Cuts in Public Spending on Medical Research

1285 advertisement by a chiropracter stating that he specialised in treating "victims of agent orange". He listed the symptoms: backache, headache, lassitude, impotence, and all the rest that are claimed by certain people to be caused by this chemical. I thought to

myself, "How marvellous! A non-treatment (chiropractic) for a nondisease (chronic agent orange poisoning)". Can this happen only in America? Department of Medicine, Piedmont Hospital, Atlanta, Georgia 30309, USA

NICHOLAS E. DAVIES

Commentary from Westminster Fig 2-Follicles aspirated and oocytes retrieved for the HMG and FSH

regimens.

IVF attempts (twenty-one oocytes collected from 20 attem.pts). was infused subcutaneously at a dose of 1000 µg (five 500 µg (four), or 250 µg daily (two), starting on the day before or day of menstruation. This treatment was continued until we obtained ultrasound confirmation of the disappearance of all ovarian follicles and of the endometrial lining. This took 15 days on average (fig 1). The patients were then randomly allocated to treatment with HMG or FSH, given in doses of two ampoules daily for 6 days and followed by four ampoules daily for a mean of 11days. 10 000 IU HCG was administered when two or more follicles reached a diameter of 20 mm or more. Oocytes were recovered by laparoscopy alone or in combination with ultrasound-guided follicle aspiration, via the percutaneous transvesical approach. This treatment regimen was associated with a striking increase in the number of oocytes recovered (eighty-seven oocytes from the eleven treatment cycles). There was, however, no significant difference in the mean number of follicles aspirated (11.5 in the HMG group, 8.6 in the FSH group) or in the mean number of oocytes recovered (9’ 3 amd 6 - 2, respectively) between the two

Buserelin

patients),

groups. Moreover fertilisation rates were not different FSH 73%). One of the treated patients now has a continuing clinical pregnancy with a detectable fetal heart beat on ultrasound examination. These data confirm the relative unimportance of LH for the and indicate that pituitary stimulation of follicular

treatment

(HMG 82%,

development3,4

an LHRH analogue followed by gonadotropin stimulation offers an effective method of induction of multifollicular ovulation for IVF, particularly in women who prove resistant to other methods of treatment.

suppression by

R. N. PORTER W. SMITH I. L. CRAFT

IVF Unit, Cromwell Hospital, London SW5 0TU

Cobbold Laboratories, Middlesex Hospital, London W1

N. A. ABDULWAHID

H. S. JACOBS

1 Craft I, Porter R, Green S, et al. Success of fertility, embryo number, and in-vitro fertilisation Lancet 1984; i: 732. 2 Seppala M, et al The World collaborative report on in vitro fertilisation and embryo replacement: Current state of the art in January, 1984 Paper read at Third World Congress on IVF and ET (Helsinki, May, 1984). 3 Jacobs HS, Abdulwahid N, Adams J, et al Endocrine control of follicular growth in humans Vth Reinier de Graaf lecture In: Rolland R, ed Gamete quality and fertility regulation: Proceedings of the Vth Reiner de Graaf Symposium (Nijmegen, August, 1984). Amsterdam: Elsevier (in press) 4 Kenigsberg D, Littman B, Williams R, Hodgen G. Medical hypophysectomy II. Variability of ovarian response to gonadotrophin therapy Fertil Steril 1984, 42: 116-26

