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Claims by researchers that government funding for medical research is inadequate

KERRY O'BRIEN: Australia has produced some of the world's best medical researchers but we have never valued them enough to give them sufficient funds to do the job they say has to be done. The AMA says Australian medical research funding is no better than Third World levels. The Government has promised to change that but the AMA says that is an empty pledge. So what is at stake and what priorities should we give to medical research? Funding under the microscope - that's our story tonight.

When the Government announced an extra $3 million for breast cancer research in this last Budget, it probably expected the medical community to applaud. Instead, most doctors and scientists across Australia in the medical research field, many of whom actually work in the field of breast cancer, are crying foul. They say it is a smoke screen, hiding the Government's failure to meet an election promise to dramatically increase overall levels of funding for medical research; and they are warning that the funds for breast cancer research may well be wasted anyway because the Government has bypassed its own autonomous funding advisory body, the National Health and Medical Research Council.

Before the last election, both major parties agreed that Australia's medical research funding was hopelessly inadequate. It needed to be almost doubled, to 2 per cent of total health spending by the year 2000. That would bring us into line with international standards. At the moment, not only are we near the bottom of the developed world, we even fall behind some of the developing countries. But so far, say the critics, the Government has been slow to deliver. In a moment I will talk to Health Minister, Carmen Lawrence, and two top medical researchers, but first, Eleanor Hall has done some research of her own.

ELEANOR HALL: Inside this Sydney laboratory is a unique colony of cells that may hold the key to survival for hundreds of thousands of cancer patients world-wide.

PAM RUSSELL: We are doing very significant work on both bladder and prostate cancer and we have been able to grow cell lines and xenograph lines in this laboratory, that nobody else has been able to do in the world. That means that you have ... sort of on edge, adrenalin-pumping all of the time in order to get somewhere, and when somebody comes in and says, 'Okay it is no use doing that work any more, there is no money for it anyway', you sort of think, oh.

ELEANOR HALL: It is an indication of the state of Australia's medical research commitment that this ground-breaking research is being funded not by the National Health and Medical Research Council, our public-funding body, but in large part by the local bowling club.

Professor Pam Russell has been training her team for a decade and has had National Health and Medical Research Council support in the past. This year she was knocked back but she says begging for money for her research is nothing new.

PAM RUSSELL: And it is why young scientists go to other countries, why the brain drain occurs, and they don't want to come back because they know how hard it is to fight for money in this country.

ELEANOR HALL: And it is not only to charities that our scientists go begging. Recently an Australian researcher applied for a United States grant on the basis that Australia is a Third World country in terms of its funding for medical research, and he was successful. By international standards, Australia doesn't adequately fund medical research. The International Commission for Health Research and Development recommends even developing countries should spend a minimum of 2 per cent of their health budget on research; Australia spends around half that. Recognising this, the Government made a commitment prior to the last election to increase medical research funding to 2 per cent of the health budget by the year 2000, and in this year's Budget the Government says it is on track for delivering on that promise.

RALPH WILLIS: As a step towards the Prime Minister's election commitment of lifting health and medical research, an additional $93 million is being made available for such research over the next four years.

CARMEN LAWRENCE: There was a commitment given in the Budget, sorry, in the election by the Prime Minister, that medical research would, by the year 2000, reach 2 per cent of the medical funding overall. That target is still a commitment and it will be reached, in my view.

ELEANOR HALL: But the medical community doesn't agree.

BRENDAN NELSON: Well, it is dishonest for the Minister to say that this is a boost for medical research. It is not true to say that we, at the moment on one of the Government's forward commitments, is going to meet its commitments by the year 2000. I know and the Minister knows, it is a nonsensical, dishonest, smoke and mirrors approach to presenting the facts in relation to health and medical research.

ELEANOR HALL: Studies by Access Economics and the Australian Institute for Health and Welfare further undermine the Government's claims. Using the Government's own Budget figures and forward estimates, both studies indicate that rather than increasing, direct government spending on medical research will actually decrease from just under one per cent of health outlays at the moment, to .83 per cent by 1997-98.

IAN McCLOSKEY: Now you might say why does Australia want to compete at international level at all, because we do only a fraction of the world's research. But the fact is that for the good of all Australians we need to have a seat at the international table so that we know what is going on where the bulk of the world's research is done; and the price of admission to that table is to do quality research yourself, to bring to the table. And we are in grave danger of slipping out of the race in many areas, and it will be to the detriment of the Australian people if we do.

