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{\operator Richard Gordon}{\creatim\yr2000\mo5\dy25\hr9\min15}{\revtim\yr2001\mo12\dy4\hr11\min18}{\version2}{\edmins7}{\nofpages5}{\nofwords1101}{\nofchars6280}{\*\company University of Manitoba}{\nofcharsws7712}{\vern8243}}\paperw11906\paperh16838 
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\par }\pard \s15\sl360\slmult1\widctlpar\faauto\rin0\lin0\itap0 {\fs28 Poulin, B.J. & R. Gordon (2000). }{\i\fs28 Tomorrow\rquote s Cures Today? How to Reform the Health Research System}{\fs28  by Donald R. Forsdyke. }{\i\fs28 Canadian Public Policy}{\fs28   }
{\b0\fs28 26}{\fs28 (2), 7-8.}{\f4 
\par }\pard \s15\qc\sl360\slmult1\widctlpar\faauto\rin0\lin0\itap0 {\f4 
\par Medical Research Runs at Low Efficiency: 
\par A Book Review of 
\par Donald R. Forsdyke\rquote s }{\i\f4 Tomorrow\rquote s Cures Today?}{\f4  
\par }{\f4\fs28 by Bryan J. Poulin}{\f4\fs28\super #}{\f4\fs28  and Richard Gordon*
\par }\pard\plain \widctlpar\faauto\rin0\lin0\itap0 \fs20\lang2057\cgrid {\f4\fs28\cf1\lang1033\super #}{\f4\fs28\cf1\lang1033 Faculty of Business Administration, Lakehead University
\par 955 Oliver Road
\par Thunder Bay, ON P7B 5E1, Canada
\par Phone: (807) 343-8543, Fax: (807) 343-8443
\par E-mail: BPoul@FoBA.LakeheadU.ca
\par 
\par *Departments of Radiology and Electrical & Computer Engineering
\par University of Manitoba, Health Sciences Centre
\par 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
\par Phone: (204) 789-3828, Fax: (204) 787-2080
\par }\pard\plain \s15\sl360\slmult1\widctlpar\faauto\rin0\lin0\itap0 \b\fs32\lang1033\cgrid {\b0\f4\fs28\cf1 E-mail: GordonR@ms.UManitoba.ca
\par }{\b0\f4\fs24 
\par }{\b0\f4\fs28 Donald R. Forsdyke (March 2000). }{\b0\i\f4\fs28 Tomorrow's Cures Today? How to Reform the Health Research System,}{\b0\f4\fs28  London: Gordon & Breach, 168 pp. / Cloth / ISBN 90-5702-603-1 / Illustrations: 2 line drawings, 1 halfton
e/EUR 35 / GBP \u163\'a326 / USD $38 
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\par 
\par }\pard \s15\qj\sl360\slmult1\widctlpar\faauto\rin0\lin0\itap0 {\b0\f4\fs28 The lack of cures for such high profile diseases such as cancer and AIDS has called into question the effectiveness of health research. Is it simply a case of
 not enough money to do the research? Is something else required if cures are going to be found in time to save people\rquote s lives and decrease suffering and misery?
\par 
\par Forsdyke argues that the managers of medical research, the grant funding agencies, are more c
oncerned about their own security than with encouraging breakthrough opportunities in health research. He further argues that more funding support is required for those researchers \ldblquote at interfaces between disciplines\rdblquote 
 (p. 135), instead of just specialists. 
\par 
\par Forsdyke identifies three major impediments to the immediate improvement of health research. These are: 1) lack of involvement by constituents including politicians, patients, health professionals, and disease-related charities; 2) agency problems with t
hose people responsible for approving and distributing grant monies, including those at the MRC; and 3) conflicts of interest and understanding between peer reviewing and research conducting scientists. (For non-Canadian readers, MRC = Medical Research Co
uncil of Canada, soon to be superseded by the CIHR = Canadian Institutes for Health Research.)
