very occasionally seven-year grants to enable greater continuity of support and overcome the stop-start mode of research. It would also reduce administrative costs.

Recommendation

• Ensure that mechanisms and funding are provided to enable Australian scientists and scholars to work with continuity and predictability of support.

The importance of 'fundamental' medical research vis-à-vis 'strategic' or 'applied' research

The calls for a shift to 'short-term' 'targeted' research, should not obscure the well-established fact that most of the major advances in health care in the community come from 'fundamental' investigator-driven research. This has been documented by Comroe and Drips in their scholarly investigation of the origins of medical and health care advances, published in Science in 1976 (Vol.192, pp.105-111). Most claims for the need for 'targeted' clinical research are not based on well-informed studies of the type undertaken by Comroe and Drips.

There has been an increasing tendency for government, as part of a push for short-term medical goals, to create priority areas for research funding, in some cases guided more by community fashion than by expert advice. This can be at the expense of fundamental research which has been the source of most real advances for the community in health care and other areas. There is a danger of seeking magic bullets.

Recommendation

1. That the necessity of fundamental research as the most effective research path for direct health-care benefits be recognized, and
2. That government's role in medical research policy should not be driven by short-term pressures.

Footnotes

1. Compiled by Coopers & Lybrand. Scoreboard 97: Business Expenditure on Research and Development, Industry Research and Development Board.