Sounds from a different drum.


Some 14 years ago when I first came to these meetings there was an air of excitement, optimism, and momentum. The impact of modern biology on medicine was widely appreciated, and the academic community was striving to harness this new knowledge to understand perplexing disease. During the subsequent decade biomedical research flourished, and the buoyancy of the late 1950's was retained. In the last three or four years, fortunes have changed. Biomedical investigation has come under sharp criticism, support has been curtailed, and the atmosphere has become subdued and pessimistic, no less in our schools than at these meetings. In general terms, the reason for the sudden sag in appreciation and support of medical research is the crisis in health care. We now know that precisely during the halcyon days of biomedical research, costs of medical care were mounting astronomically, the availability of care throughout the nation was not appreciably improved, and the indicators of the state of the nation's health remained unimpressive. It is illustrative that health expenditures rose by 50% in the 1960's and that, in 1968, health insurance covered only 29% of personal health expenditures. The current problems in biomedical research and training have been thoroughly examined by others. I shall mention only briefly what they have explored in detail. Medical research and especially clinical investigation arose in significant part from the incapacity of physicians to understand disease and hence to care for patients effectively. It was a response to the health care crisis of yesteryear created by medical ignorance. The fruits of research in the past two decades are striking in terms of illnesses understood, treatments devised, and suffering alleviated. We are on the threshold of even more impressive gains against major causes of morbidity such as cardiovascular disease, malignancy, emotional illness, and arthritis. Virtually every time that calculations have been made on the cost effectiveness of research, the money saved through reduction in morbidity, diminished hospitalization costs, and increased work productivity, has far outweighed the costs of research. The spectacular increase in cost of medical care is not due to costs of research. As a nation, we spend on medical research something less than 5% of our total expenditures for health care, a figure quite consistent with research investment in other developing activities. This relationship may be viewed in another way. There are 17 million arthritics requiring medical care in this country. Arthritis is the second leading cause of limitation of activity. The annual cost of arthritis in terms of lost income and medical expenses is $3.6 billion. The estimated loss in taxes to the government due to activity limitation from arthritis is $200 million annually. The total national expenditure on research in arthritis is but $15 million; this is only 7.5% of the lost tax income alone and 0.4% of the cost of the illness to the public. Despite the rapid recent rise in medical faculty size, the total number of faculty members, who constitute the majority of medical investigators, is approximately 6% of the total number of physicians in the country. The university hospitals where they work account for roughly 20% of hospital admissions and outpatient visits. In the absence of substantial direct support for the costly process of medical education, the development of medical schools and medical faculties has been in substantial part subsidized by federal training and research programs. It can accurately be said that much of what is basic in our medical knowledge and practice today derives from rigorous study of disease and patients, especially as developed through the National Institutes of Health. Our research efforts are hardly excessive in comparison with the magnitude of either our ignorance or our expenditures on health care. To

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@article{Holman1971SoundsFA, title={Sounds from a different drum.}, author={Halsted R. Holman}, journal={The Journal of clinical investigation}, year={1971}, volume={50 6}, pages={1369-72} }