With respect to public funding for biomedical research and its impact on morbidity and mortality, I must take issue with Terrence Kealey. In the United States, government funding for science did not expand until after World War II, so its impact must be judged only within the last half century or so. The polio vaccine, which dramatically lowered morbidity and mortality from polio, was wholly developed in the private sector, with the basic research underlying it—successful cultivation of poliovirus strains—occurring in the late 1940s. There is no question that the first polio vaccine and antibiotics were developed without federal funding.
Since that time, however, three other vaccines that have had worldwide impact were developed with U.S. government funding: the rubella vaccine that significantly cut birth defects of babies born to mothers who contracted the disease in early pregnancy, the human papilloma vaccine against cervical cancer, and the rotavirus vaccine against childhood diarrhea that annually saves hundreds of thousands of lives of children living in the developing world. There are numerous other improvements in human health that have flowed from government funding. I will mention only three more, to avoid sounding like a laundry list: the reduction in heart disease as demonstrated through analyses of the Framingham long-term population study, the dramatic reduction in dental caries as a result of fluoridating civic water supplies, and the Women’s Health Initiative that demonstrated hormone replacement therapy to have heart and stroke risks not previously recognized. For a long list of other publicly funded biomedical research contributions to health, consult the Selected Research Advances of NIH, 1887-2011. In addition, see the basic research contributions funded by NIH as catalogued through receipt of Nobel prizes; the Nobel website will provide details about each award. Although Professor Kealey may see these as mere facts or anecdotes, I view them as data points building a compelling argument for contributions that were highly unlikely to have been produced by private philanthropy or industry.
I want to address the point made by both Patrick J. Michaels and Terrence Kealey that scientists were so afraid of having their research controlled by government that they resisted government funding. Indeed, during the legislative process for creating the National Science Foundation and the NIH grants program, scientists resisted government funding until they had negotiated a mechanism for scientists to control decisions about who received the funds—the peer review system. Peer review has its faults, just like democracy, but it has been studied and criticized and tweaked as may be seen in the long list of internal and external studies you can find on the Office of NIH History’s website. Scientists may indeed feel compelled to prepare grant proposals in light of whatever biases they perceive in this system. That is no different, however, from preparing grant proposals in light of the perceived biases of industrial or philanthropic funders whose decisions are made by a single individual or by a small committee.
The real question to me is not whether funding for science must be exclusively private or public, but what sort of balance produces an optimal outcome for society. With respect to AIDS, for example, the difference between private and public annual contributions is the difference between the ability to marshal millions of dollars and billions of dollars. And again, as David Guston noted, economic and tax policies that favor industry are, in effect, government support for the entities that produce private philanthropy, and the interests of the private sector cannot be trusted to ensure the greatest good for society. With luck, both private and public institutions will continue to work towards improved human health, and crowding out will not be an issue.