Stone the crows! Medical research can be a pain in the public purse.

Well before the last election, Tony Abbott promised to leave universities alone (at best) but explicitly committed to no medical research cuts.[i]

The politics made sense – rumours of medical research cuts in the 2011 budget bought legions of lab coats onto the streets in protest.[ii]  The funds kept flowing then, voters being told they would all die of plague if a dollar was cut from the research budget overcame responsible budgeting.

Which is the problem for governments managing research funding – no matter how much they provide it is not enough.

The Prime Minister has fallen into the trap of trying to fill the bottomless funding pit. Rather than not cutting medical research funding, he is delivering in stethoscopes by increasing it – or at least he is trying to.

While the CSIRO ($114m) and the Australian Research Council ($74m) copped cuts in the budget, medical researchers were prescribed their very own magic pudding, the Medical Research Future Fund.[iii] If it gets to the intended $20bn size by 2020 the MRRF will generate $1bn a year. When continuing funding from the National Health and Medical Research Council is added, the government predicts Australia will spend $2bn a year on research in a decade.[iv]

All this, if it happens. For a start, the cash flow for the fund is supposed to come from $5 of a $7 Medicare co-payment on GP visits, which is as politically popular as pus among the medical establishment: “A co-payment will affect those who are the sickest, most marginalised, the poorest and for that to pay for a medical research budget seems to me unpalatable,” sometime Australian of the Year Professor Fiona Stanley says.[v]

“The co-payment is unfair and unnecessary. Ideology has pushed this proposal too far. It is poor health policy. The prime minister should step in and scrap this policy. If not, it deserves to fail in the Senate,” Australian Medical Association chair Brian Owler adds. [vi]

Which is what may happen, with the government five or six senators short.[vii]

But this will upset the medical research lobby a great deal indeed, which sees nothing wrong with wanting everything at once. Simon McKeon, chair of the 2012 Strategic Review of Health and Medical Research, told the National Press Club last month that after “some give and take” the fund will get up. If it does not, “there will be lab coats in the streets.” [viii]

The medical research establishment has always had a sense of energetic entitlement – curing diseases and saving lives will do that to you. But that does not make the MMRF the best possible use of $20bn in taxpayers’ money.

There are endless explanations why too much medical research funding is never enough – well summarised in the Walter and Eliza Halls’ current Discoveries Need Dollars campaign which states:

Medical research funding in Australia is concentrated on our biggest health problems, including heart disease, obesity, diabetes and cancer …. Every $1 invested in the Australian health research and development sector returned at least $5 in national economic development. The National Health and Medical Research Council (NHMRC), which distributes Australian Government medical research funds, supported more than 8,000 jobs in Australia in 2010.[ix]

Critics are far fewer.

Certainly, there is a big literature on waste in medical research.[x] But few commentators are game to suggest that life-saving research may not be the most effective use of public money. Treasurer Joe Hockey demonstrated why when he argued the MRFF might find a cure for cancer. This is an all but unrebuttable rationale – demonstrated by its use by another wily policy player, Richard M Nixon, who committed to it in a State of the Union address, before all that Watergate unpleasantness.[xi]

The Productivity Commission tackled the related issue of endless investment in medical technology a decade back, posing the question that everybody in government would prefer to remained unasked:

There is a pressing need to explore what the community considers is an appropriate level of subsidised access to healthcare and the technology it embodies, and the institutional and incentive structures that will deliver it efficiently and equitably.[xii]

There was a great deal of debate as to how to spend the MRFF, without imposing the co-payment of course. But few commentators dared suggest we can spend too much on medical research. And those that did were the usual suspects, who dislike the state spending citizens’ money rather than leaving people to make their own decisions.

Like Brian Toohey who argued:

There is a large opportunity cost in devoting such a disproportionate share of shrinking funding to medical research. Other areas have the potential to deliver big productivity advances, including nanotechnology, communications, materials science, batteries, plant breeding and 3D printing for manufacturing and construction. Although science has done a lot to better our lives, not all research will improve productivity or personal well-being[xiii]

And Judith Sloan, who was her usual understated self:

Please, please spare us the drivel about Australia being good at medical research (where is the evidence of that?); that there are job multiplier effects; and that there will be cost savings down the track because of all the discoveries that will be made (and will be shared with the rest of the world).  More like business class travel for medical researchers.[xiv]

But it was left to David Hunter from Flinders University to make the obvious point, that the MMDF will be paid for by people who have far more immediate health needs – the already ill and under-privileged:  “New medical research is only going to benefit those who can access it, and the increasing trend towards privatisation in the Australian health-care system suggests access will be the domain of the wealthy.” [xv]

So we need the fund but not one funded by a Medicare co-payment. So what to do? Former Australian Medical Association head Steve Hambelton explains, “We need both accessibility to primary health care and research – not one at the expense of the other”. [xvi]

Simple really, you wonder how Tony Abbott missed the solution. But I doubt that paying for the MRFF would shut the medical industry up – nothing short of spending all tax revenue on health would. And even then it would not be for long.

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[i] Tony Abbott, Address to the Universities Australia Higher Education Conference, February 28 2013 @ recovered on July 6

[ii] Amy Corderoy, “Research cuts put lives at risk, say medical institutes,” Sydney Morning Herald, April 7 2011

[iii] Science and Technology Australia, “Budget science cuts and changes,” nd @ recovered on July 6

[iv] Budget 2014-15, “Medical Research Future Fund,” nd @ recovered on July 6

[v] Victoria Laurie, “Funding both curse and blessing,” The Australian, May 17

[vi]  Brian Owler, “Medical co-payment belongs ion the scrapheap,” The Age June 18

[vii] David Crowe, “Crossbench to shoot down $20bn in savings,” The Australian, July 5

[viii] Stephen Matchett, Researchers united, will never be defeated, “ Campus Morning Mail, June 12 @ recovered on June 18

[ix] Walter and Eliza Hall Institute, “Discoveries need dollars,” nd @ , recovered July 6

[x] Richard Smith, “Medical research – still a scandal,” The BMJ January 31 @ recovered on July 6

[xi] Stephen Matchett, “Cash cure,” Campus Morning Mail, May 16 @ recovered on July 6

[xii] Productivity Commission, “Impacts of advances in medical technology in Australia,” September 20 2005 @ recovered on July 6

[xiii] Brian Toohey, “Medical research dollars a dangerous distraction,” Australian Financial Review, May 24

[xiv] Judith Sloane, “Thoughts on bulk-billing,” Catallaxy Files, May 26 @ recovered on July 26

[xv] David Hunter, “Proposed medical research fund is unfair and unethical,” The Conversation, May 19 @ recovered on July 6

[xvi] Adrian Rollins, “Patients and GPs to be left worse off by co-payment,” Australian Medicine: Budget 2014 special @ on July 6