filename: /j/Q/211 ce e/' 265°
IOM ANNUAL MEETING 1980
Session |: Transforming Influences on Health in the 1980s
Basic Science and Public Health
Joshua Lederberg

Dr. Lederberg compared health research dollars, mortality and health care costs in the
United States from 1910 to 1980. A 1,000 fold exponential increase in dollars invested in
health research has occurred during the interval, accelerated at the time of World War II and
continued until recent years when the rate of increase decreased markedly. There has also
been a steady increase in per capita health care costs. The improvement in mortality has been
steady, indeed remarkably linear, in the face of increasing investment and unremitting
questions about the "payoffs" to be expected from the investment in research and the much
longer investments in health care.

For the future, continued improvement in mortality rate is no longer a reasonable
expectation although dramatic changes may occur suddenly. It should be realized that
immortality can only be approached asymptotically! Furthermore, focus on mortality alone is
a distortion of the full contributions of medical science and care. Most encounters with
medical technology today are devoted to improvement of health (normal function) rather than
saving of life.

With regard to costs, Dr. Lederberg noted that the annual U.S. investment in health
research is less than the annual increment in health services costs. The dollars devoted to
research impact these care costs mainly through the adoption of halfway technologies based
on imperfect scientific understanding of disease.

The long time interval between discoveries and their application to health care may
attenuate public support for research. Dr. Lederberg presented, as an example, a chronology
of major points in the study of DNA from Mendel and Mischer in 1865 (and the rediscovery
of Mendel in 1900) through Kan’s 1978 prenatal diagnosis -- by analysis of DNA -- of some
hemoglobinopathies and the even more recent achievements of recombinant DNA technology
(syntheses of interferon, insulin, immunoglobulins).

What accounts for the delay from lab research to clinical application? Dr. Lederberg
cautioned that “easy” explanations -- such as technological impediments -- are valid but do
not provide full explanations. He asks whether the scientific community has lacked
aggressiveness in studying human subjects and human diseases because of taboos, both
external and internal to the scientific process.

Dr. Lederberg closed his discussion with a brief analysis of what is known and what
remains to be learned of human genes. He estimates that about 1 percent of human DNA is
expressed as protein products. Of the estimated 100,000 proteins, only about 100 are well
understood biochemically, and perhaps 1000 are known sufficiently to have been given names.
There is an enormous arena of known ignorance, much research to be done and reason to
believe that much of it is indispensible to improving health.

Broad fundamental research that is exploratory in nature is a necessary parallel effort to
research directed toward clinical exploitations of empirical discoveries. Many medical
advances have been stumbled upon, rather than having been logically derived "from the
ground up": puzzles in clinical or laboratory observations compelled an illuminating closer
examination. The powerful analytic tools developed by basic research are essential to that
examination. Conversely, the convergence of empirical discovery and searching analysis has
often opened up new territories for basic scientific inquiry.
Semi-log-scale

 

 

 

EXPENDITURES FOR

   
  
  

    

 

 

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