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Commentary from Westminster

Priorities in Medical Research

EVEN Labour MPs, who belong to a party pledged tosweep away the undemocratic structure of the House of

Lords, can sometimes be persuaded to cough out theoccasional word of qualified praise for some aspects of theinstitution. That peers owe their places either to inheritanceor to selection remains, for them, insuperably unacceptable.But that the non-elected chamber can sometimes commandan expertise which the elected chamber cannot is, here andthere, candidly admitted. This superior expertise is nowheremore evident than when you compare the select committee

systems of the two houses. Some members of Commonsselect committees, starting virtually from scratch, becomeconsiderable experts in the fields to which they are assigned.But the all too frequent story with Commons selectcommittees is that one or two members come to dominatethe proceedings, ask most of the really telling questions, andshape the eventual report, and that far too much of thecommittee’s effectiveness depends in the end on the talentand ingenuity of the committee’s clerk and its outsideadvisers. The Lords, in contrast, time and again summon toselect committee membership people who know the worldthey are exploring quite as well as do the witnesses they callbefore them. The critical findings of a Lords selectcommittee may still be dismissed by Ministers with lightlyveiled contempt, or even virtually ignored. But the criticismstings, even so.

So the opening of an inquiry by a sub-committee of theLords Select Committee on Science and Technology intopriorities in medical research could turn out to mean rathermore than initial coverage (of which there was hardly any)might suggest. It will be able to build both on the report ofthe full committee on Civil Research and Development,whose implications for medicine were noted in this column,land on the near-consensus of apprehension and alarm(Baroness Trumpington excepted) which surfaced in aLords debate on academic medicine on Nov 26.2 Four peerswho took part in the research and development inquiry willalso engage in this one: Lord Sherfield, who chaired thatinquiry; the medical peer, Lord Hunter of Newington, aformer Vice-Chancellor of Birmingham ; the physicist andformer Rector of Imperial College, Lord Flowers; and thephysiologist, Lord Adrian.3 Lord Hunter also took part inthe Nov 26 debate.

The sub-committee seems destined to spend a lot of itstime exploring a theme which cropped up repeatedly in theevidence of the MRC to the research and developmentinquiry. This is the danger that in straitened times researchis becoming more and more dominated by short-termism (acondition which in other contexts Ministers keep asking usto avoid). That means too much soft money tied to too manytransient jobs, and too much emphasis on work which, whileit may produce a quick, localised pay-off, will make littleenduring contribution to the science base. Industrial andcharitable funding, increasingly crucial as official sources

1. McKie D. The economic and social benefits of science. Lancet 1987; i: 174.2. McKie D. The decline of academic medicine. Lancet 1986; ii: 1345.3. The subcommittee’s members are: Lord Nelson of Stafford (chairman), Lord Adrian,

Lord Erroll of Hale, Lord Flowers, Lord Hunter of Newmgton, Lord Kearton,Lady Lockwood, Lord Perry of Walton, Lord Sherfield, Lord Taylor ofBlackburn.

falter, pours in for research into heart disease and cancer, butis hard to find support for work on mental handicap orpsychiatric medicine, or for the sort of project which maytake ten years to produce exploitable results-and whichmay even, if things go wrong, have little to show at the end ofit. (Who now, one despairing observer asked last week,would rush forward to fund, say, the search for the secrets ofDNA?) As the retiring MRC secretary, Sir James Gowans,told the Science and Technology Committee, funding fromoutside sources must always be complementary to

Government provision through the universities, the DHSS,and the MRC, and not a substitute for it.The crisis in medical education, and its specific

implications for research, which Baroness Trumpingtonseemed ready to dismiss in the Nov 26 debate as comfortablyunder control, was specifically recognised by the EducationSecretary, Mr Kenneth Baker, in this year’s dispensationson university pay. In a message to the chairman of theUniversity Grants Committee, Sir Peter Swinnerton-Dyer,he listed medical education as one of the particular areas forwhich he wanted the UGC to make provision, and aboutwhich you could expect him to have further instructive chatswith his friend the Social Services Secretary, Mr NormanFowler. But gratitude for that is bound to be tempered bythe fact that Mr Baker’s decisions on fundings, announcedin the Commons on Jan 23, fall far short of what theuniversities had regarded even as a decent minimum. Hewas asked for k 110 million to fund a C 170 million packageagreed last autumn, but could offer only £ 71 million,conditional on efficiency measures. This is all the moreominous when two universities, Bristol and Leeds, havebeen driven to threaten that, with so little money available,the commitment to keep the salaries of academic clinical staffin line with those of their NHS colleagues might have to beabandoned. If parity goes, the trickle away from academicmedicine to more lucrative comparable employment is

predicted to become a flood. Such threats at such times areof course familiar. They might be dismissed as tacticalfrighteners (and the threat at Bristol was subsequentlywithdrawn). But in areas of continuing decline, this year’sfrighteners have a nasty habit of becoming next year’srealities.

It would no doubt be stretching the committee’s terms ofreference if it began to take up every prevalent dissatisfactionwith the funding of medical education. But with so manyformer Chancellors and vice-Chancellors and even deputyPro-Chancellors in the group, there will be plenty of scopefor informal agonising over, for instance, the rights andwrongs of the University Grants Committee’s new andallegedly more rational system of awards, picking outsuccessful departments to be rewarded, while classifyingothers as substandard and therefore to be penalised. TheUGC, anyway, could be heading for a radicaltransformation even while the subcommittee is at work.There were reports last week that the Government wouldlike it to contain rather fewer academics and rather more

outsiders, especially from industry. That would no doubtraise a howl of protest from universities alarmed at the

prospect of having their financial fates decided by peoplewho do not intimately know their ways. Some strugglingdepartments, though, might just suspect that a beefed-upUGC might have more success in wringing money out ofGovernment than a clutch of academics who can too easilybe dismissed as skilled special pleaders.

DAVID MCKIE