I am a doctor, and have been practicing Medicine for 33 years. That being said, a hobby of mine for the last 40 odd years has been buying and selling horses and mules…
I can tell you with absolute confidence that paying more for a horse or Mule does not necessarily get you a better Horse or Mule!!
It does get you a flashier looking horse at times, a fancier barn at which to view it, and a lot of (not always true) advertising to read…
Having lots of research money does the same thing. Again and again during my time in academia, I saw people try very hard to spend lots of money because they had it. They did not need that money, but they had to spend it because “if we don’t spend it, we won’t get it next year.“
Some of the most valuable medical research that has been generated has been reliant upon substantial money for equipment, etc. Some of the best medical research has also been done with very little money. As Vinay says we need to work on and control the quality of research… quality is not solely reliant upon the amount of money involved, but upon many factors.
The trade-offs are not only within the scientific-industrial enterprise but external to it. When we spend more on biomedical research we allocate less to other beneficial/deserving activities - e.g., better education, infrastructure, food, air, justice. Same for healthcare, the spend on which, in the US anyway, is delivering diminishing benefits while clawing resources from everything else we care to publicly fund.
To that end, Jobs should lay out exactly how he proposes to fund this $100BB NIH budget. What other federal programs is he willing to pull money from, and/or what new taxes is he proposing to raise? It's easy to ask for more funding in a vacuum, and another story entirely when you live in a world of scarce resources.
Well given an indifference to deficit spending on the order of trillions it’s hard to state that but to your point it’s more we deficit spend for wars more than we do for the priorities you mention.
A similar curve applies to health care. As the health spending per person exceeds a certain limit, both the quality and quantity of life (life expectancy) decline. The US has already exceeded that limit.
Federal government funding of medical research should be $0. It makes a mockery of our 10th amendment. The federal taxpayer budget, mandated from the taxpayers collectively, should be for things that are best done collectively as a nation such as the military (as we discovered during the Revolutionary War), foreign affairs and interstate commerce. Medical research funding should come voluntarily, from multiple resources such as commercial interests, educational institutions, charitable organizations, etc. If the federal government stops being a source of medical research funding does that mean that there will be less of it? Not necessarily, for the other sources will rise accordingly as we saw, for example, with the March of Dimes during the polio epidemic in the 1940's and 50's. But now it will be meaningful, responsive to need and citizen interest rather than political influence or to supply incomes to academia.
Very interesting and I think this applies to all research and funding, especially where government dollars are involved. I see AI research falling into a similar trap.
It is not clear to me why you have consistently failed to cite contemporary examples of how and why this (the suppression of scientific truths in favor of flashy grift) occurs. Clearly, both decades-long and more recent histories provide substantive evidence.
One perspective is that the mantra of “publish or perish”, the one that makes and breaks careers in contemporary medical sciences, is subservient to “who” gets to make discoveries and advances, versus who gets to take control of the economic outputs of those advances.
Advances published and publicly disclosed are often suppressed BY THE INSTITUTIONS, when they feel or believe that others within their communities should lead the charge for another scientist’s insights.
Moreover, novel methods and tactics disclosed in closed (e.g.: peer reviews of grant funding) mechanisms are wholly subject to a takeover by those who already have a pool of resources to advance someone else’s novelties and breakthroughs forward, leaving innovators and inventors by the wayside. The fraud is wholly hidden from public view and disclosure because the peer-review process is protected under the government’s skirt, and has increasingly become a tool for the organized and government sanctioned theft of novel information and intellectual property.
Like you said it’s how you spend it. Has anyone looked into duplicate work? Seems like the $$ giving process is somewhat about who you know versus who has best science. In med school a nice enough prof got millions to study aggression in dogs. Not sure much exactly came of it - that’s not my position to declare exactly since negative studies are useful - but his lectures were objectively horrible. But he did have a big grant and so he talked. That’s ancillary cost too.
Reminds me of a wonderful psychology professor I worked with whose grant-funded research revealed that the more you have in common with your spouse the better your relationship will be, or some such common sense.
