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recommend that the parliament of united Germany, theHundestas. should continue the investisations.

Annette Tuffs

USA: Indirect research costs

Congressional investigators have scheduled HarvardMedical School as their next stop in their inquiry into howuniversities spend federal money for overhead expenses insupport of research. These expenses include such costs as

building construction and renovation, utilities, the use oflibraries, and administration incurred in conducting the-research but not covered by grants. Nationally these indirectresearch costs, as they are called, add up to$1 ’5 billion a yearfor biomedical research alone.

The investigation is directed by US Representative JohnDingell of Michigan, the campaigner against fraud andmisconduct among scientists and health agency regulators.Indirect research costs are calculated on a percentage basis.Harvard Medical School’s rate, for example, is 77%. Thatmeans that for every$100 million received for research, theschool bills the Government for an additional$77 million.What prompted Mr Dingell to look at Harvard’s books wasthe school’s proposal to boost its rate from 77% to a

breath-taking 104%. In comparison, Harvard’s neighbour,Massachusetts Institute of Technology, has a rate of 58%.Government auditors are already well along in their

investigation at Stanford University. Even before the

auditors’ arrival there, the regional news media had beentreating the Stanford story as a scandal, triggered off by aleak to the press of a memorandum written by Paul Biddle,the representative on the Stanford campus of the Office ofNaval Research, which administers all research grants there.Mr Biddle’s memo referred to "fraudulent acts" and "falseclaims" at Stanford, but provided no supporting evidence.Subsequently, the Navy announced it had received"information that cost formulas may have been inaccurate,which resulted in faulty overpayment (to Stanford)".The media, relying on an anonymous source, have been

more specific. The Peninsula Times Tribune in the SanFrancisco region reported that the Government was seekinga$300 million repayment from Stanford. In response,Donald Kennedy, Stanford’s president, told the facultysenate: "That kind of stuff is enough to send trustees off totheir cardiologists. To date, despite some ominous generalcharges, we have not received any specific allegation we cantest. The$300 million figure... would be over half the totalamount of Stanford’s indirect cost reimbursement for the

past decade". An in-house audit found no wrongdoing andsaid the Government actually owes Stanford$13 million.The escalation of indirect research cost rates is bad news

for researchers since every rise means there is less for theresearch itself. Scientists at schools such as Columbia,Stanford, Cornell, and Harvard Medical School, where therate is 70% or more, could lose out on grants to schools suchas the University of California at Berkeley, where the rate is49%. Finally, there is a suspicion that these reimbursementsare not always used to support research. William Whelan, abiomedical research scientist at the University of Miami,points out that a school could channel the payment to pay fortennis courts, since its use is unrestricted.

J. B. Sibbison

East Africa: Three vignettesBaringo District lies in the hot arid plain in the floor of theGreat Rift Valley in Kenya. Above are steep hills, denselyinhabited and wooded. Below, an alkaline lake is fringedwith flamingoes, and clouds of sulphurous steam rise fromthe adjacent hot springs. Around, it is arid, hot, and dusty,and inhabitants-mostly pastoralists and a fewcultivators-are few and far between. This is not a

promising scene for "development". Yet here is the site of anew venture, funded by UNICEF but in every sense aKenyan activity. In the valley there are water developmentprojects, nursery schools, women’s income-generatingprojects, and, on the hills, a school health programme.More important is the growing expertise of the sub-chief

who, in a mixture of Swahili and English, shows a grasp ofthe theory of development that would impress a universityexaminer, combined with practical knowledge of how tolocate wells and organise health campaigns. The project hasresulted from collaboration between the district governmentofficers in charge of education, health, water resources, andplanning, a team from the universities in Nairobi, andmembers of local communities. Medical students andnurses are trained there (and teachers soon will be), andseveral university departments have strong applied researchprogrammes. These activities, together with the

development of a baseline survey questionnaire, are

coordinated by the professor of paediatrics in Nairobi butimplemented through a committee on which all the

participating groups are represented. To find suchcollaboration between Government, university,community, and agency (UNICEF) is remarkable.At Kibera, a slum area of Nairobi, the same university

group is involved, this time with the city council health staff,but the problems are different-a quarter of a million peoplelive in Kibera, but officially it doesn’t exist, because the landis not legally settled. How, then, does one organise healthcare and the other necessities for children’s healthydevelopment when officially nobody is there? Severalcharities are at work, but there is little coordination. Thefirst steps by UNICEF and the university were to involvethe city council and then to get all the non-governmentalorganisations together to agree a sensible division oftasks-an unorthodox approach to research but a necessaryfirst step in defining essential local research needs.

Kampala, Uganda, is rebuilding in every sense after theappalling civil strife of the past two decades. MakerereMedical School was badly affected, and with a consultant’smonthly salary only enough to buy food for a week, thewonder is that the school never ceased to function. Now

attempts are under way to restore the work on child healthfor which Makerere was in the past so well known. Finnishaid through UNICEF has been used to set up a child healthdevelopment centre, run by a group of Ugandan workerswith some temporary expatriate collaboration. Its aim is todevelop research linked to government programmes andcommunity needs. The centre’s help is sought by the localimmunisation programme, by UNICEF’s operationalhealth care programmes, by the crowded urban community,and by health workers seeking help with designing practicalresearch protocols from all over the country.

These three examples show how the capacity for essentialnational health research (see p 1415) is being built up. First,it needs interested research workers, then comes the difficultadaptation to working with Government and communities,not only to execute but also to define the topics of research.