Health research spending pays off
Sir Gustav Nossal in his office at Melbourne University earlier this year. Photo: John Woudstra
I WAS amazed on a trip to India to hear that the country was committed to a 20 per cent a year compound growth in spending on research and development over the next five years. Prominent in this planning was medical research. For the first time, Indian colleagues told me, resources would not be the limiting factor in their progress, but availability of skilled research workers.
I was struck, also, that former Queensland premier Peter Beattie, when made a Companion of the Order of Australia, dedicated his honour to ''scientists and innovators'' whom he saw as important to Australia for the post-mining era of the future. Beattie as premier made expansion of Queensland biotechnology and medical research one of the central planks in his ''smart state'' strategy.
Meanwhile, the indefatigable 2011 Australian of the Year, Simon McKeon, is heading a committee conducting a strategic review of Australian health and medical research for the Commonwealth. Two previous reviews utterly transformed the field, strengthening it immensely, so my peer group is wondering what McKeon can pull out of the hat. Current budgetary constraints should not deter the development of longer-term perspectives.
So where does the health and medical research sector stand today? Australia represents 0.3 per cent of the world's population, spends 1.1 per cent of the global health research dollars but performs 2.5 to 3 per cent of the world's medical research, so it clearly punches above its weight. The seven Nobel prizes in medicine awarded to Australians are the tip of the iceberg.
While fundamental or basic medical science is a traditional strength, the achievements in clinical research have also been outstanding. How many Australians realise that the following 10 breakthroughs came from local research?
■Lithium, still the best drug for the manic phase of bipolar disorder.
■The cochlear implant or bionic ear for profound deafness.
■Cure of peptic ulcers by simple antibiotics.
■A simple device for treatment of potentially dangerous sleep apnoea.
■A vaccine against the human papilloma virus, the cause of cervical cancer.
■A highly promising drug to slow the progress of Alzheimer's disease.
■Prevention of spina bifida through ensuring that the diet in early pregnancy is rich in folate.
■A group of hormone-like growth factors that stimulate the bone marrow and which have helped 10 million cancer sufferers recover from their chemotherapy.
■The anti-influenza drug Relenza.
■Hormonal and other manipulations that made in vitro fertilisation a routine clinical reality.
The immediate future looks just as exciting. From my point of view, first-class research towards a malaria vaccine and a vaccine against the streptococcus responsible for rheumatic fever in Aboriginal populations head the list, and close behind is a new strategy to control the mosquitoes that carry the dengue virus. Smarter drugs for cancer and original approaches to epilepsy spring to mind among a host of possibilities.
Against this generally positive assessment, however, a few constraints must be mentioned. While our researchers are now much more knowledgeable about commercial possibilities than 20 years ago, there is still room for improvement. The sector has not created as many successful innovative companies as it could. Furthermore, while research is being driven from the bench to the bedside, more could be done to maximise the use of research results in health policy development and hospital practice.
Where to from here? Recently, the Australian Society for Medical Research commissioned an economic evaluation of medical research. The clear conclusion was that with a benefit-cost ration of 2.17 to 1, research is an investment, not a cost. The society argues the National Health and Medical Research Council budget should rise from $790 million, or 0.8 per cent of national health spending, to 1 per cent as soon as possible, and increase by 0.2 per cent each year until it reaches 3 per cent.
The Australian Academy of Science has a slightly more modest proposal: that health and medical research should reach 2 per cent of total health expenditure by 2025, including a contribution by the states.
If these goals can be approached, we could see a virtuous circle arising, where the research investment drives better prevention and treatment, generates commercial outcomes and informs better evidence-based healthcare. The resulting, even more vibrant research sector could inspire and lift the whole expensive health enterprise.
Sir Gustav Nossal is professor emeritus at the University of Melbourne.