"There is no doubt that 1 billion dollars in NIH funding will yield more scientific advances than 0 dollars"
Not so sure. If no money is spent by NIH, private research would move in to what are perceived to be the more lucrative areas that they may currently not enter due to NIH taking up the space. This would provide a very different research topic list, but I am not sure it wouldn't be less productive overall.
Like whole body MRI screening... it is easy to sell these ideas when you think that they are spending other people's money and not your own. People generally believe that "more is better".
The trade-off has a second axis besides truth vs. fraud: what the system counts as output. Once "impact" means publications plus a closing paragraph promising the findings will "feed" policy, missing impact is never a failure. It's the justification for the next grant. Finland's Research Council put €756,612 into a nail-salon labour project whose public description ends exactly that way, without naming which authority is supposed to change what. Add zeros to that budget line and you don't buy more cures, you buy more feeding. I went through a handful of these line by line: https://vanmardigain.substack.com/p/the-taxpayer-pay-the-researcher-increases
To be fair, a case could be made that everything you said is also true, in spades, for the for-profit medical industrial complex. The for-profit Big Pharma, Big Medtech and Big Hospital cartel already parasitically suck way over a trillion dollars from the US economy.
And all that throwing trillions at for-profit Big Medicine does is incentivize the c suite executives, not their rank and file researcher employees, of Big Pharma & Big Medtech to discover innovative ways to suck more trillions out of the US economy and redirect those dollars into their pockets and their corporate shareholders' pockets.
Most of the researchers employed at Big Pharma and Big Medtech corporations don't even get to enjoy the patent royalties from their patented inventions; they usually give those patent rights up in exchange for a regular paycheck and benefits. So all the incentives to 'innovate' for Big Pharma and Big Medtech is for the executives to order their researcher employees to only innovate in ways that make the corporation and their shareholders more money.
But if more funds were directed towards government research like the NIH, then there could be more freedom for the scientists to direct their research in ways that have the potential to benefit patients, rather than the bottom line of some corporation that is legally obligated to look after their shareholders' financial interests and not their customers, the patients, best health interests.
Just for an example, maybe the NIH could look into claims that in high enough doses, drinking baking soda dissolved in water, can cure cancer. With the alleged baking soda cancer cure, there is maximum incentive for Big Pharma to suppress such a cure if they have any reason to believe that it actually works. I read that the entire course of the baking soda treatment would involve three pounds of ordinary baking soda. Go to Aldi and you can pick up three pounds of baking soda for less than three dollars. But what does the average cost of a full course of mainstream chemical poison therapy, better known by the euphemistic misnomer chemotherapy, cost these days? I know it's well into the six figure range. That's a lot of incentive for Big Pharma to suppress any replacement treatment like baking soda that is unpatentable and virtually free.
For those who might reflexively and immediately dismiss, out of hand, the baking soda cancer treatment, I have a theory for its mechanism of action as a treatment. Even mainstream oncology acknowledges that cancer cells abhor an alkaline environment and instead craves a slightly acidic environment. If the baking soda treatment works, what might be going on is that by drinking so much baking soda water, one's body becomes merely overly alkaline than what is ideal for noncancerous cells, but not toxic. But for the cancer cells, all that baking soda makes the patient's body alkaline enough to cause deadly alkalosis toxicity for the patient's cancer cells; the idea being that toxic alkalosis happens far sooner for cancer cells than it does for noncancerous cells. That's just my hypothesis, but I think it's worth exploring. And the NIH could very well explore such an alternative route, and all the other potential alternative cancer treatments, given that they don't have the disincentive of potentially losing out on the massive profits that chemical poison therapy, aka chemotherapy, already brings, if they were to discover the baking soda protocol, or other alternative protocols, actually works. But of course Big Pharma does have a massive financial incentive to do whatever it can to make sure such a treatment never sees the light of day in mainstream oncology prescription medicine.
I call this” it’s for the children “ scamming. Virtually ANYTHING can be excused, as long as you say IFTC first. A close corollary is “ for safety”.