BRENDAN NELSON: This is a crisis. The fundamental thing that people must understand is that every day what doctors do for human beings in Australia, what GPs, your physician or your surgeon or your young intern at the hospital, all the things we do is based on medical research. If you don't put appropriate amount of money into understanding the basis of disease and what can safely be used to treat it, then you might as well wind up your health care system.

ELEANOR HALL: But if the Government has been attacked for not spending enough, when it granted extra funds for research into breast cancer, it sparked even more outcry.

CARMEN LAWRENCE: Nothing that takes the lives of Australian women at the rate breast cancer is taking them can be ignored. Over the next five years we are actually going to put well over 200 million into a co-ordinated approach to dealing with all aspects of breast cancer.

ELEANOR HALL: The main complaint is that this breast cancer funding bypasses the Government's own advisory and grant body, the National Health and Medical Research Council.

IAN McCLOSKEY: I was astounded. The Government went on with a lot of fanfare. The now Deputy Prime Minister, Mr Howe, who was at the time two years ago, Minister for Health, said that after fifty-five years of existence the National Health and Medical Research Council, the Government's major advisory body, was so important that it needed to have its independence enshrined by turning it into a statutory body, and he proceeded to do that. Now at the first hurdle, the Government finds the independence of the NHMRC too unpalatable to face and so it walks around it.

ELEANOR HALL: And this is what the previous Health Minister had to say about the importance of the NHMRC in increasing our research effort.

GRAHAM RICHARDSON: We will spend plenty, the largest single increase since federation. But I think more important than that, it is going to be spent by the National Health and Medical Research Council, by experts in their field, by peers reviewing peers, not by politicians sticking their nose in and making political decisions.

ELEANOR HALL: Yet a matter of months later the Government is abandoning this path, leaving the research community bemused as to its motives.

IAN McCLOSKEY: I believe that the Government did it to create a smokescreen. It walked away from its own promise to raise expenditure on health research to 2 per cent of total health expenditure, but it wanted something to show. The breast cancer research lobby is very powerful. There is no doubt in the minds of anyone, I believe, in research or outside research, that breast cancer is a major problem that needs attention, so where better to create the smokescreen to hide behind when you are not meeting your promises.

ALAN COATES: I think that is being unduly harsh on a positive contribution to an important Australian problem.

ELEANOR HALL: Breast cancer researcher, Professor Alan Coates, who hopes to receive some of this new money, is positive about particular disease lobbies receiving special funds, but even he has reservations about any dilution of the NHMRC's role.

ALAN COATES: I think there is no doubt that certain areas of illness will always be tear-jerkers. Children with any disease, cancer, heart attacks are always going to be tear-jerkers, and other diseases will be less glamorous and that is a proper responsibility of national policy making to ensure that a balance is maintained. We have an organisation charged with that responsibility, in the NHMRC.

ELEANOR HALL: But researchers like Professor Russell working in as yet unglamorous fields like prostate cancer, must put their faith in the Government's promises for the year 2000.

KERRY O'BRIEN: Now, our studio guests. Dr Carmen Lawrence is Minister for Human Services and Health, and prior to entering federal politics and Cabinet in March this year, she was Labor Opposition Leader in Western Australia, and of course before that, Premier of that State from 1990 to '93.

Dr Christine Clarke is President of the Australian Society for Medical Research. She is also a Research Fellow at the National Health and Medical Research Council in the Medical Oncology Unit at Westmead Hospital in Sydney. She was a post-doctoral researcher in France, and also spent three years teaching at the Hershey Medical Centre at Pennsylvania State University in the US.

Professor Priscilla Kincaid-Smith is Chair of the Federal Council of the Australian Medical Association, and President of the World Medical Association. She is also Director of Nephrology at Epworth Hospital in Melbourne, Professor Emeritus of the Department of Pathology at Melbourne University, and senior medical adviser to the Victorian Health Minister.

Carmen Lawrence, you have had some fairly trenchant criticism targeted at you in that background report. I would like to leave the breast cancer element until the back half of this discussion, but firstly, Paul Keating did make a very clear promise last year before the election that he would boost funding to world levels by the year 2000; yet the AMA says that in real terms, quoting Access Economics, that within two years your funding effort will actually be in decline, that your funding increases in this year's Budget were just an illusion, smokes and mirror.

