Sunday, May 20, 2007

Biomedical Philanthropy

This week's issue of Nature has a number of interesting articles on Biomedical Philanthropy. Given the reality of the challenges we face with respect to biomedical research (e.g. its risky, costly, etc.) we need to appreciate the limitations of relying on state funding alone if we hope to mitigate (in the foreseeable future) the arbitrary and often tragic consequences of the genetic lottery of life. This means that an efficient and fair regulatory system will permit room for both state-funded and privately-funded biomedical research. And this has important implications for determining how robust intellectual property rights should be (e.g. gene patents), the nature of the relationships between academia and private industry, and the proportion of the government's budget that should be spent on pursuing experimental genetic interventions versus other cost-effective measures which mitigate disadvantage.

Appeals to abstract moral/political ideals alone (e.g. equal opportunity, prioritarianism, sufficiency, inclusion, etc.) will not help equip us with the theoretical tools necessary for addressing the challenges we face in the real, non-ideal world. That is, a world with pervasive pluralistic forms of disadvantage, indeterminacy, scarcity, etc. Once we appreciate the complexity of the challenges we face with respect to making real success on this front we realise that the question of what constitutes a just regulatory framework for biomedical research is a difficult challenge, but one we cannot afford to ignore or take lightly.

So the latest issue of Nature provides some useful insights into the role philanthropy plays in biomedical research. Here are some excerpts from the issue.

"Biomedical philanthropy: The giving machine"
Lucy Odling-Smee

The Gates foundation contributes roughly 10% of the US$12.7 billion a year spent on health-related aid to developing countries by donors such as the United States, United Kingdom and France. The world needs to commit a lot more funding to improving global health. Estimates of the additional resources that are needed to meet the United Nations Millennium Development Goals for health range from $25 billion to $70 billion per year. We believe that our funds have been catalytic in many ways. For example, our initial $750 million contribution to the GAVI alliance — formerly known as the Global Alliance for Vaccines and Immunisation — prompted further donations of more than $2 billion. GAVI has helped to increase immunization rates in millions of children in 70 developing countries.

....As a private foundation, what can you do with your money that other funders cannot?

We often support 'high-risk, high-reward' projects that can be difficult for governments or the private sector to fund. For example, the Medicines for Malaria Venture, one of our major grantees, is partnering with industry to conduct clinical trials of new treatments for malaria. Private companies would not be able to fund these trials alone, because of the high financial risk of conducting expensive trials on products that do not have a market in wealthy countries.

"Biomedical philanthropy: Love or money"
Erika Check

....With their new focus on delivering cures, today's foundations also insist that researchers deliver results or, in the case of high-risk projects, at least show that they tried. Some ask for detailed reports every six months or a year, and make further funding contingent on meeting strict milestones. High Q awards contracts rather than grants to ensure that scientists actually do the work they say they will do, rather than pursuing serendipitous tangents — a luxury that is allowed or even encouraged with government grants. The foundation also insists that researchers share the results of their work as quickly as possible, and discuss unpublished findings openly with colleagues at meetings.

Some researchers find this type of oversight too onerous or controlling. They resent the loss of intellectual freedom and tend to stay away from groups such as High Q. Robi Blumenstein, a former businessman who now manages the operations of High Q and the CHDI, acknowledges that their business-like procedures can chafe some academics, but he makes no apologies. "We want people to have great ideas, but we need to get them done," he says. "When we switched to this more rigorous model we acknowledged that we weren't going to get everybody to work with us."

"Biomedical philanthropy: State of the donation"
Meredith Wadman

....These new givers — the gigaphilanthropists — are perceived to be making an impact on the research landscape that is much greater than the sum of their dollars. "The effect of the private foundations is not reflected in the total funding they supply. They have disproportionate influence," says Hamilton Moses of the Alerion Institute, a Virginia-based think-tank that focuses on innovation in biomedical research. They can, and do, take financial and scientific risks unthinkable with tax-payers' dollars. They fill gaps left by government and industry, dictate exactly what their money is spent on and act quickly compared with the sometimes glacial pace of government agencies. But although those running the organizations are sure that private money buys more and better science than public money, there is little concrete evidence they are right.

The new wealth also comes with strings attached: some funders keep a businesslike control over the direction of the research they pay for and demand a level of accountability that can make researchers uncomfortable (see page 252). Some observers worry about the growing power wielded by the gigaphilanthropists over the research agenda if, as is predicted, charitable giving reaches new heights in the future. They are concerned that too many important decisions with an impact on biomedicine will be made in the boardrooms of foundations with little scientific expertise — and no public input or accountability. "You may have foundations with assets larger than almost 70% of the world's nations making decisions about public policy and public priorities without any public discussion or political process," says Pablo Eisenberg, a senior fellow and philanthropy-watcher at the Georgetown Public Policy Institute in Washington DC.