I am a doctor, and have been practicing Medicine for 33 years. That being said, a hobby of mine for the last 40 odd years has been buying and selling horses and mules…
I can tell you with absolute confidence that paying more for a horse or Mule does not necessarily get you a better Horse or Mule!!
It does get you a flashier looking horse at times, a fancier barn at which to view it, and a lot of (not always true) advertising to read…
Having lots of research money does the same thing. Again and again during my time in academia, I saw people try very hard to spend lots of money because they had it. They did not need that money, but they had to spend it because “if we don’t spend it, we won’t get it next year.“
Some of the most valuable medical research that has been generated has been reliant upon substantial money for equipment, etc. Some of the best medical research has also been done with very little money. As Vinay says we need to work on and control the quality of research… quality is not solely reliant upon the amount of money involved, but upon many factors.
The trade-offs are not only within the scientific-industrial enterprise but external to it. When we spend more on biomedical research we allocate less to other beneficial/deserving activities - e.g., better education, infrastructure, food, air, justice. Same for healthcare, the spend on which, in the US anyway, is delivering diminishing benefits while clawing resources from everything else we care to publicly fund.
To that end, Jobs should lay out exactly how he proposes to fund this $100BB NIH budget. What other federal programs is he willing to pull money from, and/or what new taxes is he proposing to raise? It's easy to ask for more funding in a vacuum, and another story entirely when you live in a world of scarce resources.
Well given an indifference to deficit spending on the order of trillions it’s hard to state that but to your point it’s more we deficit spend for wars more than we do for the priorities you mention.
A similar curve applies to health care. As the health spending per person exceeds a certain limit, both the quality and quantity of life (life expectancy) decline. The US has already exceeded that limit.
We are definitely on the far side in healthcare today.
"Preventive medicine is largely an oxymoron."
Managed care!
Federal government funding of medical research should be $0. It makes a mockery of our 10th amendment. The federal taxpayer budget, mandated from the taxpayers collectively, should be for things that are best done collectively as a nation such as the military (as we discovered during the Revolutionary War), foreign affairs and interstate commerce. Medical research funding should come voluntarily, from multiple resources such as commercial interests, educational institutions, charitable organizations, etc. If the federal government stops being a source of medical research funding does that mean that there will be less of it? Not necessarily, for the other sources will rise accordingly as we saw, for example, with the March of Dimes during the polio epidemic in the 1940's and 50's. But now it will be meaningful, responsive to need and citizen interest rather than political influence or to supply incomes to academia.
Very interesting and I think this applies to all research and funding, especially where government dollars are involved. I see AI research falling into a similar trap.
It is not clear to me why you have consistently failed to cite contemporary examples of how and why this (the suppression of scientific truths in favor of flashy grift) occurs. Clearly, both decades-long and more recent histories provide substantive evidence.
One perspective is that the mantra of “publish or perish”, the one that makes and breaks careers in contemporary medical sciences, is subservient to “who” gets to make discoveries and advances, versus who gets to take control of the economic outputs of those advances.
Advances published and publicly disclosed are often suppressed BY THE INSTITUTIONS, when they feel or believe that others within their communities should lead the charge for another scientist’s insights.
Moreover, novel methods and tactics disclosed in closed (e.g.: peer reviews of grant funding) mechanisms are wholly subject to a takeover by those who already have a pool of resources to advance someone else’s novelties and breakthroughs forward, leaving innovators and inventors by the wayside. The fraud is wholly hidden from public view and disclosure because the peer-review process is protected under the government’s skirt, and has increasingly become a tool for the organized and government sanctioned theft of novel information and intellectual property.
This truth is tough to accept, but it is the truth.
100% agree. Dr John Ioniddes found that very issue. AI will only obfuscate further
Like you said it’s how you spend it. Has anyone looked into duplicate work? Seems like the $$ giving process is somewhat about who you know versus who has best science. In med school a nice enough prof got millions to study aggression in dogs. Not sure much exactly came of it - that’s not my position to declare exactly since negative studies are useful - but his lectures were objectively horrible. But he did have a big grant and so he talked. That’s ancillary cost too.
Reminds me of a wonderful psychology professor I worked with whose grant-funded research revealed that the more you have in common with your spouse the better your relationship will be, or some such common sense.
