- Email: [email protected]
Germany: Contraction of Berlin-Buch
666
NIH or by the Dingell committee. "What do I do?", Gallo asked. "I’m not a policeman". Agreeing that the NIH had moved very slowly, Dr Raub testified that Dr Sarin was suspended from his job at the end of January and is now under criminal investigation. The second item on the scholarly portion of the Dingell agenda concerns Stanford University, which last year received about$175 million in "direct" federal support of research. At issue is its wondrous interpretation of allowable charges for the "indirect" costs generated by federally supported research. These added another$85 million to Stanford’s federal receipts. Normally, indirect costs apply to such matters as library services and materials, administration, and security, all of which are presumed to be stretched by the presence of research activities. To help pay for them, federal agencies add a percentage to the sum directly provided for research. At Stanford the indirect rate is 74%. Mr Dingell and his staff are especially fascinated by several unusual items on the Stanford indirect-cost accounts, including$4000 as Washington’s share of a $17 000 wedding reception that the Stanford trustees held for the university’s president and his bride in 1987. Accused by a government auditor of padding its bills, Stanford initially responded by proclaiming that, to the contrary, modesty in seeking its due had actually resulted in undercharges to the government of$13 million. But then, acknowledging that perhaps some billings were unwarranted, Stanford agreed to repay nearly$700 000 in indirect-cost receipts. With Chairman Dingell’s auditors swarming over its books, Stanford hired a couple of high-powered Washington lawyers to handle its swelling problems, including one who formerly was the chief lawyer on Mr Dingell’s committee. It also engaged the services of one of Washington’s top public-relations specialists and appointed a blue-ribbon committee to study its financial relations with federal research agencies. Stanford’s time on the Dingell carpet was scheduled for March 13. In the psyche of the research and academic communities, Mr Dingell is firmly established as the bête noire, and probably nothing short of his permanent retreat from the field can alter that perception. The congressman shrugs off accusations of glory and power seeking at the expense of science, noting that he already possessed a great deal of both when he initially looked into scientific affairs, and that he hasn’t profited at all from his revelations of wrongdoing in the realms of scholarship. Chastised for criticising NIH, perhaps the holiest of government agencies, Mr Dingell points out that his father, who preceded him in Congress, was one of the legislative founders of NIH. And he contends that, by exposing ethical failings in science, he is performing a beneficence for the scientific community. "We have spent years investigating corruption in the defense industry", Mr Dingell declared. "Some of these matters have led to prosecutions and, hopefully, improvements by the industry. However, the scientific community, which apparently has been treated like a sacred cow for too long, acts like a victim of government persecution if questioned about accountability for federal funds". That’s a fair assessment of the matter. The scientific establishment feels misunderstood and persecuted. Mr Dingell feels he is performing a sacred duty. Conciliation is nowhere in sight. Daniel S.
Greenberg
Round the World Germany: Contraction of Berlin-Buch In idyllic park-like surroundings in the outskirts of the former East German capital stands one of the world’s biggest campuses of hospitals and medical research institutes. The general hospital ofBuch hosts a few thousand patients; and the three big research institutes, formerly belonging to the now-defunct Academy of Sciences, together employ almost 2000 scientists and assistants. The Zentralinstitute fur Krebsforschung, Molekularbiologie und Herz-Kreislauf-Krankheiten were pioneers in their respective fields of cancer research and treatment, molecular biology, and cardiovascular diseases-at least in Eastern Europe. However, Berlin-Buch, in common with all research institutions in the east, is now undergoing review by external experts, a process which, according to the German unity treaty, must be completed by the end of this year. The international committee evaluating the research work in Berlin-Buch on behalf of the federal republic’s scientific council (Wissenschaftsrat) has concluded that, although some work is excellent and worth preserving, most projects are not of international standard. For instance, the close cooperation of the Molecular Biology Institute with the commercial sector will not continue. On the whole, the expertise in biochemical methods was judged to be good, whereas knowledge of modern techniques and concepts was
lacking. Only