CARMEN LAWRENCE: Well, unfortunately Brendan Nelson's phraseology is very colourful but his argument is inaccurate. The figures don't actually support his view and Access Economics' methodology is flawed. I would have to say I agree with the view that we haven't taken the necessary large steps to meet that commitment by the year 2000, but we will meet it, and there are real increases in this year's Budget. What Brendan Nelson is overlooking and some critics are too, is that the commitment was to reach that percentage of total health expenditure and it includes private as well as government funding. And the Government has also put in plan a number of programs that will increase research and development and actually make the private sector increase its contribution. One of the benefits, I suppose, of other overseas programs is that they have a lot more private contribution than we do, as well as more government.

KERRY O'BRIEN: Okay, but even allowing for that private contribution and even putting your current Budget figures in the best possible context, unless the money does start to come in buckets in the last two years of the century then you don't have a hope of fulfilling that promise. And I wonder if that is any real way and responsible way to fund research, that you start with a pittance, if you like in terms of increase, and end in a flood.

CARMEN LAWRENCE: Well, I don't believe that is fair. I have been looking at the figures very carefully and I won't go through them in detail because I am sure that we would lose your viewers very quickly, but over the last decade for instance, Kerry, the funding for medical research, direct funding through the NHMRC, has doubled in real terms. It has gone from $30 million in '82-83 to $125 million this year.

KERRY O'BRIEN: But you would be the first to concede that that was an abysmal commitment to medical funding then.

CARMEN LAWRENCE: Yes, it was, it was, and the 2 per cent commitment is designed to redress that. But I would also add that that 2 per cent at the moment, the way it has been calculated by Access Economics and others, doesn't include for instance, the very significant funding that is going toward AIDS research, HIV and AIDS research in this country, some $10 million. So we have got to sit down with the Institute of Health and Welfare and the research community and get some firm views about which figures should be included and which not, otherwise we are going to have these hopeless debates about whether it is or is not going up or down. And I don't want to have that sort argument with the research community. I actually want to see their funds increased and applied in the best possible way to improve the quality of research in Australia.

KERRY O'BRIEN: Alright, well very briefly, in terms of the kind of funding that the National Health and Medical Research Council will see this year, do you believe that that will adequately deal with the kind of research demands that are out there, for quality research?

CARMEN LAWRENCE: I think earlier in the program one of your interviewers suggested that getting the private research dollar was somehow an inferior research dollar. I would want to rebut that. I think it is important that we get funds from a range of sources, and the medical community does much more readily, I might say, than other areas of science. They get bequests; they get State Government funding; they get the charitable dollar; they get a whole range of funds. And I think if we are going to look at this question dispassionately, we should collect all of those funds together and make sure that they are distributed fairly through the research community.

KERRY O'BRIEN: Christine Clarke, I know that Carmen Lawrence argues that she has given you, the NHMRC, a real funding increase for this year alone, of 3.5 per cent or $9 million. Now, how much new research will that fund, and is it adequate?

CHRISTINE CLARKE: Unfortunately it is not going to fund any new research at all. The 3.5 per cent increase will only be sufficient to maintain current commitments and so that investment of 3.5 per cent is not adequate at all.

KERRY O'BRIEN: How common is it for the National Health and Medical Research Council to reject funding applications for projects that they regard as having significant potential?

CHRISTINE CLARKE: It is actually very common indeed. Indeed, over 65 per cent, indeed over 70 per cent of applications received by the NHMRC must be rejected through lack of funding.

KERRY O'BRIEN: But I assume that some of those are rejected because they are not up to the mark. Are you saying that 70 per cent are rejected, that the 70 per cent that are rejected are quality, are quality projects that potentially are going to yield good dividends?

CHRISTINE CLARKE: No. The percentage that is funded at the moment, or the percentage that was funded in 1993 was 27 per cent. Now, at least as many again were considered worthy, but probably realistically, a success rate of between 30 and 40 per cent is what is required to fund the high quality research that is being applied for at the moment.

KERRY O'BRIEN: Carmen Lawrence, what do you say about that?

CARMEN LAWRENCE: Well, I don't know that you can point to a specific figure and say that is the ideal figure. I mean, I was a referee for the NHMRC on a number of projects, and of course there are a range of projects that are worthy that are not being funded from that source, but many of them pick up funding from other sources. We heard an example earlier of a charitable dollar being applied, and in addition, the research community in medicine gets another $200 million through the universities. Now I would be the first to argue that we should improve our research effort and I want to see that occur, but I do want to see all of the funds that are actually being used for research, including some of the private foundations which actually contain the favourite research dollars, if you like, of a lot of researchers, being included in the argument. We have a range of foundations round the country which while they may not be flush with funds, also provide additional avenues for research that is perhaps rejected by the NHMRC.