"There is no doubt that 1 billion dollars in NIH funding will yield more scientific advances than 0 dollars"
Not so sure. If no money is spent by NIH, private research would move in to what are perceived to be the more lucrative areas that they may currently not enter due to NIH taking up the space. This would provide a very different research topic list, but I am not sure it wouldn't be less productive overall.
Too much fraud is involved.
Another fantastic, thoughtful article.
Like whole body MRI screening... it is easy to sell these ideas when you think that they are spending other people's money and not your own. People generally believe that "more is better".
The trade-off has a second axis besides truth vs. fraud: what the system counts as output. Once "impact" means publications plus a closing paragraph promising the findings will "feed" policy, missing impact is never a failure. It's the justification for the next grant. Finland's Research Council put €756,612 into a nail-salon labour project whose public description ends exactly that way, without naming which authority is supposed to change what. Add zeros to that budget line and you don't buy more cures, you buy more feeding. I went through a handful of these line by line: https://vanmardigain.substack.com/p/the-taxpayer-pay-the-researcher-increases
Great point, with an excellent curve that describes so many things in life and in policy!
To be fair, a case could be made that everything you said is also true, in spades, for the for-profit medical industrial complex. The for-profit Big Pharma, Big Medtech and Big Hospital cartel already parasitically suck way over a trillion dollars from the US economy.
And all that throwing trillions at for-profit Big Medicine does is incentivize the c suite executives, not their rank and file researcher employees, of Big Pharma & Big Medtech to discover innovative ways to suck more trillions out of the US economy and redirect those dollars into their pockets and their corporate shareholders' pockets.
Most of the researchers employed at Big Pharma and Big Medtech corporations don't even get to enjoy the patent royalties from their patented inventions; they usually give those patent rights up in exchange for a regular paycheck and benefits. So all the incentives to 'innovate' for Big Pharma and Big Medtech is for the executives to order their researcher employees to only innovate in ways that make the corporation and their shareholders more money.
But if more funds were directed towards government research like the NIH, then there could be more freedom for the scientists to direct their research in ways that have the potential to benefit patients, rather than the bottom line of some corporation that is legally obligated to look after their shareholders' financial interests and not their customers, the patients, best health interests.
Just for an example, maybe the NIH could look into claims that in high enough doses, drinking baking soda dissolved in water, can cure cancer. With the alleged baking soda cancer cure, there is maximum incentive for Big Pharma to suppress such a cure if they have any reason to believe that it actually works. I read that the entire course of the baking soda treatment would involve three pounds of ordinary baking soda. Go to Aldi and you can pick up three pounds of baking soda for less than three dollars. But what does the average cost of a full course of mainstream chemical poison therapy, better known by the euphemistic misnomer chemotherapy, cost these days? I know it's well into the six figure range. That's a lot of incentive for Big Pharma to suppress any replacement treatment like baking soda that is unpatentable and virtually free.
For those who might reflexively and immediately dismiss, out of hand, the baking soda cancer treatment, I have a theory for its mechanism of action as a treatment. Even mainstream oncology acknowledges that cancer cells abhor an alkaline environment and instead craves a slightly acidic environment. If the baking soda treatment works, what might be going on is that by drinking so much baking soda water, one's body becomes merely overly alkaline than what is ideal for noncancerous cells, but not toxic. But for the cancer cells, all that baking soda makes the patient's body alkaline enough to cause deadly alkalosis toxicity for the patient's cancer cells; the idea being that toxic alkalosis happens far sooner for cancer cells than it does for noncancerous cells. That's just my hypothesis, but I think it's worth exploring. And the NIH could very well explore such an alternative route, and all the other potential alternative cancer treatments, given that they don't have the disincentive of potentially losing out on the massive profits that chemical poison therapy, aka chemotherapy, already brings, if they were to discover the baking soda protocol, or other alternative protocols, actually works. But of course Big Pharma does have a massive financial incentive to do whatever it can to make sure such a treatment never sees the light of day in mainstream oncology prescription medicine.
- Glen Wallace