WE LIKE TO THINK that scientific and therapeutic wisdom prevail when the federal government annually spends nearly $4 billion on healthrelated research. By and large, that seems to be the case, as shown by the healing accomplishments and innumerable scientific prizes of the government's own researchers and the thousands of scientists whose work it supports in universities and hospitals.
But then we come across the newly issued report of the National Commission on Digestive Diseases, and we are drawn to wonder about the mismatch that sometimes exists between the health afflictions of humankind and the research priorities of the biomedical enterprise. We hasten to acknowledge that money alone cannot dictate the swift arrival of effective treatment, cures or preventive technique; the requisite knowledge sometimes is slow in coming, regardless of the budget. Also, we know that biomedical-research politics is ringed by various "disease-of-the-month clubs" that often exploit misfortune to rouse public and congressional support for their particular health disorder.
Even so, it is a wonder that the mandarins of medicine have managed to assign a relatively low priority to research on something so painful, prevalent and costly as digestive diseases -- a catchall term that encompasses ulcers, liver disorders, gastrointestinal cancers, hemorrhoids and a variety of other afflictions, from slight to lethal.
The commission, created by Congress to provide an external jolt to the policy-makers at the National Institutes of Health, adduces the expectable stack of statistics to demonstrate the inadequacy of research in its field of interest: total annual spending of less that $100 million for a collection of disorders that accounts for 10 percent of the total cost of illness, 15 percent of general hospital admissions, and nearly 200,000 deaths, for a total economic loss -- including time lost from work -- of $35 billion a year.
Whatever the validity of those startling numbers, it seems clear that there is a serious imbalance between the problem and the response, and that the commission's recommendations for more attention and money in the field are altogether meritorious.
It will be argued, of course, that money can't substitute for good ideas -- and that's true. But what's alsotrue is that scientific talent flocks to money. We have no doubt that if the grants are there for research on digestive problems, bright scientists will quickly arrive to make good use of them.
In the prestige rankings of the biomedical sciences, we suspect that the mechanics of, let's say, stomach trouble, rank considerably below the profundities of submolecular research -- which probably accounts for the commission's finding of a dearth of digestive-disease studies in our medical schools. It is this pridebound narrowness of the sciences that impelled Congress to create the digestive-disease commission, as well as similar commissions for diabetes, arthritis and other diseases -- usually over the opposition of the established scientific leadership.
If not sensibly applied, this process carries the dangers if scientific resources being squandered simply to appease raucous constituencies. Such was the case with the national cancer program, which was forcefed money beyond the capacity of the scientific community to make good use of it. However, a carefully formulated expansion into a neglected area of research is a different matter.And that is what has been persuasively recommended by the Commission on Digestive Diseases.