On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.101 n.10 Cape Town Oct. 2011
Questioning the UCT Lung Institute
To the Editor: The enthusiastic account of the 10th anniversary of UCT's Lung Institute (Pty) Ltd in the June issue1 raises many questions. Is medicine a caring profession or a business? Is it desirable that the replication of such initiatives be encouraged? Is it possible to replicate it even if one wanted to? Is the Institute sustainable in the light of its dependence on the exceptional ability and determination of a unique individual?
Judged as a business, the Lung Institute seems to be a resounding success. Starting 10 years ago with a little 'nest egg' and support from a pharmaceutical company, it is now a limited company with a budget, according to Professor Eric Bateman - founder and CEO - of R40 million a year.
Although it sounds as if he is proselytising, Professor Bateman says he is not, and I believe him. To enable others to follow would require that he instruct them in the finer arts of the business such as how the Institute is kept 'light on its feet' and circumvents burdensome bureaucracy, which he identifies as 'the enemy of enterprise'. Every successful businessman is entitled to his secrets, and no businessman in his right senses would deliberately open up his market to competition.
However much I admire the achievement, I find the self-promotion distasteful. There are several aspects of the arrangement that I don't understand, and one of them is of deep concern.
What I don't understand is what the university gets out of its wholly owned tax-free subsidiary for 'educational and charitable purposes'. There are presumably no dividends, because 'Surpluses are utilised for the activities of the institute in pursuant of goals'.2
How much does UCT earn from government subsidies from Institute publications in peer-reviewed journals? How does the Institute add value to the core university function of teaching? A few postgraduate researchers are mentioned, but what about a contribution to medical student and postgraduate registrar instruction and supervision?
What is of greatest concern to me is the fact that the Lung Institute and GINA3 - the Global Initiative for Asthma, of which Professor Bateman has been appointed [sic] Chair of the Executive and Science Committees4 - are both dependent for their existence on the pharmaceutical industry.5
For me it's like a nightmare come true. At about the time the Lung Institute was founded, John Le Carré, the noted author, was warning:
'But Big Pharma is also engaged in the deliberate seduction of the medical profession, country by country, worldwide. It is spending a fortune on influencing, hiring and purchasing academic judgement [sic] to a point where, in a few years' time, if Big Pharma continues unchecked on its present happy path, unbought medical opinion will be hard to find.'6
Emeritus Associate Professor
Division of Paediatric Pulmonology
Department of Paediatrics
University of Cape Town
1. Bateman C. Helping comrades over the social upliftment line (Izindaba). S Afr Med J 2011;101(6):374-376. [ Links ]
2. Lung Institute. http://www.lunginstitute.co.za/content/governance.html (accessed 25 July 2011). [ Links ]
4. GINA - the Global Initiative for Asthma. http://www.ginasthma.org/about-us-executive-committee.html (accessed 25 July 2011) [ Links ]
SAMJ News Editor Chris Bateman replies: The article was the result of a confluence of events. Firstly, several deans of medicine had painted an alarming picture to the Parliamentary Portfolio Committee on Health of dysfunctional funding of tertiary institutions and, more importantly, the paucity of medical clinical research in this country; this remained fresh in my mind. Secondly, having reported on some exemplary application of the Lung Institute's research in the field, I decided that its 10th anniversary was worthy of coverage, given the context of which I'd recently become aware. The Institute's achievements speak for themselves. While the long-distance runner metaphor may have sounded 'enthusiastic', the facts made it a readily available journalistic tool to convey the message in an entertaining way. As for being 'distasteful', that's a matter of opinion and goes to a debate that Professor Klein has raised - which my article did not speak to. Lastly, and perhaps pertinently for the record (given the literary enthusiasm I displayed), a disclaimer was printed at the bottom of the article stating that I am in no way related to Professor Bateman. Professor Klein puts an entirely different set of issues on the table, and if my article 'raises many questions', that is in keeping with my job.
Professor S R Benatar, Acting Chair, on behalf of the University of Cape Town Lung Institute directors, replies: In response to Max Klein's uninformed criticisms and questions about the Lung Institute based on a news report, we begin by recommending that he read the 10-year formal report of the Lung Institute's activities (http://www.lunginstitute.co.za).
As part of the extended Faculty of Health Sciences platform for teaching, learning and research, its mission is to serve the University of Cape Town, the Faculty of Health Sciences and the community. Its widely acknowledged significant contributions to all the above have earned its researchers many honours over the past decade.
Apart from its legal status, the Institute is no different from a large research grouping within an academic department. Its academic staff, whose work in the Institute is supported by their research income, have formal faculty appointments and contribute to teaching (all levels) within their departments. Several postgraduate students undertake projects in the Institute towards master's and doctoral degrees, funded by the Institute and supervised by Institute academic staff.
Although the Institute does not directly earn state subsidy, publications by its members with UCT appointments draw subsidy for UCT, as in any university department. In addition to retaining and benefiting from the very considerable outputs of highly motivated staff, without having to provide the overheads ordinarily required for a large research grouping, numerous collaborations with other university departments have generated successful joint grant applications, and support for postgraduates.
The Institute strikingly provides a platform for a wide range of socially responsive and public service activities. Senior Institute staff deliver regular unpaid clinical and consultation services in the Division of Pulmonology, the Department of Critical Care at Groote Schuur Hospital and Brooklyn and Brewelskloof TB hospitals, and at primary care clinics in the Western Cape.
Notable academic outputs include studies of the burden of lung diseases in South Africa, the testing of new drugs, diagnostics and vaccines for tuberculosis, and a reference allergy service. In the field of knowledge translation, an innovative, integrated practice manual for chronic and infectious diseases for use in primary care clinics has been developed, and is being adopted and rolled out in South Africa as well as in Malawi and Kenya. The Knowledge Translation Unit has trained more than 800 nurse trainers and more than 13 000 primary care nurses in the use of this integrated care guideline.
While an initial and welcome pharma donation received by UCT provided for constructing the building, we refute any misconception that the Institute is entirely dependent on the pharmaceutical industry. We acknowledge the challenges facing most academic institutions worldwide in their relations with industry, but the Institute's 10-year report provides evidence for the success of our endeavours to become increasingly independent from such support. For several years, income from grants and non-pharmaceutical sources has exceeded income received from research contracts with the pharmaceutical industry. The governing Board of Directors with a finance committee appointed by the directors oversees all aspects of Institute activities, ensuring that funds obtained through research contracts with pharma are raised and utilised transparently, with full accountability and in keeping with university policy.