a small percentage of scientists have a realistic chance of continuing with their work. The committee recommend the merging of the three institutes into one biomedical centre, which would be unique in Germany. The new institute will have only a third of its former staff and the positions will be open to international competition. The chairman of the evaluation committee, the cell biologist Prof Horst Kern from Marburg, sees a unique opportunity to establish a research centre engaged in research on diseases as different as cancer and heart disease from the common standpoint of molecular biology. Also unique, for Germany, is the close cooperation with a research clinic. It has always been an important demand of the scientific council that clinical research be improved, and the opportunity in Berlin-Buch is very welcome. The immediate reaction of the people in Berlin-Buch was to feel insecure and disappointed They had hoped that the three research institutes would be amalgamated into a
"Gro&bgr;forschungseinrichtung",
a
big
independent
institution supported mainly by the Government in Bonn-similar to the German Cancer Research Centre in Heidelberg. Such a recommendation had been proposed by another scientific committee, and plans were already being made along these lines. But "Gro&bgr;forschungseinrichtungen" are unpopular with many scientists. They have been compared to lumbering battleships, swallowing much money but not generating enough good work. Once they are under way, their course is difficult to change. Even if completely off course they are virtually impossible to sink. Scientists and doctors in Berlin-Buch are also worried by the council’s recommendation that only 100 beds (compared with 300 at present) be available for clinical research. The hospital would no longer provide routine care of patients with cancer or cardiovascular disease. It is not yet clear whether the health authorities of Berlin will set up other
667
the resulting shortfall, a step the doctors in Berlin-Buch say is necessary to avoid having a hospital that is purely research oriented. Doctors also fear that they will have fewer referrals. In the competitive German health system losing a patient means losing the money he brings in from his health insurance. Even more pressing is the insecurity among doctors and nurses in Berlin-Buch, who know that they might be unemployed by the end of 1991. Nurses are especially tempted to accept the lucrative offers from the west promoted by the shortage of health personnel there. Prof Manfred Lueder, director of the cancer hospital recently announced that seven anaesthetist nurses were planning to exchange their positions in Berlin-Buch for new jobs in the beds
to cover
west.
Annette Tuffs
Caribbean: Joint efforts in perinatology Interest in early-childhood and even intrauterine origins of adult disease has turned a spotlight on perinatology. A field hitherto for specialists in development and handicap, it has become a focus for adult-oriented epidemiologists. A meeting in Guadeloupe last November, organised by the Caribbean Institute of Perinatology,* brought together respresentatives not only from the French island departements, including Martinique and mainland Guyane (part of France and hence the European Community), but also from the Dutch speaking island of Curaçao, the anglophone territories served by the University of the West Indies, and speakers from Haiti and Santo Domingo. Only Cuba, which now has the lowest infant mortality in the region (now at risk through contraction of Soviet support), was missing but would have been welcome. The meeting was sponsored by pharmaceutical companies and INSERM, the French medical research organisation. Regional variations in perinatal and maternal mortality in the Americas were discussed. The Jamaican perinatal survey illustrated the morbidity from hypertensive pregnancies and how public-health effort might best focus on poor single mothers to encourage early local antenatal attendance. The high toll of fetal hypoxia during labour was reported from Trinidad, and from Curacao came a detailed study of maternal mortality that showed a surprising lack of social-class variation that contrasted sharply with findings from the French islands. The "prematurity paradox" of ethnic variation in fetal maturity (black infants and those originating from the Indian subcontinent being about 1 week earlier in maturation than white babies for a given stage of gestation) was consistently reported in careful studies from Johns Hopkins and South Carolina in the US, by Papiemik’s group in Paris and Martinique, and by Tambyraja from Singapore. The next step will be to examine postmaturity in a controlled trial. Finally, Thorburn outlined efforts in Jamaica and Montserrat to pinpoint childhood disability risk factors prenatally and to develop a system for supporting handicapped children despite very few resources. Once again, the social and political basis of these problems and how health care is organised were the most important issues. These were illustrated by the lack of central government initiative in Haiti, where there were reported to be only four fully trained midwives for the whole island.
