CBES is a Research Unit composed by one researcher. It was created in the PCP in 1990, after a two-year mission as scientific consultant to Nicaragua’s health research in contact with PAHO/WHO in Managua. It passed to the CRC from 1992-95 to obtain minimum resources to develop international collaborative "health & medical R&D policy & current investigation" projects. The researcher has carried out for 30 years several unpublished studies on "health & medical scientific R&D policy research", at Cuba & Nicaragua, including a Dr.Sc.=Ph.D. thesis degree in the Institute for Oncology & Radiobiology. They gave the main methodological bases for three programmes: Cancer Struggle and Oncology Speciality Cuban Programmes 1987-2000; and Objectives, Aims & Directives of the Cuban Health System Programme 1992-2000. These have been done mainly in over-time due to a personal interest, from the beginnings of his training in different specialities=M.Physiology, National Scientific Research Centre; Internal & General Medicine (for three years); MPH & M.Biostatistics, Institute for Health Development.

The full-time "health & medical scientific current research" of the CBES is now shared in two complementary fields of research collaboration: 1) nuclear cardiology & oncology high-tech. research projects, including drugs, monoclonal antibodies, other biomolecules, at the CRC, with biomedical centres; 2) research projects with appropriate-tech. on reproductive & child health, acute & chronic diseases, aged health, & health services, at the PCP, and other polyclinics & hospitals. The over-time "health & medical scientific R&D policy & current research", as a contribution for poorest countries, have been done by CBES preparing and developing several projects by itself, which will be offered as "goodbuys" in the GFHR Forum 3. These have been prepared without any staff, high-tech. latest computers, communication, information & library facilities, etc, neither foreign partner nor grant for scientific visits of exchange --except the given by GFHR for Forum 3.

The CBES plan has been developed in the spirit of main materials of WHO HQ & GFHR. It reflects basic ideas of a global strategic paper I wrote granted by WHO RPS (& ACHR) in September 1997: "A Unified Approach to Medical & Health Scientific Research Methodologies". It has three tasks, which can be done by itself, independently of the Health & Science Ministries. Two of them are conceived in the framework of the GFHR’s Initiative "The Alliance for Health Policy and System Research (AHPSR)" as well as the "Capacity Building for Health Research (CBHR)" developed by the GFHR. The tasks are as follows:

a global health & scientific problem of health research of the poor populations in the world. The most general initiative to solve the most global problem is the Special Program for Research & Training on Health Policy & Systems Research. The others are the Special Programs for Research & Training on more Specific Global Health & Scientific Problems of Health Research of the Poor. About the first initiative, it has been recognised in a pre-Forum meeting in Stockholm, 1996, that "health policy research was a comparatively neglected field in great need of expansion [...]". The whole field and even its area of more uncertainty: "health & medical scientific R&D policy research", however, continue being part of the "practical work of the policy-makers" together with the health & medical current investigators of several specialities, and the other social actors.

This complex area is essential to achieve the objectives of the GFHR and WHO HQ. It needs unified health & medical scientific R&D forecast & policy studies, passing over all the existing differences between the thoughts & methods of the health & medical schools & specialities. Due to the studies highest complexity, which include an ample spectrum of knowledge from a single genome to a globalised poverty, they should be carried out with rigorous scientific logic & methods, to achieve the same quality results that most difficult epidemiological & experimental studies do. There is a need for health scientific R&D policy investigators, beside the practical health policy-makers and the health & medical current investigators in the low- and middle-income countries & regions. They should be well trained in health & medical scientific R&D policy research. The training could be given in a centre such as the proposed, mainly on health scientific policy logic & methods promoted by WHO RPS, ACHR & GFHR, IHPP, LSHTM, as well as on medical experimental & clinical logic & methods developed by other top level biomedical academic centres.

Interrelation of both policy & current investigators, ways of thinking & enquiring, are needed simultaneously, to design & carry out from an holistic perspective, comprehensive health & medical scientific R&D forecast & policy research of the main global health problems from the country level up to the world one. Health policy makers & current investigators cannot continue investigating on health & medical R&D policy & current research in isolation, because they are inseparable elements of the same complex process of scientific prediction of health effects, as it will be described in the second task. The scientific problems for the research training and for the suggestion of national, regional & global strategic principles & guidelines by the centre, could be given by several forums: The GFHR Forums, Council, AHPSR, Other Initiatives, CBHR & Secretariat; WHO World Health Assemblies, Executive Board, ACHR, RPS & Secretariat; CHRD, ICEN, IHPP, LSHTM, and other scientific advisory groups & institutions. Finally, they could be internally also given by the centre’s staff itself.

