Healthy, wealthy and affordable

Transcript of the QIMR Berghofer Medical Research Institute 2014 Derrick-Mackerras Lecture, 21 October 2014.

Transcript

Each of us in this room, every one of us, has benefited from health and medical research.

Our vaccinations in childhood – or maybe you’ve had the Hep B jab as an adult. I’ve had pneumococcal vaccine; probably some of you have as well.

Some of you will be on hypertension control drugs, some of you will be like me; on a statin. Some of you will have been treated for serious diseases such as cancer.

And we’re all kept healthy too by research that leads to excellent public policy. In Australia – road traffic rules, anti-smoking policies, slip slop slap and so on.

And of course that’s just focusing on the specific issues. Perhaps the most pervasive benefit of research is the way a doctor approaches your treatment: scientifically, rather than leeches, evidence-based on what works from research rather than snake oil and mumbo jumbo – although there is, still, quite a lot of that around. And I’ll talk about that later.

There is much to do and that’s why QIMR exists. Cancer is not cured, Alzheimer’s threatens to overwhelm our economies and our carers. We can hardly do anything useful for an injured brain, or an ailing kidney, or an ailing heart, and for most mental illnesses.

It only takes a disease like Ebola to make us aware of the need for research. Of course, the immediate responses to Ebola are rapid public health responses and clinical responses. But just think how helpless we are at the moment because have no therapy for those who are affected by Ebola and no vaccine to prevent it.

Prevention and treatment will only come from research. And so, at its heart, medical research is about hope.

A single, simple word. A four-letter word, hope.

I have two daughters and they tell me that I’m prone to sermons. So I hope this talk doesn’t come across as a sermon but I do want to talk today about what we need to do in Australia to have healthy Australians, a wealthy Australia and an affordable health system.

But before I go onto that I just want to say a word of thanks to the community members in the audience and those who support medical research and support QIMR, because we are all dependent on their support. Not necessarily financial support through tax of course – that’s certainly crucial – but by community participation in research in clinical trials, in public health research, epidemiology, clinical research in hospitals such as that one next door.

And also the community gives us permission to do a lot of the research by acceptable standards in ethical areas in research involving people with cognitive impairment, vulnerable groups, children, and people who may not be able to give informed consent. And also permission to use animals in research, stem cells, and other controversial areas.

One of the other major parts of my week is in the non-research parts of NHMRC in our clinical guidelines, in our ethical areas. And it reminds me all the time of how we do our research with the support but also the permission of society in a democratic country like this one.

And just before I finish I want to give a few personal indulgences; highs and lows as head of the NHMRC. I’m going to name names – no, I’m not going to name names!

And I certainly won’t be talking about individual grants but I do want to talk a little bit about the anti-science parts of our society on the way through.

I don’t have to tell this audience that Australia has a vibrant health and medical research effort. It’s high quality, it has a wide breadth, and is capable of attracting some of the absolutely top students to do science and biomedical science and then attract them into PhDs.

The question from a taxpayer point of view is how do we make sure Australia benefits from this talent and from this research?

As researchers, we natural focus on attaining the funding so that our career, and indeed our passion to solve difficult problems can be supported. But let’s focus a bit on our funders for the moment, the taxpayers, the people of Australia who benefit from our work and in whose name we do the research.

When we think this way, it also becomes a bit of a challenge to us in research, and it certainly comes as a challenge to the NHMRC as the custodian of the taxpayer’s funds.

For example – 97% of medical research happens outside Australia. One of the previous treasurers of Australia was heard to say, ‘Why fund medical research at all, why don’t we take it all from overseas?’

It’s a serious question, one we have to grapple with. Why shouldn’t we just leave it to the rest of the world to do medical research?

Well, several reasons, and you’ll know them.

Perhaps the first is, we’re a wealthy country. And this comes, from my point of view, with an obligation to do our fair share of discovery, of fundamental research. We should do more of that relative to our population than countries much less wealthy than we are.

But perhaps more importantly, if we are to benefit from the other 97% of research, we need researchers and practitioners in Australia who contribute to research, who connect with that research, and who translate that 97% here in Australia.

Can you imagine our hospitals, our colleges of specialties, if they were filled with people who could read the research literature but wouldn’t understand it because they themselves had not been in research? We can’t afford to simply pick things off the shelf.

