Money makes health go round

By SIMON COLLINS



Five hundred New Zealand babies every year are born so prematurely that they weigh less than 1.5kg.

Of the 450 that survive, half have some brain damage because their tiny skulls have not had time to harden before their perilous passage into the world.

At Auckland's Liggins Institute, a renowned centre of research on foetal and infant development, Dr Jeff Keelan believes that after a decade of work, he may finally have found a chemical trigger that causes premature births - and which might be able to be blocked to stop prematurity.

He plans to apply to the Health Research Council, and to an American foundation, to fund his research team to investigate it.

But he wonders whether he will be wasting his time.

"I've had a history of grant [applications] submitted getting good reviews from the peer reviewers, then not getting funded because there's not enough money.

"So I'm really keen to have it funded, but the chances of having it funded are so poor that people are saying, why should I bother?"

This year the Health Research Council (HRC) received 199 applications for funding, down from 409 in 1996-97.

It funded only 45 of them - 23 per cent, down from 48 per cent in 1996-97.

In monetary terms, it spent twice as much - $53.3 million this year, compared with $25.1 million in 1996-97.

But the amount of research it buys with each dollar is now less than half what it was, because since 1997-98 it has paid not just for the direct costs of extra researchers and equipment, but also a proportion of the time of salaried academics such as Keelan who supervise the research, plus "overheads" to the universities of 114 per cent of the direct costs at Otago University and 121 per cent in Auckland.

An evaluation of New Zealand's health research, commissioned by the Government from the Australian Expert Group in Industry Studies (Aegis), concluded last week that our health research was "in serious danger of falling below a level necessary to sustain a functioning health research system". The view was put to us by researchers that the HRC's support for biomedical research is 'teetering on the subcritical'," it said.

New Zealand spends 0.04 per cent of its national income on health research, compared with 0.03 per cent in Japan, 0.05 per cent in the European Union, 0.06 per cent in Australia and South Korea and 0.24 per cent in the US.

Aegis recommended lifting spending by $11 million on top of a $5.5 million increase in this year's Budget just to cover the universities' higher overhead charges, plus a further $17.8 million to raise our health research spending to the European average.

But the Government is unconvinced.

"I have to remain more strategic than trying to oil squeaky wheels," says Science Minister Pete Hodgson. "Notwithstanding that I have delivered a useful increase in health research, I don't myself think we're doing enough."

Hodgson says he gets "a bit testy" when well-paid consultants get their figures wrong. Aegis included $7.8 million in health research grants from the Royal Society's Marsden Fund, but ignored a further $19.2 million which the Foundation for Research, Science and Technology paid last year to business-oriented biomedical research - including money to the Liggins to look for medically valuable "bioactives".

If that is included, Hodgson says we already spend about $75 million on health research - 0.06 per cent of our national income, equivalent to Australia's spending and twice Japan's.

Taxpayers spend money on health research for two main reasons - first, to improve the health of their people and, second, to boost living standards. Rich nations are no longer rich because of what they make (many things are made in China), but because of their ideas, and the high prices they charge for those ideas.

That is why Australia doubled its health research funding between 1999 and last year, in real terms (it still does not pay for overheads). It is why Singapore pours billions into medical biotechnology.

A report by Access Economics for the Australian Society for Medical Research last year estimated that health research accounted for at least half the increase in the average Australian's years of good health in the past 40 years through lower age-adjusted death rates for both the major killers, cancer and heart disease.

The medical director of our National Heart Foundation, Professor Norman Sharpe, says death rates from heart disease have come down in New Zealand too, but less than in Australia or the US.

"Part of that is research, and part of it is quality of care and access to care," he says. "Research actually does improve the quality of care and access in the long term."

So if taxpayers put more money into health research, what would they get?

Sharpe says the Heart Foundation would revive rejected projects on improving the quality of care for patients with heart attacks and heart rhythm problems, and on detecting early signs of diabetes in rural Maori people in the Waikato.

Auckland cardiologist Harvey White might be able to start a trial of a drug that may prevent kidney failure when patients undergo angioplasties, and a project testing the effect of having a specialist nurse visit heart-attack patients after they have gone home.

Doctoral student Suzanne Reid could work fulltime on a protein that may trigger Alzheimer's disease, instead of working as a technician to fund her research.

Auckland Medical School researchers might actually be paid to provide genetic tests for families suspected of being susceptible to sudden heart failure. Lack of funding forced lecturer Mark Rees to process the tests in his spare time until he finally took a professor's job in Wales a few months ago.

Professor John Tagg, the founder of Blis Technology, might be able to extend the unique anti-bacterial technology that Blis is using against bad breath to fight killer diseases such as meningitis and rheumatic fever (see Business Herald, page CX).

Wellington's Malaghan Institute might be able to keep working on bone marrow transplants for cancer patients and a new compound that stops the development of multiple sclerosis (MS) in mice. Without funding, its bone marrow specialist is about to leave for Melbourne, and MS researcher Thomas Backstrom will be out of a job by Christmas.

"He has been talking about real estate or taxi driving," says Malaghan director Graham Le Gros. "He's written 10 grant applications, national and international, because he's a committed researcher."

For some, it is already too late.

Former Heart Foundation medical director Boyd Swinburn moved to Melbourne in 2001 after failing to get HRC funding for a study on obesity. Australian state and federal Governments are funding the study.

Former Christchurch haematologist Derek Hart left three years earlier after Prime Minister Jenny Shipley rejected his proposal for a new research unit. He set up the now 80-strong institute in Brisbane instead, where Queensland Premier Peter Beattie has given him $13 million so far for new equipment from the "Smart State Facilities Fund".

The founder of the Auckland Clinical Trials Research Unit, Professor Stephen MacMahon, moved to Sydney four years ago to start another now 100-strong research centre, the George Institute, after Pharmac's cheap-priced medicines policy drove most big drug companies out of trials in New Zealand.

"The questions that we wanted to answer, such as how to reduce the risk of death in patients with heart failure, or how to reduce the complications of diabetes, were not going to be possible with the available public resources in New Zealand alone," he says.

Microbiologist Russell Snell says New Zealand cannot afford to simply "consume" medical knowhow from such offshore institutes. "We have some unique populations in New Zealand, and we know that the pharmaceutical industry operates by market size."

"The Pakeha and Chinese and large population groups are going to be extremely well served by the development of new technologies such as genomic medicine. But isolated populations won't be, because they are too small to be worthwhile."

Auckland University physiologist Mark Cannell, who missed out on HRC funding for a study of heart transplant patients, says New Zealanders also want to contribute towards relieving broader human suffering.

"It's a global effort that we have to take part in," he says.

The problem, of course, is that there are also other claims on our limited money - such as better basic health care.

Petra van den Munckhof, coordinator of the Healthcare Aotearoa network of iwi-community-based primary care services, says there is already plenty of research showing that the best ways to keep people healthier are "cheaper fees and services being delivered by people who are able to relate to the people who require the services".

But even she believes that we need more money for research to find out more, for example, about why some groups are not getting the care they require.

"Funding needs to be targeted," she says.

"So I don't think it's a black-and-white issue. I can see the greys."