AGENT ORANGE

SIR,—I was interested in your Oct 20 Round the entitled Agent Orange: a New Twist. In Kansas City I twist

involving

agent orange. A

daily

Cuts in Public

Spending on Medical Research THE Government still professes to believe that an economy grows in direct proportion to its efficiency. People and institutions, according to the theorists, become more prosperous to the extent that they use their resources with decreasing wastefulness. This is no doubt true of commercial enterprises. For five years now the Government has applied the same theory to the management of essentially noncommercial enterprises-to the NHS and to medical and scientific research. Budgets have been steadily reduced, since they represent a drain on public expenditure; and reducing the Public Sector Borrowing Requirement is the sine-quanon of policy. When expenditure cuts are discussed by Ministers, there is nobody in the Cabinet who determinedly speaks up for medical and scientific research, it was suggested by the independent peer, Lord Sherfield, when the House of Lords debated the financing of the Research Councils. In the most significant speech of the debate, the Tory peer, Lord Jellicoe, who is chairman of the Medical Research Council, spoke gravely of the situation that has developed for medical research. Its prospects should be very bright, he said, because the MRC had recently taken important new

by creating new programmes in the fields neurobiology, psychiatry, tuberculosis, and dentistry.

of In

these and other fields the MRC

an

initiatives

newspaper carried

a

large

present faced with

limited. Cash for out-of-house research, for instance, was insufficient to meet applications for good, new work. Inhouse work had been curtailed to the extent of closing twenty units over the past eight years, but was still badly

underfunded. These were hard times: Lord Jellicoe was not alone in that pronouncement. The cost of equipment was now rising explosively. The MRC’s income had fallen in real (after inflation) terms, and looked like falling further. Income had been even more reduced by other items: salary increases following a university pay award well in excess of the Government’s cash limits; an increase in superannuation contributions from the MRC, demanded by the Government Actuary; a loss from rounding-down of cash grants by sponsoring Government department; and sharply rising costs for subscriptions to international bodies, because of fluctuating exchange rates. "Not only is the Council’s ability to fund new work

World item saw another

was at

unusually high degree of first-class applications for research grants. "Our ability to implement these opportunities depends upon cash-and spare cash is just what we lack," he declared. Despite careful management ("good housekeeping") the MRC’s room for manoeuvre was desperately

now

in

adequately to

question, but, even worse, our capacity existing commitments is now very much

meet

in doubt," Lord Jellicoe declared. The Council had been forced into making a 2107o cut in the overall running expenses

1286

of its units. "We have also been unable to support over half of the top-class alpha, high-scoring applications for long-term grant support." He was especially worried that the future promised an even worse state of affairs. The MRC expected to have its funding further reduced in the next two years. The situation was "pretty critical" for scientific research as a whole in Britain. Lord Jellicoe described the "stark expedients" which had been forced on the MRC. In the coming year the Council would cut by half its normal provision for capital equipment. The capital building would be cut back hard. Support for long-term projects in universities would be reduced by a quarter; support for short-term work there was to be cut by 7.5%. The universities, he pointed out, were already suffering in this area because of cuts in support from the University Grants Committee. Training awards from the MRC to universities had also had to be cut by one-third. Lord Jellicoe warned: "If this goes on we shall be faced with a situation in which our ability to exploit new opportunities in medical research will be hamstrung by a shortage of trained workers. It is precisely the situation with which this country is faced at the present time in information technology. It seems to me cavalier to incur it needlessly in medical research". Lord Jellicoe accepted that there was a need for the Government to curtail public spending as much as possible. But he doubted whether Ministers really understood the gravity of the situation. More funds were needed to give research stability in real terms. If the Government failed, they would lose many opportunities. These included the expanding field of nuclear magnetic resonance imaging, in which Britain was still a world leader, and from which a large commercial dividend stood to be won. This would, however, require cash from the Government. So would the application of British expertise in molecular biology. The Government should also offer more support for the MRC’s work in the study of absence from work through sickness, and its research into senile dementia. There was support for Lord Jellicoe from the independent peer, Lord Adrian, master of Pembroke College, Cambridge, who pointed to the MRC’s reduction of expenditure on important items such as consumable supplies, chemicals, and radioisotopes. The Social Democratic peer, Lord Kilmarnock, warned of the possibility that cumulative underfunding would eventually cripple the country’s research effort. The MRC’s funds were likely to decrease, in real terms, by at least 17% over the coming ten years, he feared, though some people predicted a 25% drop. How much importance, he wondered, did the Government attach to the MRC’s work affecting preventive (and thus cost-saving) medicine? The Council was studying transplantation immunology, cardiovascular disease, AIDS, environmental medicine, and cot deaths. Financial restriction meant that the MRC was no longer simply refusing to fund unconvincing research projects, but was forced to reject the creme de la creme.

