Alvin
M. Weinberg introduced the term "big science" into the national
lexicon in 1961. Big
science is research that requires the coordination of massive resources,
including thousands of our best minds and cutting-edge technologies to solve
massive, complex problems.
With
visionary gusto, Weinberg wrote that "the monuments of big science, the
huge rockets, the high-energy accelerators, the high-flux research reactors ...
will be symbols of our time as surely as Notre Dame is a symbol of the Middle
Ages."
The
concept of big science is especially timely in a highly charged political
environment with the debate focused on the Affordable Care Act, streamlining
services and controlling costs. As a result, vital research often gets short
shrift.
Big
science is expensive and time-consuming, but the results can have exponential benefits: the
potential for dramatically improved health outcomes throughout the world.
I've
been privileged to see this firsthand at the University of North Carolina
School of Medicine. In 2011, after more than a decade of rigorous trials in the
Republic of Malawi and eight other countries, a team led by UNC's Myron Cohen
discovered that the antiretroviral drugs used to treat people with HIV would
also significantly reduce their ability to pass the disease on to others.
At a
Washington, D.C., event attended by three U.S. presidents and titled "The
Beginning of the End of AIDS," Dr. Anthony Fauci, the U.S. government's
top HIV/AIDS scientist, called the study "astounding." The
prestigious journal Science honored it as its 2011 "Breakthrough of the
Year."
This
breakthrough never would have happened without enormous resources and
strategic, coordinated teamwork by large, interdisciplinary teams of
scientists. Cohen's study brought together investigators at 13 sites in nine
different countries. More than 4,000 subjects participated, and the study cost
more than $70 million.
AIDS
is such a formidable enemy that this number, while large, represents only a
small percentage of the $15 billion per year that is devoted to AIDS research
and treatment. In addition, the president's Emergency Program for AIDS Relief
(PEPFAR) and numerous other world-wide organizations, centers of research
excellence and the pharmaceutical industry support a community of more than
20,000 scientists, health-care providers and advocates.
While
historical legends of science had the luxury of being solo artists, today's
best scientists must be more akin to conductors of orchestras. Developing
hypotheses and rigorous trials to test them is only the start. Today's scientists
must also be charismatic leaders, relentless fundraisers and lithe improvisers
who arbitrate and resolve the fierce disputes of passionate scientists -- all
often in the same day.
The
public often views medical research from a prism of giant breakthroughs that
lead to treatments or cures. The reality is less dramatic.
Most
scientific breakthroughs result from small steps along paths with no clear
destination in sight. By addressing one problem followed by another,
researchers inch their way forward. It is a path often littered with blind
alleys, but with enough resources these blind alleys can sometimes lead to
serendipitous avenues.
One of
these serendipitous avenues was found in Malawi in the 1990s. Since the special
equipment needed to analyze the samples was not available, the specimens were
frozen and transported by plane back to UNC. This was before 9/11, when there
were far fewer regulations. Post-9/11 the study might have ended right there.
Shortly
after the study was published, then-Secretary of State Hillary Clinton said,
"The goal of an AIDS-free generation may be ambitious, but it is
possible."
At a
time of budgetary constraints, it reminds us that true breakthroughs depend on
thoughtful investment. Big science -- fully funded and full of global
collaborations -- is the key to solving our most challenging and entrenched
medical and public health problems.
No one
knows when the cure for AIDS will be found or what it will entail, but a cure
will be found and proven, and we'll have big science to thank.
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