So if you take that line, it means for the NHMRC we can’t afford to exclude any particular area of research relevant to health if the country is to benefit from this sort of leadership of the research-trained health and medical world.

And so, when asked about priorities, I usually answer along the following lines – that our priority is to fund the best ideas by outstanding researchers.

Of course, we do have some other priorities. We have a priority around Indigenous health. 97% of the research is not going to come from the rest of the world on Indigenous health – it’s our shame, and it’s our responsibility to improve Indigenous health.

And sometimes we have specific health threats. Often, actually, from Queensland like Hendra virus, where again, this is an issue for us – we have to tackle it.

But in a sense if you’re a funding body the real priorities are about new knowledge; it’s got to be about producing new knowledge. It’s got to be about how new knowledge can get implemented. And of course, research funding doesn’t implement, it just produces the new knowledge, and more on that in a moment.

And increasingly, our focus and concern, I think, to the NHMRC, is how do we ensure a steady stream of next generation stars to carry the torch forward as we of this generation – and I’m just talking about myself at the moment – we of this generation grow old and slow! Not looking at anybody else in the audience when I say that, Frank [Gannon].

So, taking the first adjective of the title of my speech, ‘healthy’, well, health and medical research is obviously aimed at improving health. But of course, health research is not enough to improve our health. If it were, the US would be the healthiest country in the world; they spend more per head on health and medical research than anybody else by a margin but have on most indicators only the 20th or 30th best health system in the world in terms of outcomes. So it’s not just about research, it’s about what you do with the research.

Results need to be implemented or “translated” for better care of patients, better preventive measures, new products, processes and treatments. And of course implementation’s not done by researchers, and neither should it be an expectation of researchers to do the translation and the implementation.

And here in fact is the major challenge I think that the country faces. If researchers are responsible for research, and administrators and policymakers are responsible for running the health system, who’s responsible for connecting the two? Who’s responsible for connecting research to policymaking and getting the knowledge across? There’s often an impenetrable barrier between research and the health system.

I think this is where my second adjective comes in: ‘affordable’. Governments everywhere, including here, are worried about the ever-escalating costs of funding healthcare. There’s no doubt about it. Medical research and its successes over the last century have made healthcare more expensive. There can be little doubt about that.

My argument is, we are now able to turn this around; to use the research and the levers we already could use from research to restrain the costs in healthcare, make it more cost-effective by supporting only those therapies, approaches and preventive approaches that have a strong evidence base.

That’s all very good, Warwick, that’s your sermon! How do we go about that?

Well, we need more research on things that don’t work and that’s hard research to do. But we already support a fair bit of it.

My favourite one, but there’s quite a lot of it, is from one of NHMRC’s Practitioner Fellows, Rachelle Buchbinder from Monash University and Cabrini Hospital in Melbourne. A few years ago, for example, she conducted a high quality blinded, placebo-controlled surgical trial to test whether vertebroplasty – now, vertebroplasty is a surgical procedure in which a surgeon uses a special sort of “cement” to stabilise bones that are cracked or broken in the vertebral column. Not the column itself, but, the backbone.

So if they become fractured, surgeons had worked up this surgical procedure to put cement in to hold the bones steady. Sounds like a good idea, sort of. It’s a fracture that occurs often in the elderly or after an accident or a fall.

But when Rachelle and her team compared the use of the cement with a shame operation – yes, the patients underwent a sham operation – she found that the patients didn’t benefit at all from vertebroplasty from this surgery and the use of cement. It wasted money, there was needless exposure of patients to pain and to surgery and the hazards thereof.

I’d also like to point out a remarkable body of work also funded by the NHMRC by the Australian and New Zealand Intensive Care Society and especially their clinical trials research group.

For example, in a major study of patients in intensive care situations, these researchers (Finfer, Bellomo and their colleagues from right around the country) compared the outcome for patients [in intensive who received] either simple saline solution or Albumin in a range of emergency situations. Again, randomised, blinded trial.

The point of the trial was that Albumin solution is much more expensive – more than 200 times ($1.60/litre vs $332/litre) more expensive – than simple saline which we know, of course, is just salt and water.

What they found was, the patients did just as well if their fluid replacement was saline instead of the more expensive albumin solution. And an independent analysis of this by Access Economics in 2009 showed that if these findings were implemented, it would have an estimated saving of $700 million per year.

That sounds vaguely familiar, it’s just about what the total NHMRC funding is so, I have offered to take the money off the Department of Health’s hands but they seem resistant to the idea!

