PHOTO: TZIGANE

Avoiding professional prostitution

PETER MACKLEM | Canada is trying to change its economy from one based on natural resource exploitation to one based on knowledge and technology. To succeed, the new economy will depend upon a continuous supply of new products and technologies arising from research labs across the country. The Canadian scientific community is being asked to become the engine to turn out those products and technologies. A major step was taken in 1990, when the first Networks of Centres of Excellence were created. There are currently 15 of these federally funded networks in the social, natural, engineering and biomedical sciences. They are interdisciplinary networks consisting of a geographically dispersed, critical mass of investigators collaborating at universities across the country to develop intellectual property that will create jobs and wealth and improve the quality of life of Canadians. Whereas countries like the USA and Japan are developing a knowledge-based economy by stimulating industrial research and development, in Canada, the industrial research and development infrastructure is so small, the government was forced to turn to university scientists to transform the economy. University scientists account for about 80 per cent of Canada's research output, measured as publications, but consume only 22 per cent of Canada's general expenditures on research and development. An article in The Economist included information about scientific publications produced by different countries in 1991. When this data is normalized to publications per capita to obtain a measure of scientific productivity, Canada ranks first among G7 countries, followed closely by the USA and Great Britain. The number of times other scientists cite a publication indicates the impact of a publication. Canada is second only to the USA in the number of citations per capita. These statistics clearly show that Canadian science is world class. If our scientists could really be incorporated into the nation's economic machinery, Canada would have a very significant competitive advantage over countries like Germany and Japan. But we have to address some serious problems before that can happen. Once a scientist creates intellectual property, much needs to be done to get the product out of the lab and into the market place. The property needs to be protected by patenting or other means. Prototypes must be developed, tested, and built with appropriate industrial design. In the pharmaceutical field, molecular modifications of new drugs are often required to increase sensitivity and decrease toxicity. In medicine, a new discovery may be in response to a need perceived not by industry, but by a doctor. In fact, physician-scientists who interact regularly with patients probably have considerably greater awareness of market needs than either the pharmaceutical or medical device industries. In order to commercialize such an invention, it is necessary to convince industry that there is a need that they haven't perceived. This requires expensive research, publications and presentations at scientific meetings to create a demand and expand the market. To commercialize intellectual property, market surveys need to be done. Due diligence and knowledge of the competition are required. A decision must be made as to whether an attempt will be made to license the IP or whether to establish a spin-off company. In the former case an extensive search for licensees may be required; in the latter, a business plan needs to be written (scientists writing a business plan?), a CEO, who will champion the product, chosen and venture capital sought. Although, ideally, university technology transfer offices (OTT) should undertake these activities, most Canadian OTTs lack both funds and staff that are capable of undertaking this multitude of tasks. As a result, there is a large commercialization gap between the discovery of a new product by a university scientist and its licensing by industry or the formation of a spin-off company. With the exception of a few, like UBC, Queen's and the University of Alberta, Canadian universities have invested little in technology development and transfer. No university in Canada, to my knowledge, has recognized the profession of transfer technologist, nor have any established interdisciplinary curricula involving business administration, law, science, engineering and biology to educate and train transfer technologists. Of course, bridging the commercialization gap is expensive and Canadian universities are hurting for money. The Advisory Panel for Science and Technology estimates that the income from IP commercialization is unlikely to exceed one per cent of a university's budget. This meagre income is little incentive for universities to upgrade their OTTs. That being the case, it seems that government incentives are required. Partial financing of a core technology transfer facility serving a consortium of universities is a potential solution. A single central technology commercialization facility to serve all members of a university consortium would avoid duplication and allow for specialization in such areas as patent law, business development, pharmaceuticals, engineering, contract law and access to venture capital. Furthermore, governments could increase university budgets contingent upon establishing training programs for transfer technologists. The other key player in the transition of our economy is our financial institutions. While they frittered away their customers' dollars by violating their own rules to finance such dubious ventures as Campeau Corporation and Olympia and York, they have largely ignored their role in developing the new