The international research community can look back over
a twentieth century of enormous progress in health and medicine.
Today, sciences such as molecular biology, immunology and
pharmacology provide a sophisticated understanding of the
human body and how it works in health and disease. We have
acquired powerful tools to diagnose, treat and prevent disease.
Most infectious diseases are amenable to treatment or prevention.
Effective treatments are available for many diseases that
were previously fatal or caused life long disability. Chronic
kidney disease is treated by transplantation; many forms of
leukaemia are amenable to chemotherapy; mental illness is
largely treated in the community. The situation is in striking
contrast with that of the early 1900s, when infectious diseases
such as typhoid fever, tuberculosis, infant diarrhoea and
pneumonia were major causes of death, chronic psychiatric
illness meant a lifetime of custodial care, and a diagnosis
of chronic kidney disease or leukaemia was a death sentence.
Australia has been a major contributor to the growth of global
scientific knowledge and to its application to human welfare.
It provides a case study in what has been achieved, as well
as in what remains to be achieved.
Australians overall are by world standards a healthy lot:
their expectation of life at birth exceeds 75 years for women
and approaches it for men; fewer than ten infants die in the
first month of life for every thousand live births. These
and other health statistics compare favourably with those
of other countries, and stand in striking contrast with Australian
figures from earlier in this century.
Why have these improvements occurred? The reasons are complex.
Changes in the standard of living have clearly been important,
especially those factors involving nutrition, hygiene, accommodation
and transport. Better organisation and delivery of health
care certainly played a role. Much, however, must be related
to progress in medical science and technology, to such developments
as the discovery of antibiotics and of vaccines for immunisation.
In each of these aspects, Australia has played a prominent
role. The Royal Flying Doctor Service, for example, led the
world in its innovative approach to health care of remote
and scattered communities. In medical research, Australian
researchers have made outstanding contributions to world knowledge,
to an extent quite out of proportion to the volume of research
effort. Australians have reaped a double benefit, from the
findings of that research and from the early knowledge and
application of overseas advances that is made possible by
the international networks and local influence of a strong
The Australian commitment to research has a long history.
A Brisbane physician, Joseph Bancroft, discovered the parasite
that causes filariasis in 1876. The nation moved early to
set up structures for the support of medical research. The
Australian Institute of Tropical Medicine, the first institute
of medical research in Australia, was established in Townsville
in 1909, and the Walter and Eliza Hall Institute of Medical
Research, established in 1916, became the premier institution
in the nation. In 1936 the government set up the National
Health and Medical Research Council which has become the major
founding body for medical, dental and health research in Australian
universities and institutes of medical research. In 1989,
the Council supported 1,100 individual research grants, several
institutes, numerous programs, fellows and scholars from a
budget of 100 million Australian dollars.
Australian medical research has had its high points. Two
Australian scientists, Sir Frank Macfarlane Burnet and Sir
John Eccles, were awarded the Nobel Prize. Other scientists
have earned international recognition, as for example in the
important contribution made by Fenner to perhaps the most
exciting development of the last twenty years, the global
eradication of smallpox. The elucidation of infectious diseases
indigenous to Australia led to some notable discoveries. For
example, the description of Q fever by Derrick, the identification
of its causative agent by Burnet and the development of an
effective vaccine by Marmion. The science of immunology owes
many of its insights to Australian researchers and research
institutes. Indeed, it stands on an Australian hypothesis
Burnet's clonal selection theory of immunity, which is recognised
as one of the corner stones of modern biology.
Australians have made many discoveries of great practical
importance. Early in the century, Queensland physicians proved
that lead poisoning from paint was the cause of a disturbingly
high prevalence of chronic kidney disease. Sir Norman Gregg
discovered how infection of a pregnant mother with rubella
(german measles) could cause congenital defects in the infant.
Cade pioneered the use of lithium for the serious mental illness
manic psychosis. Dr Kate Campbell recognised the causal association
of the blinding disease retrolental fibroplasia with overuse
of oxygen in the resuscitation of premature babies. More recently,
Australian scientists and clinicians have contributed to technological
developments in microsurgery and transplantation, and in the
treatment of infertility and deafness (the "bionic ear").
This proud tradition continues in research on the very substantial
challenges that remain. Cancer and heart disease account for
more than half the deaths in our society. Australia shares
the world's concerns with an epidemic disease unknown before
1980, and its researchers contribute more than their share
of new findings about HIV and AIDS. Australia's population
is ageing, and senile and pre senile dementia syndromes such
as Alzheimer's disease have emerged as major problems, and
therefore as major targets for research.
The progress of medicine and medical science has its disappointments.
Still, in some countries, daunting problems of infectious
and parasitic disease, malnutrition and overpopulation remain.
In Australia, the Aboriginal population has levels of mortality
and morbidity comparable with those seen in the so called
Exciting progress is, however, being made in some areas.
Australia leads the world in some aspects of the search for
a vaccine against malaria, still a major scourge in much of
the tropical world. The technology and insights of molecular
biology are being applied aggressively to all fields of medical
research, with revolutionary advances in our understanding
of such fields as genetics and cancer. Physiologists and bio
engineers collaborate in studies of vision and hearing, and
new and better tools to help the disadvantaged are on the
horizon. Australian epidemiologists are taking advantage of
modern computer technology to study disease in populations,
and to measure subtle effects of the environment on health
and disease. Australians, with the highest incidence in the
world of skin cancer including melanoma, have cause to see
those studies as important. Physicians, other health professionals,
scientists and engineers are collaborating to produce new
approaches to rehabilitation through better prostheses. Australian
researchers are collaborating with industry to bring their
discoveries to commercial development. A current example relates
to acclaimed basic studies by Professor Don Metcalfe of the
Walter and Eliza Hall Institute, of factors which stimulate
the multiplication of blood cells, and to the application
of those factors in the treatment of currently intractable
It is not difficult to predict that this level of productive
activity will continue into the future, and that the results
will mean important gains for the health of Australians. It
is not so easy to be specific about details. There is certainly
one important direction for progress, to bring the benefits
of modern medicine to all communities throughout the world.
Can we or our successors expect to live longer? There may
well be natural limits to the extension of the human lifespan,
but gains are clearly still possible for some parts of our
community, and there is room for all to live more effectively
and die with greater dignity. At the other end of life, we
have clearly not exhausted possibilities of assisting or controlling
fertility, and of predicting, diagnosing, preventing or remedying
genetic defects. We come closer each year to understanding
our major enemies, heart disease and cancer, and to being
able to intervene effectively to prevent or treat them. There
are tempting horizons towards which we can extend the advances
already made with the high technology of organ transplantation
and body imaging. Perhaps even more exciting may be the advancer
that we cannot predict. Just as some of the most important
discoveries in the last 30 years could not have been predicted
at the beginning of that time, so students graduating in the
1990s will see progress that their teachers could not imagine.
World medical research now has the tools to tackle scientific
questions that were previously insoluble or indeed could not
be formulated at all. The solutions to those questions will,
in turn, revolutionise our capacity to treat and prevent disease.
There is every reason for medical researchers to view the
future with confidence, ambition and excitement. Australia
is well placed to play a major part in that ambitious future.
It has an established network of research units, and it has
a well developed national system for their support. The basic
necessities are there for a scientific thrust into the 21st
century that will yield great benefits for people all over
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