Research Strategy Proposal: High-Tech Exploitation of the Unexpected

What do we believe should be done differently in AIDS
research?

In the history of medical advances against other infectious
diseases, but our impression is that the key discoveries have
usually been unexpected -- not the result of institutional
programs based on the theories of the day. Therefore, we
propose a research strategy of being prepared to make the
best possible use of the unexpected -- for example, by
"mining" the hundreds of available research leads which are
known, and often published in scientific journals, but which
are largely ignored today because of the institutional
mindset which controls research direction and funding.

This empirical approach to research (being guided first by
what works, and building theories later, instead of using
theories to set research direction) could be far more
effective today than it ever could have been in the past, for
at least three reasons. First, biological technology is much
more developed now, compared to the times when major advances
were made against other infectious diseases. Second, there
are far more scientists today than in the past, so more work
is being done; many more interesting research leads come into
existence, allowing better opportunities to be chosen for
development. And third, modern communication technology makes
possible more effective sharing and use of the information
produced by the scientific world.

How does this proposal differ from what is being done
already? Research leads are always being selected and
followed up. But there are two major problems. First, the
academic need to look good in committees, by having a well-
supported case and not risking being wrong, biases the system
in favor of well-worn research tracks (such as AZT and
similar drugs) which offer little opportunity for major
advance. And second, so much momentum is required to get a
new treatment approach into the earliest human tests, that
usually nothing happens unless there are commercial or
technological rewards outside of AIDS to drive the work. Just
the chance to save lives has not provided enough momentum to
get past the pre-clinical barriers. As a result, most of the
creative treatment development work has gone into the
building of elaborate, difficult technologies, while more
practical approaches (such as screening for LTR inhibitors)
have been neglected.

It will be hard to change the current momentum, because
research funds are extraordinarily scarce; the intense
competition for funding encourages old-boy networks and
discourages new, creative approaches. One possible strategy
is to develop professional support for the seemingly unlikely
combination of high-tech, rational methodology, with the
willingness to take a leap of faith (and chance of being
wrong) on high-risk, high-reward (but usually low cost)
ventures. If top scientists and physicians will support this
approach to research, then it can be implemented little by
little, as options for movement become available.