I could go on in this vein for hours, but just one last example.

The NHMRC Program Grant is a major supporter for the Care Track Study.

Bill Runciman and his colleagues have shown how such common procedures in the health system such as the use of antibiotics, is a major waste of government and patients’ money. Antibiotics are either prescribed when they are not needed – it’s a virus, not a bacterium – or the wrong antibiotic is prescribed or in fact they’re not used enough, particularly by surgeons post-operatively.

So the patient becomes infected and it costs more to maintain them than [would otherwise be the case].

So there are vast savings from proper implementation of research.

What do we do about it? How do we get better evidence-based health practice and by definition, they are likely to be more cost-effective. It’s too big a topic for today, but, we do our bit; we publish clinical and public health guidelines, support the wonderful Cochrane Collaboration, and so on.

In some ways, Australia does do this quite well, which is why we have a better outcome for lower cost than the United States through the PBAC and MSAC which are evidence-based government decision making processes. But, I won’t go on.

I do, though, want to talk about other wasted money. Your money, and public money. Does it annoy you as much as it annoys me that private health insurers offer rebates for unproven treatments?
Some of these rebates are for what we tend to call traditional medicine where they might not have a good evidence base. But others are in the alternative medicine area and in many cases where the simple scientific basis seems implausible on the basis of known science.

Except for perhaps the placebo effect, do we really believe that manipulation of an “aura” will work for patients? Or that diluting a substance to the equivalent of one molecule in the entire volume of the solar system is likely to have a biologically therapeutic effect?

Removing from public or private reimbursement of these treatments that have no evidence would save heaps including on your private insurance.

My view – and this is where the sermon starts – is this is a professional responsibility for healthcare providers, I think. That if you’re providing advice and care to patients, you should be clear about the evidence for the treatment. It should be the responsibility of all people offering healthcare, not just doctors, all people, to give patients some idea of the security of the evidence upon which they’re offering the treatment.

We will soon, before the end of the year, release our public statement on homeopathy. Already some pharmacists are urging their profession to stop stocking these remedies and others that don’t have an evidence base. Pharmacy, after all, is a profession based on and trained in science. So it comes as a shock to walk into some pharmacies to see them urging products on customers where there is no evidence base of effectiveness.

So that’s all very good, Professor Anderson, but how then do you explain the popularity of complementary and alternative medicine?

There are some estimates that Australians spend more money on complementary and alternative medicines than they do through the PBS, so, for ethical treatments.

I’ve been thinking about this for a long time, and it just so happened last weekend while preparing for this talk I came across a quote by Peter Medawar who won the Nobel Prize with Australia’s own Macfarlane Burnett back in the sixties. And this is a quote from him: “If a person is A) poorly, B) receives treatment intended to make him better, and C) gets better, then no power of reasoning known to medical science can convince him that it may not have been the treatment that restored his health.” And I think there’s a lot of truth to that.

Another quote – this is from Carl Sagan of astronomy acclaim – it’s a quote about the role of science and the responsibility of science. And the difference of science to most of what happens in our societies. So here’s the quote: “In science it often happens that scientists say, ‘You know that’s a really good argument; my position is mistaken.’ It doesn’t happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion.” And I do think we have to value and protect the values of science in our sorts of societies.

A final word on the sermon about complementary medicines. Of course, many of these “remedies” cause no harm; one molecule in water that dilute is unlikely to do harm. And if people want to spend their money on useless “wellbeing” products, is that really a problem?

Well, mostly not, but sometimes it is. And I wonder how many of you in this room have had the same experience that I have, knowing somebody with a potentially fatal disease, but a disease that is treatable, who instead trusted alternative, stuck to alternatives, and then passed away as a result?

So sometimes, there are serious consequences by choosing ineffective treatments.

Alright, I’ve spent the last ten minutes on an argument that we could save money by the better use of research. But what about making money for the country so we’ve got more tax and we can give the NHMRC more funds so all the researchers in this room can get grants they deserve?

Well, making Australia wealthy through medical research is quite a good story. It’s an optimistic story, it’s a largely unknown story. I have personally been banging on about this for a number of years; obviously to little effect. Because still too often, the sector pipes up about the pessimistic; that we’re not good at commercialisation.

But let me give you a few facts.

