© 2004 American Thoracic Society
Politics of Fundraising for ResearchTo the Editor:Recently, Pro/Con Editorials regarding whether greater funding of cell and molecular biology has or has not delivered what was promised to respiratory medicine were published in the Journal. Lenfant (1), taking the pro side, points to some successes that have come or will come soon from cell and molecular biology. He admits that it is not hard to find examples where such research has not yet influenced disease outcome and indicates that we must be patient. Macklem (2), taking the con side, stresses that only a paucity of discoveries have had a favorable effect on pulmonology; the promises remain unfulfilled and we should seek alternate directions. Neither author addresses the question of who made the promises referred to in the title. I believe they were made by physician-scientists who were speaking to Congress, exhorting the members to appropriate money for research, or who were soliciting gifts from the public to support research. Such presentations frequently exaggerate what science can deliver in disease alleviation and the time frame of its delivery. Physiology tells us how the lung is affected by disease and guides us in supporting the lung while it heals. Epidemiology identifies risk factors for disease. But only cell and molecular biology can lead to an understanding of pathogenesis. None of us can predict accurately whether a particular piece of cell and molecular biology research will affect treatment or cure of a given disease. However, one can say with certainty that if we do not engage in such research, we will not learn about disease mechanisms. How long should it take for cell and molecular biology research to yield a useful answer? The late Karl Singer, who made major discoveries in the hemoglobinopathies, said, "Whenever we devise a simple hypothesis to explain the pathogenesis of a complex disease, we are inevitably wrong." It follows that with rare exceptions, it will take a very long time, perhaps decades, for science to influence the course of a disease. The problem is not with cell and molecular biology. It is with expectations and promises. Despite four decades of work, first with cell biology and later with molecular biology, we are just beginning to understand the mechanisms of chronic obstructive pulmonary disease. We must take care to not falsely raise expectations when we ask the public or Congress to adequately support medical research.
Boston University School of Medicine Boston, Massachusetts FOOTNOTES Conflict of Interest Statement: G.L.S. does not have a financial interest in a commercial entity that has an interest in the topic of this letter. Dr. Lenfant was given an opportunity to respond to this letter but declined to do so. REFERENCES
From the Author: When Dr. Snider writes that "Neither author addresses the question of who made the promises referred to in the title," I can scarcely believe he read what I wrote (1). The fourth and sixth words of the con editorial identified who made the promises: "Sixteen years ago, Hurd and Lenfant outlined NHLBI's strategy for research funding of respiratory science" (1). What the promises were is stated in the rest of the first paragraph. As for the rest of Dr. Snider's letter, I agree with him (and with Dr. Lenfant) that it takes a long time for "science to influence the course of a disease" and that "we must take care to not falsely raise expectations." The thrust of my editorial was that promises made have not yet been delivered. This statement has not been refuted.
McGill University Health Centre Research Institute Montreal, Quebec, Canada FOOTNOTES Conflict of Interest Statement: P.M. does not have a financial relationship with a commercial entity that has an interest in the subject of this letter. REFERENCES
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