Are science and charity too cosy?: Bodies such as the Wellcome Trust will soon be financing more medical research than the state. Tom Wilkie looks at the implications and calls for a public debate on the issue

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THE NEXT time your doctor gives you a prescription for penicillin, be grateful for a private charity's foresight. Although Alexander Fleming observed penicillin's germ-killing abilities in 1928, he was unable to capitalise on his discovery; and the government-funded Medical Research Council (MRC) refused to finance the researchers who actually developed the drug some 13 years later. Howard Florey and Ernst Chain, who shared the Nobel prize with Fleming in 1945, had to depend on the Rockefeller Foundation to support their research.

Since the Second World War, charities have provided a safety net, funding medical research that the state, in the form of the MRC, has overlooked. This year, however, the state lost the initiative. Before very long nearly two-thirds of British medical research will be commissioned and paid for by charity.

The turning point came at the end of July when the world's biggest medical research charity, the Wellcome Trust, raised nearly pounds 2.2bn from the sale of shares in the pharmaceutical firm Wellcome plc. In the next financial year, the trust's income will exceed pounds 220m, allowing it to more than double the amount it allocates to medical research. Barring a Stock Exchange melt-down, it expects that within two years it will be spending more on medical research than the Government.

More money is always welcome, but some observers worry that this may be the beginning of a creeping 'privatisation' of medical research; and that the Government is abdicating its duty to ensure that vital areas of research are not neglected. Most charities focus their attention on specific diseases - cancer or cot deaths, for example - and research into unfashionable conditions, such as Aids, may therefore go by default.

A more powerful objection to 'privatisation' of medical research is that much of the charities' funds is spent on 'applied' science. This builds on basic research, that has often been done because it is scientifically interesting rather than with a view to its actual application. And it is precisely because no applications may be immediately apparent that the Government needs to continue funding basic research.

Paradoxically, the point is illustrated by the Wellcome Trust's belief that it can spend its money in accordance with strict criteria of scientific excellence. If it is correct, at least pounds 100m worth of good medical research has not been done in British universities and research institutes, because no one would finance it. Each pounds 100m 'buys' the productivity of about 2,300 researchers, so the trust's intervention highlights an extraordinary situation. It appears that thousands of medical researchers, educated at the taxpayers' expense, have been unable to fulfil their potential for lack of cash.

This impression is reinforced by anecdotal evidence that has been percolating through the laboratories for years. I know one senior research Fellow who was told that the MRC could not afford to finance his research but would pay his salary for the following three years, essentially to do nothing.

MRC officials concede that 'the volume of science we can 'buy' has declined'. A simple measure is that of the staff researchers whose salaries the council can afford to pay: it now has 15 per cent fewer scientists than a decade ago. Yet, in the post-war years, the council dominated British biomedical science. It sent Francis Crick to Cambridge to work beside James Watson, a collaboration that resulted in the most important scientific discovery of the late 20th century: the double helix structure of DNA. And it supported Sir Richard Doll's studies in Oxford, which found the definitive link between smoking and cancer.

In the past few years - even before the Wellcome Trust's actions this year - charitable funding was beginning to outstrip the MRC's contribution. In 1990-91, the 46 members of the Association of Medical Research Charities spent pounds 220m on research, whereas the Government granted the MRC only pounds 185m.

Most of the charities involved are supported by donations from the public. Their activists relentlessly rattle collection cans at street corners, or work behind the counters of high-street charity shops. In addition to such direct donations, some of the charities receive a substantial proportion of their income from legacies and bequests. The Wellcome Trust is an exception: it is a charity in that it is giving away money, but that income is being derived from stocks and shares, not from donations.

As the trust's policy has demonstrated the huge amount of medical science that remains untapped in Britain, so the response to the other charities' fundraising activities has revealed a suppressed public demand for that science. Sir David Phillips, one of the Government's senior science policy advisers, believes that 'there is an argument that all the charities are engaged in 'deficit funding'; that there is a public perception that more money should be spent on medical research, and this is demonstrated by the way that members of the public keep on giving to these charities'.

Most of the medical charities that depend on public contributions, deal with diseases, and their income reflects the public interest in, and fear of, a specific disease. Thus the biggest ones tend to be the Cancer Research Campaign, the Imperial Cancer Research Fund and the British Heart Foundation, because so many people are affected by cancer and heart disease. Others, such as the Motor Neurone Disease Association or the Foundation for the Study of Infant Deaths (cot deaths), are much less generously supported, despite strenuous efforts.

Major-General Leslie Busk, chairman of the Association of Medical Research Charities and director-general of the British Heart Foundation, says there is a danger that, as the charities' fundraising expands, the Government may decrease its support for areas such as heart disease and cancer. 'I don't approve of it, but it's natural.' He thinks that the Government should finance research in publicly unfashionable areas, such as Aids, or even back pain.

There is another concern. Although the charities are spending more money, they may not be able to buy more science, because of little-noticed accountancy changes within government. The charities used to pay the direct costs of the research they commissioned: equipment, chemicals and other 'consumables'; but they did not have to pay for 'overheads', such as heating and lighting the laboratory, and contributing to the cost of the university library.

However, the Government now 'encourages' the universities to charge charities the full economic cost of the research projects. And as the cash- strapped universities eye the charities' coffers, they must be tempted to apply the new economic rigour. Thus, for every pound put into the collecting cans, as much as 40p might go on items such as photocopying paper rather than the latest piece of analytical technology.

To their credit, the charities are aware of these concerns. The larger organisations have generously backed long-term, basic science as well as 'mission-oriented' research. Dr Bridget Ogilvie, the Wellcome Trust's director, has publicly expressed her concern that too many good scientists are on 'soft' money (short-term contracts that allow neither career development nor the continuity needed for front-rank research). The Wellcome Trust aims to rectify this, and is carefully consulting researchers about how to avoid duplication of grants.

Superficially, increased private contributions to medical research brings Britain closer to the American model of financing science. For example, research into Alzheimer's disease in Florida is supported largely by donations from the wealthy who have retired there and have a personal interest in the progress of such research. But Britain is not America: our scientific research is organised differently, and our tax system does not make such generous allowances for charitable donations.

The fact remains, however, that a big change is occurring in how British medical research is carried out, without an informed public debate about whether such change is desirable; or even what the future shape of our medical research system should be. The Minister for Science, William Waldegrave, is at present drawing up a White Paper on the future of science in the United Kingdom. It should address this issue.

(Photograph omitted)