Australia currently has $50 billion invested through the stock exchange in biotech and related areas. It’s the only index of the stock exchange that has risen progressively over the last 15 years and it’s increased about ten-fold. The All Ordinaries – only about twice.

The pharmaceutical industry alone invests about $600 million a year according to their own figures in commercial clinical trials in Australia.

It’s estimated about 13,000 Australians are employed in the private biotech sector; that’s three times as many as Canada, a country we often compare ourselves to.

Scientific America’s Worldview Scorecard, which they publish yearly, last year ranked Australia 7th in the world in biotechnology, up from number 10, so that’s a shooting star, up from number 10 the year before. They also ranked Australia best in the world for “best growth in public markets” and second globally for “greatest public company revenues.”

The medicines manufacturing industry is now Australia’s largest elaborately manufactured export earner: beats wine, beats cars. Again, a story that’s not well known.

And finally, the great company in Melbourne, CSL, alone contributes over $2.5 billion to the Australian economy and invests around $200 million in R&D in Australia.

So, so far I’ve argued that health and medical research makes Australia healthy and wealthy and needs to be used more actively to make healthcare affordable in the future.

So now let’s look at ourselves. Are we up to the challenges of the future?

Will we be able to make the most of the public investment in health and medical research, especially with the Government’s promise to set up a fund of $20 billion by 2020?

Will a vibrant, innovative industry continue to develop from health and medical research in this country?

To answer these and similar questions, we need to examine ourselves as fearlessly and without prejudice as we would tackle any research issue as researchers ourselves.

A short answer: I think there are some big challenges we need to address. And we need to address them to be worthy of the trust of the taxpayer for this funding.

First, the world of research is changing, fast and at a speed we’ve never seen before.

Biomedical research is changing. Maths, physics, computational biology, sophisticated modelling, advanced imaging – large scale, nano scale – more and more of these are now essential tools. 

Research is becoming ever more international. Science has always been extremely international, more than any other human endeavour. But I would expect almost every researcher in this room will have collaborators around the world. Collaborators have complementary interests and expertise; it may not be a practical collaboration, it’s often an intellectual collaboration.

I know I did when I was a researcher and before I became a bureaucrat. I just didn’t choose very well so our two collaborations were in cities on the whole that weren’t the best choices if you wanted to go somewhere interesting. So we didn’t choose anyone in Paris or Berlin. One was in Jackson, Mississippi; too hot, boring. And the other one was in Goteborg in Sweden; actually quite a nice place but bloody dark in winter and even colder than Canberra!

One of the things I’ve noticed in my eight years now at NHMRC is extraordinary growth in international funding and strategic international research collaboration. I’ll just mention a few of them that we’ve signed up to: the International Cancer Genome Consortium with folks from Brisbane among our grant holders; the Global Alliance for Chronic Disease – both of these involve Canada, the NIH, the UK MRC, the EU, China, Japan and so on - the Rare Diseases consortium, child and maternal health initiatives, and mental health initiatives and many, many more.

Research teams are getting bigger, they’re becoming more fluid, more multi and inter-disciplinary. We are tackling, and we need to tackle, problems in more powerful ways: bigger teams needing bigger grants.

For example at the NHMRC, the average number of researchers on a health services grant is 5.4 Chief Investigators. And public health grants, 5.1. The numbers of investigators on our Centres for Clinical Research Excellence is nearly always 10. So these are big teams, tackling things from a range of approaches.

The other challenge apart from those is around funding and as a result, lowering success rates here and around the world. Every six months I meet with my equivalents in North America, in Europe and in Asia. And nearly all governments with a few exceptions are dealing with their budget consequences of the Global Financial Crisis.

As the Director of the NIH, Francis Collins, recently pointed out, NIH’s budget has been flat for a decade, and he then said that’s why [they] aren’t funding much Ebola research, which I’m sure he wishes he hadn’t said if you read any of the blog sites.

NHMRC’s Forward Estimates – so that’s the formal, four year in advance commitment of the government in the May budget – our money going forward is flat and it has been for the last three years, so. Apart from China, and a few other countries in our region, the Republic of Korea and Singapore, this situation is now sort of the new normal in health and medical research following the Global Financial Crisis.

It’s therefore very welcome in Australia the announcement by our government that it intends to set up the Medical Research Future Fund. If they manage to succeed in doing that, the Senate permitting, then we can join China, Korea and Singapore as expanding research countries.

