Sunday, September 30, 2007


I'm glad that I didn't read this until my applications were done. Not that I was oblivious to the quagmire that is the NIH funding system.

While training more medical scientists than we can realistically support (and then having them drop out of research) is certainly a concern, another equally unfortunate scenario that could result from a glut of MD/PhD graduates would be if all of the promising candidates ended up in industry. Biotech is booming, and many predict it will be a juggernaut by the time I graduate, so they may indeed end up picking up the slack for a lack of government funding. Of course this is not inherently bad; many great things come out of industry research. But it would be a shame if industry consolidated too great a share of our biomedical capital, much as the pharmaceutical industry has done. Many very bright medicinal chemists and pharmacologists (and probably a few other specialties) have virtually no choice but to work for the overlords of Big Pharma.

Many of them do good work, but it's no secret, for example, that urinary incontinence is a very active area of pharmaceutical research. Why? Obviously, this is not a pressing medical issue. However it is a fairly common problem and, more importantly, one which won't kill you. If a drug were developed, a patient might well take it continually for 20 years. I won't belabor that it is a terrible disconnect when treating an innocuous "disease" is incentivized over one with a high mortality rate. It would indeed be a shame if many of our best and brightest physician-scientists were beholden to such a system of crass bottom lines. The people who will make the greatest innovations in medicine over the next several decades need only to have their patients' best interests at heart, not their stockholders.

Commercially viable research is driven by profit potential, and this end does not always square nicely with medicine's obligation to treat even the toughest, most unrewarding of cases. That is why we must maintain a strong backbone of government supported investigation into the difficult, ugly, never-gonna-make-anybody-rich-but-could-save-many-lives problems. Further, there is an important synergy here; basic academic research lays a foundation of knowledge by which industry can judge if there is potential for a commercial solution, and run with the promising ideas that academia has illuminated. So much preliminary investigation is involved before an idea can even be considered for the industry pipeline that industry would virtually never produce anything new if they had to do all the research in house. The fact of the matter is that an unbelievable percentage of promising research turns out to be a clinical dead-end, so the risk is simply too great for any company to sustain active R&D in that kind of field. That's why we need to have plenty of NIH money: everyone depends on it.