A medical school consists of a 

 dozen or more semi-autonomous de- 

 partments, each with its own budget. 

 In the schools fa\'ored with a large 

 endowment, research projects arc con- 

 stantly in progress in all departments; 

 in financially weaker schools, the 

 budget of a department may be too 

 small to supply as much as a secretary 

 for the department head, and research 

 is, of course, a financial impossibility. 

 E\'en in the most fayorcd depart- 

 ments, the quality and quantity of re- 

 search would be greatly increased if 

 it were possible to employ an extra 

 technical assistant or tvyo, to purchase 

 additional supplies or a necessary 

 piece of equipment, to improve or 

 enlarge animal quarters, or to meet 

 other countless small financial re- 

 quirements that may arise suddenly 

 and may be of a temporary nature. 

 In departments with small budgets 

 such requirements are eyen more 

 pressing. Many medical schools at 

 present haye small likelihood of se- 

 curing grants-in-aid because they 

 ha\'e neither personnel nor equip- 

 ment to conduct successfully the type 

 of research project appropriately fi- 

 nanced by this method. 



If a central agency were to attempt 

 to meet item by item these many 

 requirements by means of specific 

 grants, the administrative costs would 

 be prohibitixe. The amount needed 

 for each item is small, but the total 

 amount needed by an institution may 

 be relatively large. 



Furthermore, a central agency 

 would lack the flexibility to meet the 

 rapidly varying and often temporary 

 research needs that arise in the medi- 

 cal schools. A promising lead in re- 

 search mav prove patently false 

 within a month or two. It is equally 

 important that the project should 

 then be stopped, and its personnel 



and equipment promptly diverted to 

 more producti\'e work, as it is that the 

 project should have been given a trial. 



A special use for general research 

 funds would be to provide "junior 

 fellowships" which would allow a 

 medical student to interrupt his 

 course, usually between the preclini- 

 cal and clinical years, and to devote 

 himself full-time to research for a 

 year or two. The chances in this 

 country for medical students to gain 

 research experience prior to gradua- 

 tion are few, and as a result much 

 research ability goes undiscovered. 

 Candidates for these fellowships 

 would be unknown to a central 

 agency, which would have to rely 

 entirely upon the judgment of the 

 local research board for their selec- 

 tion. Hence it would be proper and 

 economical to provide these fellow- 

 ships from the general research funds 

 administered by the local board. 



The provision of funds as block 

 grants to local research boards would 

 exercise to greatest advantage the 

 principle of decentralization of con- 

 trol of research; would eliminate 

 costly overhead; would create a flexi- 

 ble mechanism to meet rapidly vary- 

 ing needs; would allow full play to 

 the wisdom and experience of medi- 

 cal school faculties and administra- 

 tors, whose knowledge in aggregate 

 and whose particular knowledge of 

 local needs must always exceed that 

 of a central agency; would promote 

 research in laboratories where it is 

 now poor!)' developed; would foster 

 investigations of an exploratory na- 

 ture; and would provide the greatest 

 and most eff'ective stimulus to medi- 

 cal research. 



¥e\\o\vs\i\fs 



Federal funds should be used to 

 support fellowships, extending over 

 periods up to 6 years, to be awarded 



59 



