Thank you for Adam Keiper’s terrific cover story in the Winter 2010 issue of Philanthropy. Your “Six Strategies for Philanthropic Funding of Medical Research” were spot-on. I would like, however, to suggest one more.
The incentives behind most government and industry research are profits gained through the creation, protection, and exploitation of intellectual property. The incentives behind much of university research are academic promotion gained through publication in premier journals and acquisition of large and long-term funding commitments. Unfortunately, these incentives do not support funding for some of the most promising research that can quickly, safely, and economically affect patients:
- repurposing FDA-approved drugs and devices to treat “off label” diseases;
- modifying current treatment protocols to help more patients for longer periods of time; and
- testing anecdotal successes reported in clinical practice using already available therapies, including those from integrative medicine.
We call these projects “Rediscovery Research” because they reuse and reconfigure scientific knowledge and medical resources that already exist in the literature or clinical practice, but have not yet been scientifically validated and published to support their wider use.
Rediscovery Research has created better treatments for patients in many diseases, including once-fatal childhood genetic diseases like auto-immune lymphoproliferative syndrome and familial dysautonomia, as well as multiple sclerosis, lung cancer, and multiple myeloma. We have ongoing Rediscovery Research in type I diabetes, myelodysplastic syndrome, prostate cancer, Batten Disease, Birt-Hogg-Dubé Syndrome, and a number of other diseases.
Unfortunately, these projects rarely create intellectual property that can generate significant profit. They do not cost much to fund or take long to complete, so they do not generate large grants or long-term funding commitments. And since the results are rarely published in top-tier journals, they do not increase an academic scientist’s opportunity for promotion. But they often make a quick, safe, and economical difference in patients’ lives—all while reducing overall healthcare costs.
To take advantage of this critical niche, Partnership for Cures has been piloting Rediscovery Research since 2005, mining the vast scientific and medical literature created over the last two decades and more, looking for leads that can save or improve lives. We are eager to create ways for Rediscovery Research to go from one of the best-kept secrets in medical research to being one of the “Seven Strategies for Philanthropic Funding of Medical Research.” It is an opportunity for philanthropy to use existing medical research to help patients while they are still healthy enough to benefit from them.
—Dr. Bruce E. Bloom
Ashoka Fellow, 2009–11
President and chief science officer, Partnership for Cures, Chicago
In his cover story on medical research, Adam Keiper cites as positive examples two of the eight case studies I write about in Great Philanthropic Mistakes. Donors should understand why both Abraham Flexner and Mary Lasker are bad examples.
Abraham Flexner, in Medical Education in the United States and Canada, did do a good job in exposing abuses by shoddy medical schools. But as a program officer, he insisted that medical schools receiving Rockefeller money only hire professors without outside medical practices. He offered no evidence in defense of this policy, and refused to consider reasonable alternatives, such as Harvard Medical School’s policy that its professors could see private patients as long as they did so in a teaching hospital. Flexner’s obstinacy ensured that Rockefeller donations to medical schools were far more protracted and messy than they should have been.
Mary Lasker’s philanthropy was based on the premise that if the federal government spent enough money, cures for cancer, heart disease, and stroke would be found. She did not understand that science advances by small steps and not giant leaps, and her insistence that she understood medical research better than scientists angered many potential allies—not least James Shannon, Director of the National Institutes of Health from 1955 to 1968. Although she was the catalyst behind the Nixon administration’s “War on Cancer,” an analysis performed by the Miami Herald in 1978 showed that the $5.2 billion spent by the federal government on cancer research between 1969 and 1978 had no effect on national cancer rates.
There are many good examples for potential medical donors to follow, such as the Rockefeller Foundation’s creation and funding of the Rockefeller Institute for Medical Research (now Rockefeller University). But Flexner’s and Lasker’s funding strategies are ones that the rising generation of donors should avoid.
—Martin Morse Wooster
Senior fellow, Capital Research Center, Washington, D.C.
Adam Keiper replies:
I am grateful to Dr. Bloom for his kind note and for outlining the Rediscovery Research approach. In the 19th century, many potential drugs and treatments were slow to be adopted because medical research was not yet fully industrialized. In the 20th century, the worldwide proliferation of well-funded academic and industrial research laboratories brought us many more drugs, treatments, and cures—but by concentrating chiefly on the most promising and profitable results, some discoveries were overlooked. In the 21st century, aided especially by our new information technologies, it has become feasible to seek out those unexploited (or under-exploited) discoveries—a process that private philanthropy can do much to spur.
Mr. Wooster seems to have misread my article: I cited the Flexner study and the work of the Albert and Mary Lasker Foundation as major historical examples of the influence of private philanthropy on medicine, not as role models to be emulated today. Having read Mr. Wooster’s book, I am familiar with both his indictment of Abraham Flexner’s tenure at the Rockefeller Foundation and his criti-cism of Mary Lasker’s work. And although I think he overstates his case against Ms. Lasker and does not go nearly far enough in his critique of the broad Rockefeller project to recast medicine, I would recommend Mr. Wooster’s book to thoughtful donors hoping to understand the potential pitfalls of philanthropy.