Unfortunately for the traditionally anglo-oriented Caribbean, official British interest in the health problems of the region has been very limited; and the UK Overseas Development Agency is now actively withdrawing its limited support. The small annual maintenance grant of some £30 000 to the Caribbean Commonwealth Medical Research Council (CCMRC) is to countries of the
go next year, and
is the British contribution to the region’s major public health coordinator based in Trinidad, the Caribbean Epidemiology Centre (CAREC). The British cold shoulder, excessive UK course fees for overseas students, and a failure of an important-and successfulBritish Medical Research Council unit in the Caribbean to train able local graduates have all contributed to the dubious profile that the British have acquired here. One suspects that the present generation of both medical and government officials in senior positions in the UK have lost their international vision. Perhaps they have failed to learn that, as their predecessors found, constructive and generous relationships can bring subtle long-term benefits and that altruism-without dictating the terms-could still be a virtue in world affairs. Meanwhile France, Canada, the US National Institutes of Health, and individual US investigators seem delighted to find research opportunities in genuinely joint programmes with local research teams. As several speakers at the congress pointed out, a novel and timely code of research conduct is being developed, whereby funding agencies have some responsibility to see through results into at least initial practice. Research grants will now need to contain "followup" sums so that, for example, limited initial screening for rubella, chlamydia, cytomegalovirus, and HTLV-I can be implemented if results warrant it (as they mostly do). The congress illustrated how sharing data can lead to joint initiatives, not least to try to standardise birth and death certificates, and the possibility of a central database with access via electronic mail. The hope here is that the UK Government will renew its interest in the health problems of the Caribbean and will reverse its decision to withdraw its so now
support. *Address: Witteweg 46, PO Box 112, Barbados
Curaçao, Netherlands Antilles. A correspondent
Kenya: Maasai warriors and their sexual partners One does not have to drive far out of Nairobi to see areas of the countryside in which the ecosystem is deteriorating and Maurice King’s "trap" (see Lancet 1990; 336: 664-67) is likely to close. Many of the homesteads have tiny plots. Such grass as there is is interspersed with imported eucalyptus, which is so difficult to eradicate, or cypress, most of which is dying. My visit took me to a rural school that had 800 pupils but was much smaller than many others in the district. The Kenyan population is growing at around 4% a year and will double every 17 years. At this rate there will be a ten-fold increase in the population by the time the children I saw become grandparents. Although the Kenyan Government has accepted family planning, there is still no major programme to limit families to two or at the most three children, and population growth has not yet become a prime concern.
the tribal groups, the Maasai have probably suffered more than most. Being nomadic people, few are educated. Their population growth rate is thought to be over
Among
NIH or by the Dingell committee. "What do I do?", Gallo asked. "I’m not a policeman". Agreeing that the NIH had moved very slowly, Dr Raub testified that Dr Sarin was suspended from his job at the end of January and is now under criminal investigation. The second item on the scholarly portion of the Dingell agenda concerns Stanford University, which last year received about$175 million in "direct" federal support of research. At issue is its wondrous interpretation of allowable charges for the "indirect" costs generated by federally supported research. These added another$85 million to Stanford’s federal receipts. Normally, indirect costs apply to such matters as library services and materials, administration, and security, all of which are presumed to be stretched by the presence of research activities. To help pay for them, federal agencies add a percentage to the sum directly provided for research. At Stanford the indirect rate is 74%. Mr Dingell and his staff are especially fascinated by several unusual items on the Stanford indirect-cost accounts, including$4000 as Washington’s share of a $17 000 wedding reception that the Stanford trustees held for the university’s president and his bride in 1987. Accused by a government auditor of padding its bills, Stanford initially responded by proclaiming that, to the contrary, modesty in seeking its due had actually resulted in undercharges to the government of$13 million. But then, acknowledging that perhaps some billings were unwarranted, Stanford agreed to repay nearly$700 000 in indirect-cost receipts. With Chairman Dingell’s auditors swarming over its books, Stanford hired a couple of high-powered Washington lawyers to handle its swelling problems, including one who formerly was the chief lawyer on Mr Dingell’s committee. It also engaged the services of one of Washington’s top public-relations specialists and appointed a blue-ribbon committee to study its financial relations with federal research agencies. Stanford’s time on the Dingell carpet was scheduled for March 13. In the psyche of the research and academic communities, Mr Dingell is firmly established as the bête noire, and probably nothing short of his permanent retreat from the field can alter that perception. The congressman shrugs off accusations of glory and power seeking at the expense of science, noting that he already possessed a great deal of both when he initially looked into scientific affairs, and that he hasn’t profited at all from his revelations of wrongdoing in the realms of scholarship. Chastised for criticising NIH, perhaps the holiest of government agencies, Mr Dingell points out that his father, who preceded him in Congress, was one of the legislative founders of NIH. And he contends that, by exposing ethical failings in science, he is performing a beneficence for the scientific community. "We have spent years investigating corruption in the defense industry", Mr Dingell declared. "Some of these matters have led to prosecutions and, hopefully, improvements by the industry. However, the scientific community, which apparently has been treated like a sacred cow for too long, acts like a victim of government persecution if questioned about accountability for federal funds". That’s a fair assessment of the matter. The scientific establishment feels misunderstood and persecuted. Mr Dingell feels he is performing a sacred duty. Conciliation is nowhere in sight. Daniel S.