For the Government, the Earl of Swinton had little cheer to offer. He assured the House that the Government would wish to give the Research Councils every encouragement in the endeavours they were making to attract money from the private sector. He then lapsed into techni-speak, hoping piously that the Research Councils would seek to "increase efficiency, transfer technology to industry, publish corporate plans, and translate into their own operations the principles of the Government’s financial management initiative". RODNEY DEITCH

Obituary NORMAN GESCHWIND

Lyons, FRCPG Professor Geschwind, James Jackson Putnam professor of neurology at Harvard University and professor at Massachusetts Institute of Technology (Psychology), died on Nov 4, aged 58. MD Harvard, D Sc

Born in New York, he entered Harvard College in 1942 and served in the United States Infantry from 1944 to 1946. He graduated MD cum laude from Harvard in 1951. After internship at the Beth Israel Hospital he won a Moseley travelling fellowship to the National Hospital, London, where he stayed until 1955. There he was very happy, carrying out research in membrane excitability and gaining clinical experience, in particular under the tutorship of Sir Charles Symonds. Back in Boston he was appointed chief resident to Dr Denny-Brown at Boston City Hospital and then had two years as research associate at MIT. He then became neurologist to the Boston Veterans Administration Hospital, where he was made chief in 1963. He was made professor and chairman at Boston University and director of the aphasia unit in 1966. During these years his energy was unlimited and in the rich intellectual and scientific environment of Boston his interest was guided towards higher cortical function. He delighted in his friendships with Professor Quadfasel and Professor Yakovlev, gaining from them an extensive and unusual knowledge of the early history of European neurology and of neuroanatomy. This period led to his classical work on the disconnection syndromes in animals and man. Over the next few years he published work on aphasia, the history of language, language-induced epilepsy, and the apraxias. He discovered the anatomical asymmetry of the brain and became interested in dominance and laterality. He was a prolific writer and in further papers dealt with isolation of the speech area, the apraxias and agnosias, normal-pressure hydrocephalus, and the anatomical pathways underlying higher cortical function. In 1969 he became James Jackson Putnam professor of neurology at Harvard, in succession to Denny-Brown. In the same year he was made president of the Boston Society of Neurology and Psychiatry, of the section of neurology and psychiatry of the Massachusetts Medical Society, and of the American Association of University Professors of Neurology. Other honours were membership of the American Neurological Association, the American Academy of Neurology, the Academy of Aphasia, the American Association for the Advancement of Science, and the American Academy of Arts and Sciences. He was made an honorary member of the French Society of Neurology, the Brazilian Academy of Neurology, and the Royal Society of Belgium. He was also given several honorary degrees, but the honour that gave him especial pleasure was his fellowship of the Royal College of Physicians of Glasgow. Norman was physician, scholar, philosopher, and warm friend. He was clever and ingenious, doing everything well. He could write and converse in six languages and mastered in weeks the art of juggling, having read about the physics of this skill in French. His ideas and observations, not only on the disconnection syndromes but also on language mechanisms and latterly on the learning disorders, laterality, and hormonal influences on the brain, are seminal. Happily his hypotheses are now being confirmed. Shortly before his death he came to St Andrews, where he was one of the founder members of the Rodin Academy, dedicated to research in learning disorders. His warmth, boundless energy, humility, and stimulating conversation on a vast array of subjects endeared him to everyone he met. His endocrinologist brother Irving died in 1978, but Norman is survived by his wife Pat and their three children. For those who knew and loved him, the loss of this unique man is irreparable. P. 0. B.