Information security, the science budget, and medicine were the first three topics of the New York Academy of Sciences' Science and Technology Policy Forum breakfast meetings in the 1998-99 academic year. The speakers were Kenneth Flamm, Professor and Dean Rusk Chair in International Affairs at the School of Public Affairs of the University of Texas (Austin, TX) on 17 September; D. Allan Bromley, Dean of Engineering at Yale and Science Advisor to former President Bush on 5 October; and Randall J. Tobias, Chairman of the Board of the Eli Lilly Company on 21 October. Breakfast at the New York Academy of Sciences
by Irma S. Jarcho
In exploring the problems faced by big government and big business in their attempts to safeguard the privacy and security of their transmission of information, Professor Flamm began by sketching the background of coding and decoding during World War II. As is well known, the United States cracked both Japanese and German codes during that war.
Flamm pointed out that the situation is now ever more critical. According to Moore's Law, computer power doubles every 18 months, and it is possible to break any code if enough effort and money are expended. Every system is vulnerable.
Flamm spoke of the United States as the "Ground Zero" of cryptography, with other countries using our technology. He seemed opposed to government efforts to control cryptography: "If strong cryptography is outlawed, only outlaws will have it," he said. There is as yet no resolution of this struggle, and Flamm felt that each side was in "denial." He did not see any magic formula, but he believed that, if it is ever found, it must incorporate a definition of appropriate legal authority, it must be international (an agreement with close allies on a global standard), and it must be a government-industry collaborative, with the formation of an oversight body.
Flamm's most thought-provoking statement was that there is "something about a closet that makes a skeleton terribly restless."
In his talk entitled "The Wagons are Circled: But Do We Shoot Out -- Or In?" Professor Bromley tackled the thorny problem of the research budget and its provenance -- government, universities, or private industry. There has been a rapid shift in the shares of science research funding. Two thirds of science research funds used to come from government, but now only one third does. Scientists are their own worst enemies as far as getting funds is concerned, Bromley said, and the growth of entitlements in the budgets limits the amounts available for research. Formerly amounting to 2% of the Gross Domestic Product (GDP), research is now down to 0.8%.
Bromley noted that there are strong arguments for strengthening research -- results may have an impact where they are least expected. The return on the federal investment in science and technology has been large -- Bromley estimated that 49% of the growth of the GDP in the U.S. since World War II has been due to technological progress. The economics of federal investment in science and technology is evident from the fact that 73% of quoted patents refer to this investment.
In March 1997 four scientific societies got together and pressured Congress to increase the federal research budget by 7%. By October 1997 the group was representing 125 societies. The National Research Investment Act of 1998 doubled the federal investment in fundamental science. Emphasis has been placed on extending Research & Development credits on a permanent basis to provide stable planning for private firms. However, since funds have usually been approved only for one year, no long-term research could be planned.
Tobias' talk on "The End of Surgery and the Coming Revolution in Health Care" presented a most intriguing and encouraging look on the future of medicine and therapeutics. There is a truly amazing scientific revolution underway, Tobias pointed out, one with the potential to transform many aspects of how we live. There has been an increased proliferation of technical advances in the last few decades, among them laparoscopic surgery, through which even heart bypass operations are now accomplished through a small aperture in the body; medical imaging techniques, which enable diagnoses without biopsies; and the whole field of implants and transplants.
The most dramatic practical discoveries, in Tobias' opinion, were in the field of new drugs. These are closely linked to genomics. It is here that Tobias sees the greatest future in medicine. Life is a language written in a very simple alphabet of four compounds. The aim of the Genome Project is to sequence every gene in our species by the year 2005.
But medicine does not have to wait to see the benefits until the Project is completed, he observed. The new medicines being developed bind to the new proteins being discovered and, in some cases, the protein itself is used as a drug -- for example, insulin. A single defective gene can be pinpointed as a cause of a disease, as in the case, for example, of sickle cell anemia. The BRC-1 gene mutation has been implicated as a cause of breast and ovarian cancer in women carrying the gene. They are at present useful warning systems for those at risk. In the future they will be targets for gene repair or replacement. The trend is to use nature to correct nature.
Tobias also called attention to a new wave of "smart" medicines. A new generation of chemotherapy is being developed, drugs which are much more selective in their attack on cancer cells and therefore much less toxic to the patient and better tolerated. Other avenues of research in therapeutics include monoclonal antibodies, "anti-sense" drugs. New therapeutic solutions will be arrived at by bioengineering from tissues. DNA can now be put on a chip. New proteins for patients could be bioengineered to cure anemia. These and many others are on the drawing boards today.
Further into the future one can envision renewed research into learning and into technologies for the extension of life through extending the ability of cells to replicate. We cannot at present envision where such discoveries will take us. We are in the earliest stages of a wave of innovations. We can foresee a revolution in the practice and concepts of medicine. A new order of efficacy, power, and value is in the offing.
Rising health care costs are now being driven by high technology, Tobias noted. The high cost exists because we cannot bury the illness by attacking the cause, what Lewis Thomas called "halfway technology." A revolution enabling us to attack the cause may lower the cost of care.
The aim of more basic research is to understand the underlying events in a disease. But the current health care system is not structured to take advantage of new discoveries, Tobias lamented. He maintained that our health care system must change and that we must restructure our spending. Now the highest cost is concentrated on the last stages of a disease, staving off the end. Instead, he countered, we should back aggressive intervention at the earliest sign. As a diabetic himself, Tobias must inject himself five times a day; but if his illness could have been diagnosed before it happened, this would not be necessary.
Another major hurdle of the health care system cited by Tobias is the effort to meet the demands of those who pay the component cost: there must be managed care and managed cost. Tobias told the story of what happened in New Hampshire when they tried to keep down the cost of drugs by limiting all patients to three prescriptions per month. This measure succeeded in lowering the cost of drugs to the health care system by 35%. However, the cost for the elderly and disabled surged, because patients then flocked to clinics and emergency rooms to get the medicines denied them by the prohibition. As a result, medical costs increased seven times the amount saved by restricting the prescriptions.
In closing, Tobias asserted that a technology that can so powerfully improve life in the future must come to regard all surgery -- except trauma surgery -- as failures of the pharmaceutical industry.
Beginning with a Continental style breakfast from 8 to 8:30 a.m. and followed by an hour's presentation and discussion, these meetings were established in 1985 to afford busy science professionals an opportunity to become cognizant with some of the most advanced thinking by the most advanced participants in their fields, "an intellectually stimulating environment for the discussion of current trends related to science and technology."
Home Winter 99 Full Screen
The TEACHERS CLEARINGHOUSE FOR SCIENCE AND SOCIETY EDUCATION