So if the main challenge then is the need to improve health through research, with the added challenge of rapid internationalisation, rapid change in the nature of science (new disciplines, bigger groups and the need for collaboration), and constrained government funding post-GFC, what do we need to do to meet these challenges for the benefit of the people who provide the money that they do: the taxpayers of Australia.

Well, again, back in sermon mode here are a few thoughts:

The first is, we need to be flexible and agile, because science doesn’t flourish in an atmosphere of too much funding security, of self-satisfaction, and a closed environment.

I love this quote from Marston Bates, it says: “Research is the process of going up alleys to see if they are blind.” Which I think we’ve all – and I certainly speak for myself, I’ve been up lots of blind alleys.

Science and research also, reduced to its basis, is a contest of ideas. That’s why we use peer review to decide what to fund. We trust other scientists to make the judgement of what are the best ideas in this contest.

I’m sure we’d all like a big, safe secure pile of money for our research, but it’s not how it works and it’s not how it should work. We should need to justify our work at frequent intervals.

Another challenge – and I’ve mentioned this already – is to link biology with the clinical, to link biology with the physical sciences, to maths, and advanced statistics. And this increasingly means, in my view, that small, stand-alone institutions – this is not a small institution – will need to embrace the sort of disciplines and approaches that are offered in our faculties around universities.

Similarly, our institutions will need to be flexible, critical mass, and have access to the facilities and resources that they need.

In Australia we have many small institutions doing medical research that are highly dependent on government funding, and I think the question that sector will have to address over the next decade is can we afford so many small independent institutes. Is this likely to be a good model for the future?

Our attempt to do something about this is the Advanced Health Research and Translation Centres initiative which I am determined to get some funding for before I finish this job, to build critical mass in medical research.

Another challenge for researchers, I think, will be – and for funders like the NHMRC – will be how to support and participate in international consortia. We now, as I said earlier, participate in quite a number; some of them bilateral, some of them are multilateral, some of them are funding collaborations, as in China or Singapore – each country runs its end of a collaboration. This will only grow, and it should grow.

How do we link industry more effectively into research? When I was head of school of biomedical sciences at Monash I rented some of the university’s accommodation, to small start-ups and labs for biotech companies. It meant that the university and company researchers worked side by side. Well, IP was protected but they were in the same building, had coffee together; even started some relationships.

This is not common in our sector and perhaps it could be a little more common. I think there is space within many of the new buildings that have been provided by government and philanthropy over the last decade or more to do this and that would benefit everybody. Of course, the rent would help as well.

There’s another challenge, and this is to anybody who’s over 40 in this room, which is about 50 percent, I’d say, of the audience, so, this is a risky thing to say! Well, it’s not really.

The challenge to us is when are researchers most creative?

So, I’ll give you some Australian examples and you can draw your own conclusion.

Recent Australians who won the Nobel Prize for physiology or medicine – Liz Blackburn, Peter Doherty, Barry Marshall – were all in their 30s when they did their key Nobel Prize winning work.

So was Graeme Clark when he developed the first “bionic ear” – and look at the great Australian company that has developed from this, Cochlear.

So was Ian Frazer and Jian Zhou, who was actually in his 20s, when they did critical, innovative work that led to Gardasil, which is now making money for CSL and Glaxo.

The great Sydney physiologist Colin Sullivan was also in his 30s when he showed that positive airway pressure could treat sleep apnoea – work that has provided relief to millions of people around the world and led to the highly successful company ResMed.

There’s only one exception I haven’t mentioned and that’s the co-Nobel Prize winner with Barry Marshall (who was in his 30s) but his colleague Robin Warren was a little bit older. He was in his early 40s.

So I did say when I was talking about this to one audience -as a result the NHMRC is going to ban Fellowships and anybody over 40, but it got me into such trouble that I decided I wouldn’t do that today!

Just a few final words.

I said this to my Minister, that being CEO of the NHMRC is the best job in Australia. Some days it’s the worst job, but mostly it’s the best job in Australia. And I have been CEO since the time when NHMRC became separate from the Department of Health. So that’s four Governments. I will wait for my memoirs to comment on that area!

We’ve seen a doubling of funding over that eight years, from just over $400 million a year to close to $900 million now.

I’m proud of a couple of things; the Code for the Responsible Conduct of Research and some independence into our peer review system. The Code I think is important; I’ve been invited to speak to other heads of research funding bodies about the Code because at the end of the day, this is maintaining the trust of the community in the way we go about our business.

