Based on my experience for three years as Director of
the National Institute of Neurological Disorders and Stroke,
following a conventional academic career as Professor
and Chairman of the Department of Physiology at the University
of California, San Francisco, I make a number of observations
about the relation between science, politics and public
policy. The intent of these observations is to help bridge
the gap of understanding and culture that separates the
world of academic science and that of national biomedical
science administration, as represented by the National
Institute of Health (NIH), the leading biomedical research
institution in the world. My observations are also meant
to underline several tensions or larger questions that
modern biomedical science faces as it progresses into
the twenty-first century.
Four major themes were discussed. The first ("Insiders
vs. Outsiders") points to the need for a healthy exchange
of personnel and ideas between NIH and the extramural
world of biomedical research. The Intramural Research
Program of the NIH was used as an example of the problems
that can occur when such exchange is sub-optimal. A system
of largely internal hiring that worked well when the NIH
was at the pinnacle of research excellence in the late
60s and early 70s resulted in an institution with large
pockets of stagnation twenty-five years later. The Marks-Cassell
report and its vigorous implementation under the direction
of Dr. Harold Varmus has now resulted in important changes
in hiring policies for scientists that should restore
the NIH to its previous excellence.
A second theme ("Directed vs. Undirected Research") examined
a series of questions dealing with the way science is
performed (curiosity-driven vs. mission driven); the way
in which it is organized (big science vs. small science);
the way it is funded and directed ("bottom-up vs. top
down"). Curiosity-driven science is most familiar and
comfortable for basic scientists, who often work in relatively
small groups, whereas for clinical scientists, often concerned
with a particular disease, science is mission-driven,
and often done by teams of investigators. Both are needed
and each group needs to understand the other. Centrally
directed and organized scientific initiatives are likely
to increase as technology makes "big science" possible.
The third theme ("Doing Science vs. Curing Disease")
dealt with the discrepancy between the goals of many scientists,
particularly basic scientists, and that of Congress. CongressŐs
interest, curing disease, is unequivocal and clear. The
goal for basic scientists should not be to try to interest
the Congress in the importance of science for the purpose
of understanding, but to show its utility and necessity
for curing disease. Because members of the Congress have
varying sophistication about science and how it is carried
out and because the membership changes every two years,
information and education of public officials by scientists
on these points is an important and continuing need.
Finally, ("Political Advocacy") patient advocacy groups
are among the most important lobbyists in Washington for
biomedical research. They bring to the Congress the personal
dimension of disease research and a sense of focus and
zeal. Although scientists agree with the advocacy groups
on the ultimate aims of research, they often differ on
how to get there. Patient advocacy groups are intensely
focused on a single disease or group of diseases, are
interested in short-term results, and are often competitive
with each other for the science dollar. Increased understanding
and continuing education are essential to a strong working
relationship with these groups. In advocacy, both for
specific causes, and for the larger enterprise of biomedical
research, we must emphasize the possibilities offered
by science, but must do so responsibly and realistically.
