HEALTH: WHO Wants Research Put to Work for People

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Nov 11 2004 (IPS) - Some medical researchers are primarily interested in the three P’s of publication, patents and professorships, while others focus on policies, practice and people. Unfortunately, the former vastly outnumber the latter in the scientific world today.

A new World Health Organisation report, “Knowledge for Better Health”, reveals that of the 73 billion dollars spent annually on health and medical research around the world, more than 95 percent is spent on the kind of research that stresses the first three P’s, such as basic biomedical, clinical and epidemiological research, with a particular emphasis on genomes, molecular biology and biotechnology.

This is the traditional view of research and development, aimed at the discovery of new “interventions”, such as drugs and vaccines, diagnostic tests and medical devices, explained Tikki Pang, the director of the WHO Research Policy and Cooperation Department.

Roughly 45 percent of the 73 billion dollars spent on research comes from pharmaceutical companies, while another 45-50 percent is what is known as public sector spending, which includes funds from both government sources and non-governmental, non-private sector sources. “For example, the Bill Gates Foundation is now a major player in the founding of health research,” said Pang.

A mere five percent of the total funding is devoted to research that stresses the second three P’s, in other words, on improving health care delivery to the population.

As a result, the tremendous advances made in medicine over the last 50 years have not had nearly as great an impact on public health care systems as they could. “Despite the fact that we can sequence the human genome, we still have problems with malaria, tuberculosis and HIV/AIDS, especially in the developing countries,” Pang noted.

One of the main points stressed by the new report, issued Wednesday, is that science can have a much greater impact on public health in the future through the promotion of research aimed at strengthening health care delivery systems.

The potential for improvement in this area is great, especially in the developing world, because health care systems in these nations are currently very weak.

“Because you are talking about public health, you are talking about the delivery of health care to populations in countries where hospitals are not working well, there are not sufficient doctors and nurses, there are insufficient medicines, there is insufficient insurance coverage,” Pang said.

Moreover, many of these countries do not have basic information systems, and cannot even keep track of the number of people who die in the country of different causes, she added.

What is needed, according to Pang and the WHO, is more research into strengthening health care systems, because unless these weak systems are improved, the advances made in science will not have the same impact.

Unfortunately, this kind of research holds little appeal, and is unappreciated as well as under-funded, she noted.

When young students decide they want to specialise in research and development, “the glamour is in the genomes, in developing new drugs or developing a new machine to diagnose cancer,” Pang explained.

Research on health care delivery systems, however, is far less attractive. “You don’t ever win a Nobel Prize for doing research on how to improve access to medicine,” she said.

According to Pang, these conflicting priorities lead to a certain amount of tension between scientists who focus on the “glamorous” research, and obviously earn more money, and those who recognise the value of these new medicines, vaccines and diagnostic tests, but wonder what purpose these discoveries serve if they are not used for the people who need them most.

In view of this situation, the WHO has decided to highlight the fact that this area of research is being neglected, and to stress the need for more support for research into strengthening health care delivery systems, “not to compete with the glamorous research, but to complement it,” she said.

“We acknowledge and are very impressed with all the research that’s going on in terms of developing new drugs, but I think it has to be balanced with the research to make sure it gets to the people,” Pang explained.

Another factor pointed out by the report is that while research produces information and evidence, these are not being used in the best possible way when it comes to medical practice. There are some doctors, for example, who continue to prescribe drugs that have been scientifically proven to be ineffective.

Pang criticised the members of the biomedical research community who have lost sight of the three P’s of policy, practice and people and think only of publishing papers in important journals, winning professorships, and registering patents, as a means of earning royalties for their universities.

For Pang, who was formerly a laboratory researcher and shared those same goals, joining the WHO was a “revelation”, because she realised that in the research community, “papers, patents and professorships are really missing the point unless you also talk about policy, practice and people.”