I’ve introduced the Research Translation Faculty, and I know many in this room have contributed to that.

Some of the downsides; you would not think that the first thing that pops into my mind on the downside would be wind farms. But a few years ago our Council asked us to look at the evidence of whether wind farms caused ill health, so we did and published a statement and the world has fallen in ever since.

Our guideline on fluoridation of water supplies is uncontroversial everywhere except Queensland. And of course, some of the things I’ve been saying about alternative medicine has aroused the ire of certain sections of society here too.

Of course, I won’t mention the 80% of applicants each year who don’t get a grant and therefore are absolutely convinced it’s NHMRC’s fault that they don’t, but that just comes with the territory.

So, I’ll just say a few things about what I’ll miss and what I won’t miss, and the first one will be unpopular.

What will I miss? Well, Canberra. You’re supposed to go [makes a noise]. Canberra’s a great place to live. It’s beautiful, it’s civilised, there are outstanding people – including public servants. It gets bad press – you’ll see Courier Mail headlines every time "anberra" does something. Of course they mean the Government whose seat is in Canberra, not Canberra itself.

I also wanted to say a good word about public servants. Nobody else does, so why shouldn’t I? Public servants work hard, nobody loves them, whenever a government thinks it wants to save some money it says we’ll cut the public service and the public collapses, but some of the smartest, best, hardest working people I know are senior public servants.

The other part of the job I’ll miss is doing my best to support you as researchers. Trying to make sure we do have systems in place so we fund the best and set high standards.

I want to thank researchers too for the extraordinary commitment that Australian researchers show to peer review. We never have trouble finding people to participate on our panels; in fact I get more negative panels about, ‘I’d love to be on a panel but I never get asked’, so, it’s really a great commitment by Australian researchers.

What won’t I miss? Insider pleas for special consideration – read The Australian today. Especially claims that their area must be a priority.

Pretty much weekly, somebody calls in the press or wants to see the Minister or wants to see us about how their particular area of research needs to be a priority, and usually with the tagline that the NHMRC doesn’t understand and doesn’t fund in this area.

The one today is the usual line; Area X is a certain burden of disease for Australia, it only gets, in this case, 7% of all the funding so there’s something corrupt and the Government ought to do something about it. I did point out that they were only 6% of the applications, so the fact they got 7% of the funding means they did pretty well, actually.

It goes along with the [statement that] ‘NHMRC should…’ – fill in what you want there, support more young researchers, support more leading researchers, support more nursing researchers, support more clinical research, health services research, complimentary medicine, genomics and so on.

Priorities are a big issue for NHMRC, and if you give more support for one area, by definition there’s less support for somewhere else. And so, consistent with what I said earlier, we need to fund across the spectrum. We need people who are research savvy and trained in every area of research in Australia. And of course, we need some priorities on top of that. But, the top one must be Indigenous health.

What else won’t I miss? Senate Estimates hearings. Now I’m going to be very careful with what I say here, because I’ve got two more to go, including one tomorrow, so I can’t stay and make Frank buy me an expensive wine tonight. It’s sort of performance art sometimes, but actually it’s a very important democratic bulwark for a country like us. Why shouldn’t senior public servants have to answer to the elected representatives of the people, but, I’m really hoping for no more questions on wind farms.

Other things to miss: 6 o’clock flights out of Canberra airport in June and July. It’s dark. It’s minus 5 degrees. And there’s not a lot of people around, it’s a little scary.

So that’s it. I’ve indulged my comment there. I’m just going to finish with two quotes. First is another from Peter Medawar: “If politics is the art of the possible, research is surely the art of the soluble. Both are immensely practical-minded affairs.”

The reason I’m quoting that is that up close and personal with politicians, I’m impressed by the altruism, by the commitment to try and do the right thing in an impossible situation with so many competing demands. They cannot satisfy all the good causes that they’re requested to support.

And finally, to not agree with Albert Einstein – so that’s a pretty scary place to start off with – he said: “Science is a wonderful thing if one does not have to earn one’s living at it.” And I’m sure some of those CDFs that I had lunch with would feel something akin to that.

But in my view, instead of that quote, it certainly is a wonderful thing. And hard though it is, medical science might just about be the best and most honourable way to earn your living.

Thanks very much for the opportunity.

Professor Warwick Anderson AM
Chief Executive Officer, NHMRC