"It Was the Best of Times, It Was the Worst of Times..."

James Le Fanu, a physician by trade, suggests in a Prospect magazine editorial that "for science this is both the best and the worst of times." It is the "best," he says, because "its research institutions have never been so impressive, its funding never more lavish." But the "worst," he adds, because the scientific achievements "of the recent past have been rather disappointing," when compared with those from the beginning of the 20th century. The author is dismissive of Craig Venter's team's recent work. "Fabricating a basic toolkit of genes and inserting them into a bacterium — at a cost of $40 million and 10 years' work — was technologically ingenious, but the result does less than what the simplest forms of life have been doing for free and in a matter of seconds for the past three billion years," Le Fanu writes. Of genomics research, Le Fanu says that investigators have yet to put their data to use. "The usual response is to acknowledge that perhaps things have turned out to be more complex than originally presumed, but to insist these are still 'early days' to predict what might yet emerge," he says, adding that:

Biologists could, if they so wish, spell out the genomes of each of the millions of species with which we share the planet but that would only confirm they are composed of several thousand similar genes that 'code' for the cells from which all living things are made. Meanwhile, the really interesting question of how they determine the unique form and attributes of such diverse creatures would remain unresolved. ... At a time when cosmologists can reliably infer what happened in the first few minutes of the birth of the universe, and geologists can measure the movements of continents to the nearest centimetre, it seems extraordinary that geneticists can’t tell us why humans are so different from flies.

Zen Faulkes at NeuroDojo is not quite sure whether Le Fanu set out to make a valid argument against modern science, or simply "an active effort to troll the science blogosphere." As for Le Fanu's claims of "lavish" research spending, Faulkes is not amused. "Yes, it's so incredibly lavish that funding rates for most American federal agencies are way less than one funded proposal out of ten applications; so that good researchers devote weeks on end to revising and resubmitting in hopes of finding the resources to carry out their research," Faulkes writes. In response to the Prospect piece, Faulkes says that "science usually advances incrementally," adding that "it would, indeed, be quite sad if the best science could do would be do the same simple experiment a million times. Fortunately, this is not what we do."

Like many others that have

Like many others that have directly responded to Dr. Le Fanu’s criticisms in his blog about what new fundamental or practical insights into biology and medicine have really emerged from decades of intense research activity, I also disagree with his pronouncements about the magnitude of our progress. Compared to cosmology, physics and chemistry, biology, and in particular, molecular biology is still a relatively young science.

As partly pointed out by Dr. Le Fanu, the complexity of life provides extra challenges compared to the more established fields of science. A great deal of energy has to be initially devoted into just describing all of the diverse life forms and their properties. Hence a lot of basic biology and molecular biology is descriptive rather than predictive at this stage. Nevertheless, recent technological developments, for examples, in gene sequencing, mass spectrometry, microarray analyses and IT, has accelerated the pace of discovery and provides the means to achieve major breakthroughs.

Dr. Le Fanu does raises some very legitimate criticisms, particularly with respect to the more than doubling of expenditures for biomedical research over the last 15 years with few obvious outstanding returns. It is true that today that fewer new diagnostics and therapeutics receive regulatory approvals than a decade ago.

From a cost-benefit analysis, I am also inclined to believe that “small” science is much more productive than “big” science, and the increasing trend to focus resources into mega projects may not yield the best value. It seems that we have not been pursuing the best course of action in the war on disease in recent years.

However, in criticizing the expenditures into the biomedical research enterprise as a whole, while this does exceed a hundred billion dollars annually, it should be appreciated that it actually represents a very tiny fraction of the world’s economy. For example, the leading funder of biomedical research in the world, the U.S. government expends a little more than $100 per person annually for biomedical research conducted through the National Institutes of Health (NIH). Meanwhile, the average family income in the U.S. was recently estimated to be around $60,000 and about a third goes to taxes. Assuming an average size of 4 to a family, then it can be calculated that only about $100 out of $5000 per person in taxes (about 2%) is spent on health care research by this route. To put it another way, the average American provides the equivalent of the price of one night out with a cheap seat at a play on Broadway in New York to support biomedical research annually to improve their prospects of surviving a myriad of nasty diseases.

Moreover, a closer examination of research spending in a report from the NIH Pharmalot in the Journal of the American Medical Association in January of this year reveals that the annual growth of U.S. biomedical research funding from industry and the NIH only increased 14% between 2003 and 2007, and actually started to decline in inflation-adjusted dollars afterwards. Pharmalot also noted that in 2008, industry accounted for about 58% of total biomedical research spending in the U.S., the NIH provided about 27% and the remainder was from other federal agencies, more local governments and charities.

Consequently, while the world’s population continues to grow and age and will get sicker, our commitment to biomedical research is actually declining, and with it the opportunities for significantly improved health care.