We have met the enemy, and he is Us (and Them, too): Biomedical Research and the enemies of the public health

It's been a month now since we finished our application for the CTSA (Clinical Translational Science Award). This is the big grant that will replace the General Clinical Research Centers and the various clinical research training programs with a unified "home" for clinical research within academic health centers such as ours. This is the culmination (at least with respect to clinical research) of NIH Director Elias Zerhouni's Roadmap initiative, which has been a grand attempt to restructure NIH medical research funding efforts in a way that more directly benefits the public health. Everyone at our institution was under a vow of silence until the application was out the door. Now that the ban has been lifted, I can talk more freely about translational research from the eclectic perspectives of an IT professional, former social worker, cop and logger, and lifelong observer of the human condition.

It seems a bit specious to imply, as I did above, that the revolution in systems biology, genomics, and proteomics is not to the benefit of the public health. Although there are huge amounts of work yet to be done, the discoveries already made make clear that solutions for many if not most of the diseases and disorders that plague us now are within reach. The objective of translational research is to take these discoveries through the "last mile" between the lab benches of academia and the exam table in the community clinic.

A great effort lies ahead of us, and it seems like a good time to take stock of the barriers that stand in our way. The technical barriers, whether they relate to physical or information structures and functions, are clearly surmountable. Anyone who has lived through the past thirty years and can remember a time before ubiquitous computing and "smart everythings" can no longer doubt that engineers can come up with a gadget that can do just about anything. So what stands in our way of perfect health? I see two sources of obstacles: "Them" and "Us".

There are a lot of Them, some malignant from the git-go, and others who are essentially benign but whose actions are fraught with unintended consequences. Among the malignant there are advertisers and Republicans, and some who are both (TV evangelists come to mind). Advertisers are focused on selling us things without concern for our health - tobacco has been the whipping-boy of this group, but Big Tobacco has a lot of Big Friends, like the fast-food and theme restaurant franchises and at an earlier point in the supply chain, purveyors of high-fructose corn syrup. All these folks are squarely aimed at making and keeping us morbidly obese, with no little success. I would include the pharmas too, because not every ailment can or should be treated with a drug or device, and anything outside this category fails to get mention from their lavishly funded sales reps.

Republicans used to be a fairly benign group. I was a Goldwater Republican back in my high school days, when conservatism meant trusting in the creativity and initiative of individual human beings free to choose and act on their own, rather than a faceless Big Brother-style government that placed security over liberty, invaded its citizens' privacy at will, and spent vast amounts of hard-earned taxpayer dollars on ventures that benefited few and harmed many. Big Brother was then believed to be the end goal of the Democrats, but is a nice summary of the attitudes and policies of the current administration, which is the culmination of a takeover of the Republican Party by a coalition of fundamentalist yahoos and multinational corporate profiteers. This satanic alliance makes Barry Goldwater look like Bill Clinton.

The Republicans' policies impact the public health in two ways: they have reduced available funds for research at a time when research dollars have the greatest potential ROI in history, and they have politicized science at many levels, subordinating objectivity to administration policy.

Enough about the malignant: what about the well-intentioned folks whose actions nonetheless get in the way of advancing the public health? I include here many who know about the consequences of their actions, but are constrained by the system within which they work. Overworked and underpaid primary care providers are a good example. They lack the time and energy to do the best job they know they could do, because of the fragmentation of the healthcare system and difficulties in learning about evolving best practices. The publish-or-perish attitude prevalent in academic health centers makes researchers overly protective of their data and their subject pool, and their project-by-project funding makes it difficult for them to fund the information technology infrastructure that would make their investigation more efficient and fruitful. This latter systemic issue is complicated by a kind of dogged ignorance among some researchers regarding the knowledge and effort involved in the creation of research informatics.

On to the obstacles created by Us, the "public" in the term "public health". In the Bhagavad Gita, Krishna says something along the lines of the following: "Though he is surrounded by death on all sides, no man truly believes that he himself will die." If we choose to overeat, spend our days watching TV rather than getting fresh air and exercise, smoke too much, or drive too fast, the advances in science are wasted. If we vote into office a coalition of fundamentalist yahoos and multinational corporate profiteers, we get a faceless Big Brother-style government that places security over liberty, invades its citizens' privacy at will, and spends vast amounts of our hard-earned taxpayer on ventures that benefited few and harmed many. If we allow the environment to go to hell out of apathy, we (and worse, our children and the generations to come) live with the consequences.