Time to fix the malaise in medical research

Earlier this summer, I went to visit the University of Pennsylvania Medical Centre in Philadelphia. It is one of the top five medical schools in the US and is at the leading edge of world medical research.

Important scientific breakthroughs are made in its laboratories. Treatments and techniques are pioneered in its clinics and hospital wards. Work which will have important medical and economic effects in the new millennium is being done within its walls. Much of this work is being done by Irish men and women. And unless Ireland does something about it soon, none of it will benefit the Irish economy.

Economists disagree about most things but almost all agree that biotechnology will be the next big engine of economic growth. Just as computers have driven economic change over the last 30 years, the life sciences will do so over the next 30. Genetics, pharmaceuticals and medical research will have a huge impact on agriculture, industry and almost every area of human life.

We can, and should, argue about the moral and political implications of these changes. But there is no real argument about the need for Ireland, if it is to hold its new place as a developed economy, to engage with these forces from a position of strength.

Unless we start to develop a strong infrastructure of biomedical research, we will be left behind. And if that happens, the current computer-driven boom may come to be seen as a temporary little aberration.

It's true that Ireland is already an important base for the manufacture of pharmaceutical products. The fact that the impotence drug, Viagra, is made in Ringaskiddy, Co Cork, tends to create the illusion that Ireland is at the forefront of biomedical technology.

But let's not kid ourselves. Pharmaceutical companies are in Ireland because of the relatively lax environmental standards and the relatively cheap labour. Very few of them are doing in Ireland the research and development work which might turn a marriage of convenience into a lifelong commitment. If it becomes cheaper and more convenient to make a drug like Viagra in India or in Hungary, the Irish pharmaceutical industry will start to look decidedly limp.

The problem is not that Irish universities are failing to turn out good biomedical researchers. If anything, the quality of research done in Irish universities is astonishingly high given the meagre nature of the funding. However, the fact remains that the great majority of bright, energetic medical researchers graduating from Irish institutions have to go abroad to work and find it extremely difficult to return to Ireland.

To spend a day wandering around the medical faculty at the University of Pennsylvania is to be astonished by the strength of the Irish presence in such a prestigious institution and depressed at the overwhelming feeling that Ireland has little to offer these people.

A Dubliner, Dr Garret FitzGerald (no relation), chairs the Department of Pharmacology, holds the Professorship of Cardiovascular Medicine and directs both the Centre for Experimental Therapeutics and the Clinical Research Centre.

Dr Patrick Storey, originally from Co Wicklow, runs the international medical programmes. Dr David Kennedy heads the Department of Otorhinolaryngology (ear, nose and throat). Dr Emma Meagher heads the Patient-Oriented Research Programme. Dr Michael Lucey is director of Hepatology (liver medicine) and medical director of the liver transplantation programme.

SOME of these people have concluded that they cannot work within the Irish medical system. Dr FitzGerald returned to Dublin a few years ago to set up a cardiovascular research centre but found it impossible to work, as he does in Philadelphia, both with patients and in the laboratory. After little over two years, he returned to the US.

Dr Kennedy went back to Ireland in 1980 for a trial period to see if he could move back altogether and, regretfully, decided for two reasons, that he couldn't do so.

One reason was that the lack of basic research equipment was so severe that he found that he was spending his Sundays going around various clinics to borrow bits and pieces. The other was that he couldn't shut his eyes to the fact that people without the money to afford private treatment were being left untreated on waiting lists.

But the most serious problem is not that these senior doctors are working in the US but what's happening to the young, talented medical researchers who ought to be at the centre of building a real scientific capacity in Ireland.

I met four female post-doctoral researchers from Ireland, all working in the Centre for Experimental Therapeutics or the Department of Pharmacology in the University of Pennsylvania. Each of them is there because she is very good at what she does. Each of them would rather be in Ireland. And none of them sees much hope that she is going to be able to return to a decent job.

There is simply no place in the Irish system for these young scientists, no structure into which they might fit. Occasionally, a university teaching post becomes vacant but these women are primarily research scientists, not teachers.

Occasionally, a consultant's post in one of the Irish hospitals becomes vacant but such positions tend to be filled by older doctors at a very different stage in their careers. The pharmaceutical companies do very little research in Ireland, so there's not much available there. The best that Ireland can offer these women is the kind of thing they've come from - a poorly-paid, short-term job in a badly-equipped laboratory which is meant to give students experience.

Even an established, relatively senior scientist like Dr Emma Meagher, who runs an entire research programme at Pennsylvania, is sceptical about whether she will ever be able to do the same kind of work in Ireland.

"When the Irish come here," she says, "they flourish. They survive in a very competitive environment. But if I had stayed at home, I would have struggled. It's partly that being a woman in Irish medicine means you might as well shoot yourself.

"But it's also that medicine in Ireland is just not a scientific community. It's very difficult to actually do clinical research. The system is hierarchical and the consultants are adamant in protecting what they see as their territory, which is absolutely ludicrous because there are enough private patients to make them all wealthy. There's no incentive to do original research."

Yet the future of medical practice lies in precisely this kind of combination between clinical work and scientific research. It is simply insane that someone good enough to do this kind of work in one of the world's best medical centres can't even aspire to do it in Ireland. Ireland needs to do something about this soon. What it might be is a subject to which I will return next week.

Fintan O'Toole is temporarily based in New York