With manufactured exports and foreign direct investment falling, we are in danger of becoming a slow-lane economy, but if we can shake off conservatism in the medical world, biomedicine might point the way forward, writes Garret A FitzGerald.
Science has benefited from the recent arc of national prosperity. It has been snatched from the margins of cultural perception and graced with previously unimagined fiscal largesse. Remarkably, this investment has been deployed largely in a measured and imaginative manner.
Science Foundation Ireland, the statutory delivery vehicle for the largest tranche of Government investment, has resisted the call to spread the jam evenly, to reward the previously disenfranchised or to succumb generally to five- seater politics. Rather, it has adhered to the guidance of peer review to fund only science deemed to be excellent, offering a diversified portfolio of opportunities for support.
Realisation of the promise afforded by such investment in programmes, buildings and equipment requires also the adaptation of our institutions of higher learning.
The traditional dispersed university structures - multiple small departments largely invisible in terms of international impact, rigid in employment and promotion - are unsuited to the creation and development of the quality of leadership, critical mass and focused effort necessary to compete in the global game of science today.
Prosperity, like excellence, is not a local value; if we want to maintain it, we have to gain the flexibility to compete. Ireland still has a two-speed economy. For all the international services and the manufacturing exports fuelled by foreign direct investment, a second dependent tier is dominated by the appreciation of structural assets, such as housing.
However, both manufacturing exports and foreign direct investment have declined dramatically and only 1.5 per cent of multinationals now see Ireland as an attractive setting for investment over the next five years.
If this perception remains uncorrected, we may revert to a one-speed economy - in the slow lane - faster than we think.
Science has always been an elitist sport and competition is fiercely global. Signals of the balance of power - patents, publications and the percentage of GDP devoted to research - are diversifying away from the United States, Britain and Japan towards emerging macroeconomies like China and India and smaller countries with highly focused, state-supported efforts in aspects of biomedicine.
Just how rapidly is this occurring? Ninety per cent of the same multinationals now select China or India as their preferred site for investment. Expertise in the sciences, especially in China, is growing at a rate that justifies such expectation. One hundred million new internet users were added in China last year and English has now been made a compulsory subject for entry into college.
If our investment in science is to be competitive, we need to focus and amplify our efforts before they are outpriced, outmoded, outmanoeuvred and outgunned.
One area where we might harvest a unique advantage is in biomedicine. The internationally competitive era of Irish medicine - the 19th century - may seem a bit shop-worn in the 21st, but it has had a lasting impact on the clinical skills imparted by an Irish medical education. That, and a relatively small and geographically accessible population, may provide an advantage in this era of biomedical genomics.
We also have a developed expertise in information technology, which is fundamental to realising the prospect of individualised medicine.
Although moves towards creating an infrastructure for the projection of science into medicine have been made, the primary funding vehicle for medical research, the Health Research Board, is poorly supported.
Its €28 million (an increase of just 3 per cent over 2005) is dwarfed by the €242 million for Science Foundation Ireland announced in the 2006 Budget.
Consequently, little progress has been made in the Health Research Board's effort to establish and fund career paths for physicians who wish to pursue primarily research: their numbers remain pitifully small.
A recent article unwittingly highlighted the problem.
The paper described the high rate of migration of trained doctors from Third World countries to the axis of affluence - Britain, the United States, Canada and Australia. However, what went unremarked was that the country suffering the largest net loss of physicians was Ireland.
The announcement by Ministers Mary Harney and Mary Hanafin, based on the Fottrell and Buttimer reports, is most timely.
This €200 million initiative signals an attempt to expand and strengthen the indigenous medical student body with an emphasis on graduate intake, to attract and retain Irish physicians who have trained abroad and to foster research in the health sector with the welcome creation of Academic Clinician posts.
Intrinsic to the success of such an initiative in education and training is a more comprehensive yet integrated re-evaluation of Irish medicine. Such an analysis is relevant both to biomedical science and the quality of health care. Indeed, the two are inextricably intertwined.
Important elements of Irish society remain essentially unreformed from when our perspective was constrained by poverty, our goals modest and our concerns parochial.
The medical profession is one such segment, rivalled in its rigidity and conservatism perhaps only by the law. It includes many dedicated individuals who provide a high level of care in a selfless manner. However, the traditionally weak relationship between medical schools and their autonomous but associated hospitals means that the growth of the profession has occurred largely unguided by scientific principles.
Rather, its evolution has been fostered along mercantilist lines - a souk, in which independently contracted small business people ply their wares.
Rather than indict the motives of individuals, this merely reflects the way incentives are arranged within our healthcare system. The consultants - once again locked in dispute over issues of pay and private practice - are only reacting rationally to the present rules of the game.
Substantial challenges must be addressed if we are to harness the potential of biomedical science to contribute both to the public health and the public purse.
Firstly, there must be a marked increase in funding for the Health Research Board to amplify the development of career paths, expand facilities and afford programme support for physician scientists and health service researchers. It alone has a unique focus on fostering research in medicine.
Secondly, we must create incentives for consultants, especially those with new public hospital-based contracts, to engage in research. We must provide the conditions in which they might pursue it.
Thirdly, we must focus, as we expand our student numbers, on enhancing the quality of basic biomedical research in our existing medical schools, so that they become internationally competitive. A proliferation of medical schools risks diluting this effort. We no more need a medical school than a tertiary care hospital in every county.
Finally, the academic leadership of medical schools must be empowered within university- affiliated hospitals. This requires the formal incorporation of consultants and their remuneration into a practice plan administered by academic departments.
Correspondingly, their contribution to the integrated mission of teaching, research and clinical care must be recognised by appropriate university appointments. This will afford clarity of institutional focus, further the integration of schools of medicine with their teaching hospitals and facilitate the engagement of healthcare professionals, students and patients in biomedical research.
This all may seem unusual and quite foreign to the art of Irish medicine. It is. However, a structure of academic leadership and the infusion of medicine with science is the norm in other developedcountries. There, it acts to enrich the quality and efficiency of medical care.
Should such reform be achieved, the entrepreneurial skill, so evident among our medical profession, might be harnessed to foster an emergent knowledge- based biomedical economy. This valuable asset would then be deployed, not merely for personal gain, but also for the broader growth of the economy and the sustenance of national wealth.
Dr Garret A FitzGerald is the director of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania. He won the 2005 Irish Times/RDS Boyle Medal for excellence in science.