Bill Gardner over at The Incidental Economist has a thoughtful post on a NY Times op-ed that appeared last Friday. The op-ed pointed out that for all of our considerable investment in basic neuroscience, we have not gained many significant clinical psychiatric interventions over the past 20 years.
Gardner points out that there are a number of evidence-based psychotherapeutic interventions, and concludes that “the National Institute of Mental Health (NIMH) should be funding more research on psychotherapy!” But, he cautions, it does not follow that we should reduce funding for neuroscience research:
The brain is the most important yet least understood organ in the body. Eventually, we will understand the brain. When that day comes, that understanding will be transformative.
Now, given that one of my central areas of scholarship within public health ethics is on priority-setting, I found myself wondering if we can really avoid difficult allocative decisions simply by increasing absolute levels of funding. So, I asked Bill on Twitter, what happens if we cannot do the latter? What if we have to make a decision regarding whether to reduce funding levels for basic neuroscience in order to increase funding levels for psychotherapy research? Which is our priority, and why?
Believe it or not, I was actually not trying to be cheeky here! These kinds of questions are literally core to my research. Of course, as I argue in lots of places, we want to avoid the false choice fallacy. That is, we do not need to do either A or B or Q. We can pursue all of them. But, as I responded to Bill:
We can do lots of different things, but given scarce resources, we cannot do them all at the same level of investment. Even if we were to increase the size of the pot for research, we would still be faced with the same kinds of allocative questions: should funding for basic neuroscience be maintained at the same proportion relative to that allotted for psychotherapy research? Should we change the ratio of funding? Why or why not?
Bill argued that given the constriction of research funding for NIH in general, let alone NIMH, trying to make these kinds of priority-setting assessments would be distorted:
Here, I want to respectfully disagree with Bill. There is nothing “false” about making difficult decisions of priority-setting in times of scarce resources. Although fighting for the world we want to see is of great moral significance, as I often remark to my students, sometimes we cannot escape difficult moral problems in the here and now. We are, as they say, in the s*it.
The world we inhabit is one in which we have scarce resources for mental health research. We are faced with a dilemma as to how best to allocate those resources. Although we can choose to sponsor research in a variety of areas, we can nevertheless not avoid the question of which area we should invest relatively more or less of our resources.
Finally, as I remarked to Bill, we should also pay heed to the fact that the world we live in is one in which, as Nikolas Rose & Joelle Abi-Rached put it, the neuromolecular gaze dominates (see also Stephen Casper’s wonderful scholarship on the neuro-turn). As such, even if we were to increase absolute levels of funding, we would have as a sociological matter every reason to suspect that the lion’s share of increased funding would go to basic neuroscience research. If this is correct, and we have little reason to suspect otherwise given current neuromania, increasing absolute levels of funding would inspire little confidence that we would substantially improve the dearth of resources currently allocated to psychotherapy research.*
*James Coyne has argued in many fora that the quality of the evidence base supporting much psychotherapy leaves much to be desired (to put it mildly). I offer no opinion on that here — indeed, I’m no methodologist so am not really qualified to weigh in on many of the technical issues in this vein — but it is worth noting.