KERRY O'BRIEN: Priscilla Kincaid-Smith, you have been an eminent part of the medical research for decades, how does the depth and quality of our research measure up to the rest of the world, and is it true that there are as many lost opportunities as there are success stories?

PRISCILLA KINCAID-SMITH: Yes, I have no doubt at all that firstly, medical research in Australia is of outstanding quality. I think for the size of Australia, we have produced outstanding scientists in many areas, and particularly in medical research. Now there is no doubt in my mind at all that chronically, over the last thirty-odd years, medical research has been very grossly under-funded in Australia, and I don't think we should be looking at this year or last year, or the difference between .98 per cent and .83 per cent. I think what we really should be saying is that it should be at least 2 per cent of the health dollar and we are nowhere near that. And certainly I would say, I would echo the Minister's views on private research funding being very important, but that doesn't let the Government off the hook in terms of producing at least 2 per cent of government funding for medical research.

KERRY O'BRIEN: But I wonder whether you or Christine Clarke will at least concede Carmen Lawrence's point that in the last decade, that at least, even if it did come off a low base that funding has doubled.

PRISCILLA KINCAID-SMITH: Well, it certainly doesn't look as though it has doubled when you look at the research projects and the ones that are funded and the ones that fail to get funded. I think one of the saddest things at the present time is Christine Clarke's remark that no new projects will be funded because for a senior researcher that is one of the .... the saddest thing of all is to see new young, eager, very capable, very intelligent research workers fail to get funding because of the present system.

KERRY O'BRIEN: Carmen Lawrence, even though it seems that your critics agree with you to a degree, about a lack of private funding as well, it is an indictment, isn't it, of the Government as the first line of funding, that there will be no new projects funded this year by the National Health and Medical Research Council, because you simply haven't given them enough?

CARMEN LAWRENCE: I guess that is a function of two things, firstly, that a large number of the programs and projects being funded by the NHMRC are long-standing, long-term projects. That means they have little capacity to respond to the new researcher or to the short-term project and I frankly think that is something that needs to be examined very carefully. I think perhaps there is an over-commitment which doesn't allow some flexibility for the new research project or the short-term project.

One of the things that I will be doing very shortly is doing what was required and recommended under a review of the NHMRC, and that is establish a policy and planning committee to oversee the whole exercise. Because there has been some criticism of the NHMRC, fairly muted and fairly polite, but basically saying that it hasn't always responded to medical priorities, that it hasn't always been in line with the pressures, the health pressures in the community, and from some of the people who are interested in health advancement and health promotion, criticism that their projects don't get the necessary attention. So I am certainly looking at the way the research dollar is spent as well as the amount. I agree the amount needs to be increased. I don't need to be convinced of that. The target is a commitment that we will meet and we need to be precise about exactly how that will be done, and I am sympathetic to the research community, particularly new researchers. But we have also got to make sure that the dollars that are there are being spent on high quality research and that new projects are getting a fair look-in, as well as the establishment, if you like.

KERRY O'BRIEN: Christine Clarke, what do you say to that? I mean, Carmen Lawrence does seem to be saying, perhaps politely, that maybe the priorities have been wrong in some instances, by the National Health and Medical Research Council.

CHRISTINE CLARKE: I think there is no way to get around the fact that the system is under-funded. I think we have to acknowledge that the Government has consistently supported research during the '80s but that support and that commitment has waned in the last two to three years. And so this has happened at a time when the stresses and strains on the medical research community, and in fact our health research effort, are greater than they have ever been before. I think the Minister's point that in fact it is a matter of prioritising, that it is a matter of deciding strategically what types of grants need to be funded, is a point that is well taken, and indeed was a very positive outcome of the recent review of the NHMRC, but that does not alter the fact that our system is stretched to the limit, because many of the traditional sources of funding for health research are now drying up.

KERRY O'BRIEN: Well, what do we, as a country, stand to lose by, in your terms, failing to provide adequate funding?