Greenberg
Round the World Germany: Contraction of Berlin-Buch In idyllic park-like surroundings in the outskirts of the former East German capital stands one of the world’s biggest campuses of hospitals and medical research institutes. The general hospital ofBuch hosts a few thousand patients; and the three big research institutes, formerly belonging to the now-defunct Academy of Sciences, together employ almost 2000 scientists and assistants. The Zentralinstitute fur Krebsforschung, Molekularbiologie und Herz-Kreislauf-Krankheiten were pioneers in their respective fields of cancer research and treatment, molecular biology, and cardiovascular diseases-at least in Eastern Europe. However, Berlin-Buch, in common with all research institutions in the east, is now undergoing review by external experts, a process which, according to the German unity treaty, must be completed by the end of this year. The international committee evaluating the research work in Berlin-Buch on behalf of the federal republic’s scientific council (Wissenschaftsrat) has concluded that, although some work is excellent and worth preserving, most projects are not of international standard. For instance, the close cooperation of the Molecular Biology Institute with the commercial sector will not continue. On the whole, the expertise in biochemical methods was judged to be good, whereas knowledge of modern techniques and concepts was
lacking. Only
a small percentage of scientists have a realistic chance of continuing with their work. The committee recommend the merging of the three institutes into one biomedical centre, which would be unique in Germany. The new institute will have only a third of its former staff and the positions will be open to international competition. The chairman of the evaluation committee, the cell biologist Prof Horst Kern from Marburg, sees a unique opportunity to establish a research centre engaged in research on diseases as different as cancer and heart disease from the common standpoint of molecular biology. Also unique, for Germany, is the close cooperation with a research clinic. It has always been an important demand of the scientific council that clinical research be improved, and the opportunity in Berlin-Buch is very welcome. The immediate reaction of the people in Berlin-Buch was to feel insecure and disappointed They had hoped that the three research institutes would be amalgamated into a
"Gro&bgr;forschungseinrichtung",
a
big
independent
institution supported mainly by the Government in Bonn-similar to the German Cancer Research Centre in Heidelberg. Such a recommendation had been proposed by another scientific committee, and plans were already being made along these lines. But "Gro&bgr;forschungseinrichtungen" are unpopular with many scientists. They have been compared to lumbering battleships, swallowing much money but not generating enough good work. Once they are under way, their course is difficult to change. Even if completely off course they are virtually impossible to sink. Scientists and doctors in Berlin-Buch are also worried by the council’s recommendation that only 100 beds (compared with 300 at present) be available for clinical research. The hospital would no longer provide routine care of patients with cancer or cardiovascular disease. It is not yet clear whether the health authorities of Berlin will set up other
667
the resulting shortfall, a step the doctors in Berlin-Buch say is necessary to avoid having a hospital that is purely research oriented. Doctors also fear that they will have fewer referrals. In the competitive German health system losing a patient means losing the money he brings in from his health insurance. Even more pressing is the insecurity among doctors and nurses in Berlin-Buch, who know that they might be unemployed by the end of 1991. Nurses are especially tempted to accept the lucrative offers from the west promoted by the shortage of health personnel there. Prof Manfred Lueder, director of the cancer hospital recently announced that seven anaesthetist nurses were planning to exchange their positions in Berlin-Buch for new jobs in the beds
to cover
west.
