BIO 2006—First Dispatch—Debating Biomedical Research
Chicago-April 10–As a panelist for the Research Imperative: Curse or Cure bioethics session at the Biotechnology Industry Organization's annual convention (BIO 2006) I debated Hastings Center founder bioethicist Daniel Callahan. Daniel Perry, the executive director of the Alliance for Aging Research also participated. Callahan made his usual point that he thinks that it's a higher moral priority to provide access to everybody to already existing biomedical technologies before pouring more money into new biomedical technologies.
Callahan calls for "steady state medicine" in which "further scientific gains are not deployed until earlier ones are fully utilized." In his earlier book False Hopes, he wrote, "If we had exactly and only the same range of technologies as were available twenty or thirty years ago, there would be no problem in equitably allocating resources." Of course, if we just used rattles and beads health care would be even cheaper. In particular Callahan questions the development of new technologies that would be initially available to the rich. He mentioned that he has a new book coming out Medicine and the Market: Equity versus Choice. Since Callahan has long advocated national univeral health insurance, I suspect that the market doesn't come off so well.
I won't rehearse all of the arguments (see my pre-BIO 2006 column on the topic), but I do want to briefly deal with his specific claim that "we" are spending way too much money on biomedical research. Callahan keeps citing the fact that in the 1950s Americans spent 6 percent of GDP on education and 6 percent on medical care. Now he laments we still spend only 6 percent of GDP on education and 15 percent on medical care. So what? Spending on public education adjusted for inflation has tripled since 1960, yet American students still do badly when compared to students from other countries which spend much less than we do. I mentioned this and Callahan responded we needed an educational research effort. Never mind.
In any case, how much money is Callahan talking about? How much money goes into biomedical research each year? According to a study published in September 2005 in the Journal of the American Medical Association, "biomedical research funding increased from $37.1 billion in 1994 to $94.3 billion in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%)." The same study noted that that amounted to 5.6% of total U.S. health expenditures. In fact, that comes to about 0.7 percent of a total GDP of more than $13 trillion. Reprograming all of that money would barely make a dent in the myriad social problems Callahan claims have a higher priority, but doing so would certainly ensure that millions who would otherwise have lived longer healthier lives will suffer and die.
Daniel Perry warned that America's rapidly aging population simply cannot be taken care of affordably by relying on today's biomedical technologies. For example, it currently costs $100 billion to take care of those Americans suffering from Alzheimer's and it is possible that that number will quadruple to 16 million by the middle of this century. "The only way to cope with the unprecedented number of older Americans will be to get lucky in the lab," said Perry. That sounds almost like an imperative, doesn't it?
Yale economist William Nordhaus argues that the huge increase in average life expectancy since 1900 from 47 years to 77 years today has been responsible for about half the increase in our standard of living in the United States. This largely because people who live longer have the time to accumulate human capital and are healthier thus enabling them to lead far more productive lives. Another recent study by researchers at Harvard and Queen's University in Belfast that examined 30 years of data from 104 countries concluded that a one-year improvement in a country's life expectancy translates into a four percent improvement in economic output or gross domestic production (GDP). While such calculations don't make spending on biomedical research an imperative, they certainly do make it look like a bargain.