CHRISTINE CLARKE: Well, I think it is important to emphasise that the reason we do health research is primarily to lead to increases in the health of all Australians. If our health research effort continues to be stretched as it is, that capacity, that important national priority will be lost. Furthermore, our capacity to address problems that are uniquely Australian such as Aboriginal health, or particularly Australian such as childhood asthma or melanoma, which have the highest prevalence in this country, will be lost, and that research won't be done elsewhere.

KERRY O'BRIEN: And is there genuinely a brain drain? Does anybody have oversight of that?

CHRISTINE CLARKE: There is no doubt about the fact that it is difficult to encourage our young scientists to repatriate. The system here is not attractive to them. They have many more opportunities once having gone overseas, to remain overseas. And I think it is important to emphasise too, that if we don't do research in this country, the cost of our health care is going to increase, perhaps not today but definitely tomorrow, because every discovery we don't make here we will have to buy back from overseas.

KERRY O'BRIEN: Carmen Lawrence, I know that before you took the portfolio Graham Richardson, and perhaps he created a headache for you by doing so, he rather rashly suggested that those bucket-loads of money were going to be flowing for medical research, from your government. Now, what is the problem inside Cabinet? You acknowledge that you need more money. Is it a particular difficulty for you to convince your money Ministers and their senior bureaucrats that there is a dividend in this for Australia?

CARMEN LAWRENCE: I don't think so and one of the reasons we have got 150 per cent tax concession for research and development and the Factor F program, is to make sure that we get a commensurate improvement in the, if you like, the private effort. That is revenue foregone by the Commonwealth. I think that is sometimes overlooked by the research community. It could be spent directly in the form of a tax rebate and then it would turn up, if you like, as an expenditure item. So there is .... I think there is considerable commitment to improving Australian research and turning some of those good ideas that were talked about into products that can be sold, ideas that can be developed in Australia.

I have said I am very committed to increasing research and so is the Prime Minister, following his election promise. I believe we will get there. I think we need however to be a little more strategic in our thinking. I notice that there was reference made to research into Aboriginal health. I checked the figures from the NHMRC today and the last round of approvals - I think it is the last year, it may be the year before that - saw something like 2 per cent of the total research effort going into Aboriginal health questions. Now, given the magnitude of the problem in the community, that is not a very significant portion of the total, so I think there is a case to be made for both more money and your other participants are making that in a very articulate way, but there's also a case to be made for better development of ideas and a better priority afforded to some areas of health research.

KERRY O'BRIEN: And is that why you bypassed the NHMRC - despite the fact that only two years ago another of your predecessors, Brian Howe, acknowledged that they were the best people to be dictating where funding went - with your breast cancer research money?

CARMEN LAWRENCE: Well, the peer review process is very important, and that will be applied to the breast cancer program as well.

KERRY O'BRIEN: But not through the NHMRC.

CARMEN LAWRENCE: Well, we wanted to establish a separate foundation through the cancer societies, and they use exactly the same or very similar procedures. The important thing there was to establish a foundation at arm's length from government to see it, basically get it going and enable it to get the corporate and philanthropic dollar, if you like, to increase funding in breast cancer research.

KERRY O'BRIEN: But isn't the NHMRC also at arm's length from government? What is the difference?

CARMEN LAWRENCE: Yes it is, but they have less capacity to get that private dollar. We wanted a foundation that would actually bring in dollars because part of the effort is to get funds from the private sector, they get tax deduction for it, and then you get an increase in the amount of money available to everybody. Some of that research we saw earlier in testicular cancer, for instance, or prostate cancer, that could easily be funded under a general heading of cancer research, breast cancer research, and the community has a right to have a voice about these things. There is a very strong view in the community that there was not enough being done in the area. There hadn't been a lot of response, frankly, from the medical community and I think the end result is a good one.

KERRY O'BRIEN: Priscilla Kincaid-Smith, why has the medical community got so exited about the fact that this foundation has been established separate to the NHMRC, on breast cancer particularly?

PRISCILLA KINCAID-SMITH: Well, I think the medical community sees it as what we call politically guided research. I think this is a lobby group that has said this is an important area and must be funded, and this big sum of money, of $3 million, has been allocated by a government to a specific area of research. Now, when research is chronically under-funded I think that the priorities must be very carefully set and they shouldn't be set, in my view, by politicians who are responding to the lobby groups within the community.

KERRY O'BRIEN: But the politicians are there, when it boils down, to respond to lobby groups, as representatives broadly of society. I mean, what is wrong with an elected government establishing a particular priority in an area of concern like AIDS, as they have done, and an area like breast cancer, or whatever?

