!! spellx done
78   Society, Not Science, to Decide
     When to Cure Some Diseases
     The Washington Post    Saturday December 30, 1967

     "My son is suffering from a genetic disease that my doctors tell
me is now incurable.  How long will it take for the new methods of
molecular biology to be available for his benefit, or for other 
members of our family? What can be done now to shorten the time?

     To receive such a letter from a reader is a hard-hitting reminder
of the short path from philosophical conceptions of human nature
to the most poignant realities of human suffering.

     We can outline technical approaches to the treatment of many
baffling diseases.  The first step is a thorough analysis of its 
biochemical basis.  The most powerful techniques of analyzing metabolism
and, even more deeply, changes in the structure of proteins and 
nucleic and nucleic acids, have only begun to be deployed.

     This biochemical information may already point to effective 
solutions, like the dietary control of PKU and galactosemia.  Even a
rather crude understanding, like the relationship of insulin to 
diabetes, can help improve and save millions of lives.

     This penetration of the biochemistry of a disease is the first 
essential hurdle.  But it has scarcely been reached for the most 
grievous conditions even where we have some genetic insight.  We
have just bare hints for cystic fibrosis, muscular dystrophy, 
schizophrenia, chromosome-21 trisomy, Huntington, chorea and many 
neurological aberrations.

     No imponderable theoretical problems impede our efforts.  The
main problem is financial and moral support for the work of clinically
oriented investigators, and the further development of the skilled 
manpower to extend existing techniques to the challenges of disease.  
Behind this problem is a social decision about priorities.  An annual
health research development budget of about $10 billion would and  
could saturate the presently visible frontier at something like the
depth with which we approach problems of national military security.
This is ten times the existing budget for the National Institute of
Health, whose grants support the great bulk of health research in the
United States.  But the increase is based less on the broadening of
medical research than on the reality that research and development for
practical, clinical utilities are inherently much more expensive than
the basic, scientific work that must precede them.

     These visionary hopes are clearly at odds with the idea that re-
search is a good target for fiscal economy in competition with the
Asian war, with the concept of some controlled "rate-of-growth" of
research or with the blatantly anti-scientific attitudes displayed
by many species of Know-Nothings.

     Technically, we are also very close to the fabrication of virus-
like agents designed to supplement a gene set deficient in some 
recognizeable, vital function.  This scientific achievement is a virtual
certainty well within a decade, provided the existing momentum of
basic research can be sustained.  How long it may take to translate
such a scientific breakthrough into a treatment that can be certified
for use with patients is again, mainly a question of social policy.

     We need, of course, parallel efforts to make medical care more
broadly accessible to the whole population.  To stifle medical
research would, of course, simplify the delivery problem.  The easiest
resource to distribute  equitably is one that has no value at all!

     Such  an irresponsible solution is a curiosity of game theory, and 
might be delivered by a badly programed computer, but it does no benefit
to human life and happiness.  On the contrary, we still have to
sharpen research attention on the broadest public health questions
like the adequacy of existing nutrition for maternal and child health,
about which much less is known than is generally realized.

     For the important answers to my readers' questions I must, in the
end, reply "This is a matter you will have to take up with your
Congressman!"

-----------------------------------------------------------------------