[Financing medical research in the Netherlands: start taking care of the future now].

Less money is spent on medical research in the Netherlands than in other industrialised countries, even though Dutch science, and certainly Dutch medical science, scores qualitatively among the best in the world. Part of the explanation is that a relatively large part of scientific research in the Netherlands is financed directly by the government. As a result of several rounds of cutbacks in government spending, that were executed each time by cutting research that performed less well, the remaining research groups are at high qualitative level and highly competitive. In countries that surpass the Netherlands, there is an important second stream of government funding via Medical and Health Research Councils. In the same countries, the pharmaceutical industry also provides more money for medical research. The other side of the coin is that medical research in those countries seems more or less 'for sale'. Too heavy dependence on market oriented research leads to doubts regarding the independence of medical research. International observers judged that the direct financing of research by government in the Netherlands was an enormous bonus since it leads to flexibility to start new topics and at the same time stability of positions. However, a major concern for Dutch science is that there are too few possibilities to attract and hold promising young people. It is especially difficult to keep promising young women; though this is true for all industrialised countries, the Netherlands lags behind its major competitors as far as the position of women in the higher ranks of science is concerned. These problems will have to be solved by stimulation programmes for young researchers and flexibility of the higher echelons. The educational system must not be directed only at the production of more doctors for medical practice, but also at sufficient scientific training for these doctors so that they will be able to comprehend new developments. The ordinary daily practice of medical science is to verify the usefulness of new developments--which is just as important as breakthroughs at the top. This means that there should be new investments, not only for top ranking scientists in fashionable areas, but also to maintain sufficient numbers of medical scientists at all levels. It cannot be foreseen where the next new developments will arise, and even in a small country, active research should be ongoing in many areas to maintain contact with the international research community. New investments should primarily be in direct government financing and in augmentation of streams of money via Medical and Health Research Councils.