PRISCILLA KINCAID-SMITH: Well, I think if there were lots of money to go round it would be acceptable, but I think in a situation where the funds are short, it would be much better if the NHMRC set those priorities, and I think ....

KERRY O'BRIEN: Even if, in the Government's term, the NHMRC is not adequately setting its priorities?

PRISCILLA KINCAID-SMITH: Well, I think the NHMRC got an excellent international overseas review recently. It think its peer review process is very highly regarded and I think it is wrong at the present, for the Government to by-pass that system.

CARMEN LAWRENCE: Well, I think one of the things, and again I had another look at the Bienenstock review today, the review of the NHMRC. One of the things that he says very clearly, and as I say, quite politely, is that the question of setting priorities and areas for research is not something that has been undertaken very sensitively by the NHMRC, and that is why he recommended the establishment of a committee to oversee those questions. I will be much more satisfied when that occurs and we are able to look across the board, because it is often the same people who are critical about the Government responding to community concerns, who have their own institutes and their own, if you like, private funds - the Kidney Foundation, the Heart Foundation, the various cancer societies. In Western Australia there have been State Government funds put into an institute for child health, an eye institute, and the list goes on. It is not as if this is novel in Australian medical research. It is in fact very common, and perhaps what we should be doing is looking at, as I said earlier, the total funding picture and trying to make sure that those who don't have, if you like, access to the more prominent and fashionable funds and the ones more likely to get corporate and private sponsorship, are the ones who get more dollars from the Government.

KERRY O'BRIEN: Christine Clarke, there has been plenty of criticism over the years, muted or otherwise, that the NHMRC over time had become something of a club. Is there anything wrong in the Government trying to see greater flexibility in some of its priorities, like breast cancer?

CHRISTINE CLARKE: The issue that the NHMRC operates as a close shop or somehow a tool for the medical profession was in fact explicitly reviewed and examined by the recent external and independent review of the NHMRC. Now that postulate was explicitly rejected by the external reviewer and I think it is fair to say that the conclusion of that report was that the nation is lucky to have an organisation such as the National Health and Medical Research Council. And I think it is important to also mention that it is within the powers, and indeed the responsibilities of the NHMRC under the 1992 Act, to in fact set priorities for research.

KERRY O'BRIEN: Okay, but when the Minister looks at the figures and she says, in terms of Aboriginal health for example, and I forget which year or over how many years, but that the NHMRC had only allocated something like 2 per cent of its total funding for Aboriginal health research. And I think she also suggested that their priorities on breast cancer research were, in her term, inadequate. I mean, who reviews that, who should have ultimate responsibility for what is taxpayers' money?

CHRISTINE CLARKE: I think it needs to be restated again that the total amount of money available for disbursement into all of these areas, is completely inadequate. Our ability to address these important national priorities is limited by the amount of funds that the NHMRC has to disburse.

KERRY O'BRIEN: We are virtually out of time, but Carmen Lawrence, I notice that AMA President, Brendan Nelson, says that if research funding isn't adequate in this country, then we might as well pack up the entire health system, that so much of it actually feeds out from there.

CARMEN LAWRENCE: Well, as I say, Brendan is very colourful and I think he makes good television copy but it is not always very good argument. I agree, and I don't want to be at odds with your other participants on this question that we need increased funding. That is why the election commitment was made; that is why the Government has made steps to increase the amount of private sector funding. But I don't think for a minute there is a crisis in this area. There is a need for considerable improvement ....

KERRY O'BRIEN: Does this mean two or three years from now that if the private sector hasn't delivered, that you wash your hands of it and say, well, they haven't done their job so we are off the hook?

CARMEN LAWRENCE: Not at all, no, and the Government has a very strong commitment to pulling its weight and increasing its contribution. But I might say one of the other things about some of the so-called medical research, and I say this perhaps as a researcher, is that some of it is basically repeating material elsewhere. And one of the reasons we set up a breast cancer foundation was to try and bring together the best research from around the world and spin off that as well as doing our own original research.

KERRY O'BRIEN: Christine Clarke, you have got a thirty-second response.

CHRISTINE CLARKE: I think the Minister's belief that there is not a crisis is wrong. There is a crisis that will be manifest, if not next year then the year after. The situation is desperate and must be resolved with a major increase in funding, and we need not only the private sector but the Government to contribute, because the private sector will not substitute for government investment in research.

KERRY O'BRIEN : We are out of time, thanks to the three of you.