\par 
\par The author suggests that funding be more widely distributed so researchers with radically new ideas do not have their \ldblquote heads chopped off\rdblquote  before the validity of 
their ideas is tested. He also suggests that credible medical research scientists be given rein to explore their new ideas. Specifically, Forsdyke recommends looking to the past history of the researcher and the research group for evidence of ability to a
ccomplish what might appear to be \ldblquote risky\rdblquote 
 research. He recommends funding 100% of the budget by the most credible researchers and funding less than 100% of the budget by less credible researchers on a pro-rated, sliding scale. This proposal contrasts with t
he current practice of funding most grant applications at or near 100% until the money runs out, leaving the majority with nothing (80% in the case of MRC, according to a 1999 Manitoba survey conducted by R.G. and J. Pear). Forsdyke says it would buffer a
gainst errors in judgment and our inability to predict whose research will pan out.
\par 
\par The author supports his thesis with several examples in the field of health and biological sciences wher
e ideas were not pursued because peers did not appreciate the ideas of pioneers. Only later were these pioneering ideas followed, and only sometimes were the originators given due credit. This is \ldblquote post-mature scientific discovery\rdblquote 
: the discovery could and should have occurred much sooner in history \endash 
 hence the title of the book. In these cases, a discovery would remain ignored by the scientific establishment for decades, waiting until a body of influential scientists had matured enough in their thinking to 
recognize past genius or overwhelming evidence. In the meanwhile, many people suffered and died needlessly. One of the author\rquote 
s graphic examples describes the tragedy of millions of children dying while the U.K. medical establishment delayed the decision on diphtheria immunization for more than twenty years!
\par 
\par Forsdyke\rquote s central message is that medical research funding and health agencies all too often fail to make the best choices. Managers of these agencies are tempted to make decisions that provide for in
cremental improvements and deny funding for the breakthrough initiatives. By so doing, these agencies fail the medical researchers and their various constituents, including all of us. Forsdyke contends that this overly conservative policy must not only be
 questioned but rectified.
\par 
\par Forsdyke\rquote s conclusion is that constituents must become more actively involved in how research is funded. More specifically he concludes that the research funding agencies must be directed to establish a new set of criteria that r
ecognize past accomplishment more than present promises, so that confidence is placed in credible researchers rather than fashionable research. He recommends \ldblquote bicameral review\rdblquote  (pp. 95-97), looking to: 1) the past \ldblquote 
track record\rdblquote  of the researchers instead of the promise of the proposed research, with 2) separate administrative review of the proposed budget. His argument is that the past - being more certain \endash 
 should be given full weight in assessing the credibility of the researcher. Except in its financial aspects, the researcher\rquote s proposal should not be examined.
\par 
\par Forsdyke, at various junctures, invites us to imagine what was going on behind the scenes. This introduces a needless weakness in his argument. He excuses himself from archival research of the pe
er review system on the basis that he is an active medical researcher with little time for such endeavors. Hopefully such matters will be fully explored by historians of medicine. Enough time has passed since the \ldblquote murky\rdblquote 
 beginnings of the peer review system in the 1940s (p. 18) to permit incisive historical analysis. Another weakness is in the author\rquote s foray into the commercialization of biomedical research (Chapter 13: \ldblquote 
Partnership with the Drug Industry?\rdblquote ). He correctly points out how large brand-name dru
g companies can obstruct unfavorable evidence and that this can have a negative impact on innovation. But unfortunately he stops short of considering the most obvious alternative, restructuring that would separate the funding of innovative research from t
hat of commercialization of matured research.
\par 
\par In summary, this is an important and timely book. It examines how health and medical research is conducted and by whom. The tragedy of funded and unfunded scientists alike, who are unable to pursue their novel 
ideas, comes through clearly. It is compellingly written, and the book contains a wealth of examples and insights on what ails health research, as well as some useful suggestions on what might be done. The lessons are applicable to granting agencies every
where. 
\par 
\par Forsdyke has called for leadership in the important area of health research in Canada, but where will it come from? }{\b0\i\f4\fs28 Tomorrow\rquote s Cures Today}{\b0\f4\fs28 
 represents hope for those stricken with disease, and their relatives and friends. He calls upon }{\b0\i\f4\fs28 them}{\b0\f4\fs28  to clamo
r for reform of medical research funding, as he does not see reform coming from scientists, administrators, or government, all of whom are too enmeshed in the present inefficient system to see the way forward.
\par 
\par }\pard\plain \qj\sl360\slmult1\widctlpar\faauto\rin0\lin0\itap0 \fs20\lang2057\cgrid {\f4\fs28 The book will be read with interest by those who are concerned with medical research and health sciences. This should include us all.}{\f4\fs28\lang1033  
\par }}