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.