Annette Tuffs
Caribbean: Joint efforts in perinatology Interest in early-childhood and even intrauterine origins of adult disease has turned a spotlight on perinatology. A field hitherto for specialists in development and handicap, it has become a focus for adult-oriented epidemiologists. A meeting in Guadeloupe last November, organised by the Caribbean Institute of Perinatology,* brought together respresentatives not only from the French island departements, including Martinique and mainland Guyane (part of France and hence the European Community), but also from the Dutch speaking island of Curaçao, the anglophone territories served by the University of the West Indies, and speakers from Haiti and Santo Domingo. Only Cuba, which now has the lowest infant mortality in the region (now at risk through contraction of Soviet support), was missing but would have been welcome. The meeting was sponsored by pharmaceutical companies and INSERM, the French medical research organisation. Regional variations in perinatal and maternal mortality in the Americas were discussed. The Jamaican perinatal survey illustrated the morbidity from hypertensive pregnancies and how public-health effort might best focus on poor single mothers to encourage early local antenatal attendance. The high toll of fetal hypoxia during labour was reported from Trinidad, and from Curacao came a detailed study of maternal mortality that showed a surprising lack of social-class variation that contrasted sharply with findings from the French islands. The "prematurity paradox" of ethnic variation in fetal maturity (black infants and those originating from the Indian subcontinent being about 1 week earlier in maturation than white babies for a given stage of gestation) was consistently reported in careful studies from Johns Hopkins and South Carolina in the US, by Papiemik’s group in Paris and Martinique, and by Tambyraja from Singapore. The next step will be to examine postmaturity in a controlled trial. Finally, Thorburn outlined efforts in Jamaica and Montserrat to pinpoint childhood disability risk factors prenatally and to develop a system for supporting handicapped children despite very few resources. Once again, the social and political basis of these problems and how health care is organised were the most important issues. These were illustrated by the lack of central government initiative in Haiti, where there were reported to be only four fully trained midwives for the whole island.
Unfortunately for the traditionally anglo-oriented Caribbean, official British interest in the health problems of the region has been very limited; and the UK Overseas Development Agency is now actively withdrawing its limited support. The small annual maintenance grant of some £30 000 to the Caribbean Commonwealth Medical Research Council (CCMRC) is to countries of the
go next year, and
is the British contribution to the region’s major public health coordinator based in Trinidad, the Caribbean Epidemiology Centre (CAREC). The British cold shoulder, excessive UK course fees for overseas students, and a failure of an important-and successfulBritish Medical Research Council unit in the Caribbean to train able local graduates have all contributed to the dubious profile that the British have acquired here. One suspects that the present generation of both medical and government officials in senior positions in the UK have lost their international vision. Perhaps they have failed to learn that, as their predecessors found, constructive and generous relationships can bring subtle long-term benefits and that altruism-without dictating the terms-could still be a virtue in world affairs. Meanwhile France, Canada, the US National Institutes of Health, and individual US investigators seem delighted to find research opportunities in genuinely joint programmes with local research teams. As several speakers at the congress pointed out, a novel and timely code of research conduct is being developed, whereby funding agencies have some responsibility to see through results into at least initial practice. Research grants will now need to contain "followup" sums so that, for example, limited initial screening for rubella, chlamydia, cytomegalovirus, and HTLV-I can be implemented if results warrant it (as they mostly do). The congress illustrated how sharing data can lead to joint initiatives, not least to try to standardise birth and death certificates, and the possibility of a central database with access via electronic mail. The hope here is that the UK Government will renew its interest in the health problems of the Caribbean and will reverse its decision to withdraw its so now
support. *Address: Witteweg 46, PO Box 112, Barbados
Curaçao, Netherlands Antilles. A correspondent
Kenya: Maasai warriors and their sexual partners One does not have to drive far out of Nairobi to see areas of the countryside in which the ecosystem is deteriorating and Maurice King’s "trap" (see Lancet 1990; 336: 664-67) is likely to close. Many of the homesteads have tiny plots. Such grass as there is is interspersed with imported eucalyptus, which is so difficult to eradicate, or cypress, most of which is dying. My visit took me to a rural school that had 800 pupils but was much smaller than many others in the district. The Kenyan population is growing at around 4% a year and will double every 17 years. At this rate there will be a ten-fold increase in the population by the time the children I saw become grandparents. Although the Kenyan Government has accepted family planning, there is still no major programme to limit families to two or at the most three children, and population growth has not yet become a prime concern.
the tribal groups, the Maasai have probably suffered more than most. Being nomadic people, few are educated. Their population growth rate is thought to be over
Among