Comment: The debate about prescribing puberty blockers highlights the lack of peak institutions for medicine and healthcare in New Zealand.\u00a0The Government\u2019s plan to abolish the Health Research Council will make things worse.<\/p>\n
While we await battles in the High Court about scientific evidence, the Australian government has asked the National Health and Medical Research Council to develop new guidelines for the care of people under 18 with gender dysphoria.<\/p>\n
Australia could have called on other bodies to generate independent advice.\u00a0The Australian Academy of Health and Medical Sciences is an \u201cexpert representative voice for health and medical sciences\u201d.\u00a0The Australian Medical Association also produces \u201cposition statements\u201d on health matters.<\/p>\n
New Zealand does not have a body equivalent to the Australian Academy of Health and Medical Sciences.\u00a0Our national academy, the Royal Society Te Ap\u0101rangi, covers the whole range of science, technology, and the humanities.\u00a0Although it includes some medical Fellows, there are few who are active clinicians.<\/p>\n
We did have a Medical Association for 136 years, but this collapsed in 2022.\u00a0New Zealand must be one of very few countries that do not have a professional association for all doctors.\u00a0There are 118 national associations affiliated to the World Medical Association, and probably others not affiliated.<\/p>\n
The Health Research Council<\/p>\n
Formerly called the Medical Research Council, the Health Research Council has a distinguished history starting in the 1930s.\u00a0Nearly all the major advances in health research and discovery in this country have depended on its support.\u00a0Yet now the Government intends to disband it, with its \u201cfunctions transferred\u201d to a new committee, Research Funding NZ; the Ministry of Business, Innovation and Employment; or the Ministry of Health.<\/p>\n
This decision follows advice from a group that was asked to review our whole science system.\u00a0One can see some attraction in having all research funding disbursed by a single body.\u00a0But the Health Research Council, which is a Crown entity, has important statutory functions apart from awarding research grants.\u00a0These include advising the Minister of Health on national research policy, fostering the training and retention of people engaged in health research, encouraging initiatives in priority areas, confronting ethical issues arising from new areas of health research, and promoting the results of research in ways that contribute to healthcare delivery.<\/p>\n
Research Funding NZ is described as \u201ca new independent board\u201d. The Government has announced the names of the eight members.\u00a0These include eminent scientists and engineers, but only one of them has any experience of clinical medicine.\u00a0<\/p>\n
There will be \u201cfour pillars of national importance\u201d focused on the economy, environment, health and society, and technology.\u00a0Presumably these will be served by advisory committees, but the secretariat will be in the MBIE.<\/p>\n
As Research Funding NZ will be only a committee (three of whose members are not resident in the country), it is hard to see how its \u201cindependence\u201d will be other than notional.\u00a0I have chaired a comparable body that had its secretariat in a Government ministry: despite goodwill on all sides, we had to struggle to be anything more than a rubber stamp.\u00a0<\/p>\n
The Government statement says the Ministry of Health may assist.\u00a0For example, the development of the health research workforce will be taken over by MBIE, MoH, and Health NZ.<\/p>\n
Personnel in ministries are often changing.\u00a0The Health Research Council and its predecessor had a secretariat comprising individuals who developed, over decades, an intimate knowledge of our health research portfolio, its strengths and weaknesses, and international trends.\u00a0They fostered the development of whole new fields of research, as in M\u0101ori health, Pacific health, injury prevention, and nutrition.\u00a0Many of our leading health researchers are here only because of targeted schemes, such as training and repatriation fellowships.<\/p>\n
I have no confidence that government ministries, such as MBIE or MoH, could provide such stable and effective guidance, despite their best intentions. The arrangement proposed is certainly not what was envisaged by the Science System Advisory Group, which recommended the establishment of a body with functions like those of Research Funding NZ.<\/p>\n
One risk of the current proposal is that Research Funding NZ will be expected to favour research that may have an economic payoff.\u00a0Last week it emerged that many millions of dollars of funding for health research will be diverted to other areas.\u00a0No one would dispute the need for research in areas such as advanced technologies, but this should not be at the expense of research in fields as vital as health.\u00a0We need to remember that the main purpose of health research is not to make money, but to improve the health of the people. If we do not study our own health problems, and the working of our health services, nobody else will.<\/p>\n
Training and funding biomedical and clinical researchers have another important function.\u00a0They are essential if our medical schools and postgraduate units are to be able to attract and retain high-quality specialists.\u00a0Without such leaders, often with both clinical and teaching roles, New Zealand will not keep up with advances in the diagnosis and treatment of diseases such as cancer, or childhood infections, or multiple sclerosis.\u00a0There is already difficulty in filling posts in many fields, and this will be an even greater challenge with the establishment of a new medical school in Hamilton.<\/p>\n
The way forward<\/p>\n
The proposal to disband the Health Research Council was met by a deafening silence.\u00a0Is this a sign that our health researchers and academics are so demoralised that they have lost their mojo?\u00a0Some of us can remember the huge \u2013 and often acrimonious \u2013 debate in 1989, when the Medical Research Council was to be replaced by the HRC, with a greater emphasis on public health, M\u0101ori health, and ethics.\u00a0That reform was minor tinkering compared with the current proposal.<\/p>\n
The HRC board has been chaired, for more than a decade, by Dr Lester Levy.\u00a0I have seen no public comment from him on the proposal to close the organisation.\u00a0Some health researchers have suggested to me that one reason for their muted reaction is that they have become disillusioned by the performance of the HRC in recent years.\u00a0Apparently the funding for evaluation of research proposals has been slashed.\u00a0This means that previous peer review processes are now skipped, with funding decisions made by members of assessing committees who cannot possibly have expert knowledge on all the research proposals they have to consider.<\/p>\n
If the HRC has problems, the solution is reform, not abolition.\u00a0Because this is a statutory organisation, it can be disestablished only by an Act of Parliament.\u00a0I trust that a select committee process will enable interested parties to put forward their views, on what is a very radical proposal.<\/p>\n
In particular, I hope the Government will not run down the organisation before Parliament has made its decision.\u00a0Premature actions by earlier governments, in disbanding Crown entities such as the Public Health Commission, have lent weight to the suggestion that the New Zealand system of governance sometimes seems like dictatorship by the executive.\u00a0<\/p>\n
In recent decades, New Zealanders have proved adept at demolishing organisations, but not so clever at replacing them with institutions that are effective and enduring.\u00a0Nowhere has this been more evident than in the health system.\u00a0We should think carefully before accepting that, unlike other developed countries, New Zealand has no need for a national body dedicated to fostering health research.<\/p>\n","protected":false},"excerpt":{"rendered":"Comment: The debate about prescribing puberty blockers highlights the lack of peak institutions for medicine and healthcare in…\n","protected":false},"author":2,"featured_media":387438,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[103,172135,397,396,61,60],"class_list":{"0":"post-387437","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-health-and-science-opinion","10":"tag-health-care","11":"tag-healthcare","12":"tag-ie","13":"tag-ireland"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/387437","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=387437"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/387437\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/387438"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=387437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=387437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=387437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}