economy. Financing is needed in order to do the research and development required to bring a product to market. While this is high-risk stuff, it surely couldn't be worse than Canary Wharf and it's much, much cheaper. The NCE program has had a dramatic effect on Canadian university scientists. It has taken them out of the ivory tower and changed their self-image. They now perceive themselves as actively contributing to the economy rather than being passive bystanders. Now it is up to our financial institutions to capitalize on this. Still, there is an inherent conflict of interest between the professions and industry. Professional altruism demands that public welfare remains as important a priority as shareholder profit is for business and cost-containment is for government. If professional values fail, professional prostitution results. I will use medicine as an example. Since the time of Hippocrates and the Hippocratic Oath, medicine has been altruistic. No physician is true to his profession if he does not make the patient his first priority. The idea of profit and concerns about cost must always be secondary to the patient's welfare. On the other hand, no business is worthy of investor confidence if it does not make profit for its shareholders its first priority. The profit motive and patient priority are in serious conflict. This is clearly evident in the for-profit medical industry in the USA, where the incentives are to look after the healthy because it's cheap, and avoid the sick because they are expensive. Big business is gaining more control over the practice of medicine. In the United States, for-profit hospital corporations proliferate by buying hospitals and putting competing hospitals out of business. The for-profit system actually bought a whole medical school in Philadelphia and a teaching hospital in Pittsburgh to service it. They have started to control medical education so that their graduates will have corporate profits as their first priority. Whereas the design of randomized clinical trials to provide evidence that a new drug works better or worse than old ones is best done by reasonably objective university epidemiologists and statisticians, today most of the clinical trials are being designed by private sector clinical research organizations (CROs). Any epidemiologist knows that the design of a randomized controlled clinical trial can have a big effect on the outcome. The probability of showing that a drug is beneficial can be either maximized or minimized by the way a trial is designed. As CROs depend upon pharmaceutical firms for their income, which way do you think they will design their clinical trials? While all this has gone on, the medical profession has remained disgracefully passive. We have made almost no concerted efforts to protect the values embodied in the Hippocratic Oath. In any complex system or organization there are always competing priorities. Each priority must have its champion in order to counterbalance the efforts of those with conflicting priorities. The founding fathers of the United States recognized this when they wrote their constitution so that government, administration and judiciary each had checks and balances against the other. In today's health care system, who has championed the patients? The answer is no one except the patients themselves. The medical profession has failed to maintain the patient's welfare as the first priority of medical practice. At best this is unprofessional behaviour. At worst it represents collective malpractice. What has all this to do with science and the economy? The answer is that science, like medicine, is a profession with a strong ethical and altruistic tradition. The role of science is to provide the best possible answers to questions of importance through theory and experimentation. In so doing, science attempts to uncover truth. Whereas medicine's altruism resides in establishing the patients as first priority, science's altruism lies in honesty. What to make then of corporate scientists who defend the use of tobacco, who claim that CFCs did not damage the ozone layer, who claim that industrial fossil fuels are not responsible for global warming? Will the commercialization of science result in more professional prostitution? One can hardly expect a politician to present the down side of government policy; his job is to persuade the public of its value and get re-elected. One can hardly expect a businessman to describe negative aspects of his company's products; his job is to manufacture, advertise, market and sell. But anyone who claims to be a scientist is bound by his code of ethics to present a balanced view and to provide the evidence upon which this viewpoint is based. Scientists must be as objective as possible in their research and accept the truth that our experiments provide, even though we may not like it. If medicine and science are to make an important contribution to our country's economy by improving our standard of living, by discovering and commercializing intellectual property and thereby creating jobs and wealth, we must do so without accepting the profit motive and cost containment as our most important goals. We the scientists must not repeat the mistake of we the physicians. We must not be passive in the new economy and we must ensure that our professional values are enshrined alongside those of business and government. It is not too late for medicine to do the same thing. Excerpted from a speech by emeritus professor of medicine Peter Macklem at the 1999 Gairdner Awards. He received the Gairdner Foundation's Wightman Award as an outstanding medical scientist whose work has contributed significantly to improving the quality of human life.