This centre could be a challenging general centre needed by WHO HQ for four decades, to complement the research training centres set up three decades ago for human reproduction & tropical diseases. It could begin to function in the 21-century within the framework of the AHPSR Initiative or CBHR of GFHR or WHO HQ, even with participation within the project of a "Virtual Global International School of Public Health". The centre should be developed in a country that can guarantee complete scientific information, electronic communication, & library resources, to allow the study in depth & extent of the health & medical scientific R&D policy research matters & tools. The centre’s mission could be: to promote through appropriate research & training, national, regional & global capacity on health & medical scientific R&D policy research of quality, for the countries & regions of the South. Doing this mission it would help not only to strengthen health policy research, but also to strengthen health & medical current research at those levels.

Health & medical R&D policy & current research’s scientific problems should be solved in the developing countries, with the scientific thoughts, logic & methods that have prevailed for four centuries in the developed countries, but also with the ones that have not. Even in highest developed countries, since the 18^th-century, valuable suggestions about the need to use complementary thoughts & tools have not been appreciated. The present health & medical R&D thoughts & tools have been very successful, especially after 1945, but they should be improved and complemented. Moreover, in the 20th-century, and still at the eve of the shift to the 21st-century, in the health & medical scientific R&D policy & current research, have been deepening a disproportion in the amount of utilisation of their scientific logic & methodological means and methods.

On the one hand, there is a lack of balance between the different pressures made by two great social forces over the fundamental forces of the logic of scientific progress in the last 54 years. For instance, the improvement in high-tech., with their technological & financial incentives, highly encourages discoveries of new fundamental biomedical models & knowledge by means of a reductionistic approach. However, the betterment in sanitary programs, with more than all, humanistic & ethic incentives, still scarcely promotes enough discoveries of new fundamental behavioural, and over all, new fundamental health & clinical models & knowledge through a holistic approach. On the other hand, there is also an imbalance between the prevalent & isolated use of the very developed empirical & quantitative scientific algorithmic & heuristic methods, in relation to the scarce simultaneous use of the less developed rational & qualitative scientific methods. For example, in health & medical research, the application of statistical hypothesis design to reduce uncertainty to a minimum when tested, has not been accompanied by a clear & efficient procedure for scientific hypothesis generation, which has remained with a great non measurable amount of uncertainty, even in the computer era.

The disproportion in scientific logic & methods is only one main cause of the present not good enough cost-effectiveness rates of both health & medical research. It works not only on the incipient integral policy research, but also on the abundant partial current research of today, in the developing, restructuring, and in the more developed countries too. In the last six years, I have prepared four scientific logic & methodological research projects, as result of a long study of 30 years, beginning from the basic & technological laboratory, through the clinic at the hospital & community, up to the health area & country and world system. For the study at the international level, I have taken into account the experience of the pre-CBES five-year co-ordinating by Cuba the organisation of anticancer research with Eastern Europe, and two-year consulting to Nicaragua’s health ministry’s research. The projects have been proposed to WHO HQ. They are innovative, speculative, & adventurous, but still without partners & support, which are as follows:

1. "Complex Induction of Unifying Principles to Assist the Formulation of Medical & Health Integral Scientific Hypotheses"

(It could be useful in the Malaria, TB, AIDS, Tobacco & Other Addictions Eradication)

2. "Development of Self and Shared Disciplinary Research Spaces of Family & General Medicine & Practice"

(It could be of utility to attack Poverty-Nutritional, Reproductive, Peri-Natal, Infectious, Injuries & Non-infectious Conditions, giving New Lines to Improve Maternal, Child, Adult, Family & Community Health Research)

3. "Unified Logic & Methodological Approach to Scientific Research, Across the Laboratory, Clinic & Field. Research Education Programmes on Health & Medical Scientific R&D Policy Research".

(It could be helpful in the Integration of Basic Projects as Population Growth & Reproductive Health, with the Results of the Genome & Brain Projects, through a Project about Eastern & Western Clinical Medicine Unification)

4. "Unified Logic & Methodological Approach to Scientific Research, Across the Laboratory, Clinic & Field. Research Education Programmes for Health, Clinical & Experimental Current Scientific Researchers".

The ideas of the projects will be shown in posters as "good buys" at the Market Place Exhibit. From each project will be available handprints, and at least an electronic copy of the whole paper origin of it. More linked to my clinical research centre activity of today, I am preparing a new research project titled:

5. "Scientific Hypothesis Generation & Statistical Hypothesis Design: Both Must Receive

for their research would be only "relevant information" of the scientific literature & experience.

-Stüsser RJ. [Unified Health & Medical Scientific Scenarios for the Struggle against Cancer in Cuba 1985-2000"]. Dr. Sc.=Ph.D-degree thesis. Havana: Oncology Institute, 1987. (Spanish)

-Stüsser R, Golubev I. [Methodological System to Develop Unified Forecasting Models to Solve Main Health Problems]. Salud 1988;14:4:27-31. (Spanish)

-World Bank. World Development Report 1993: Investing in Health. Summary. New York: Oxford University Press, 1993.

-WHO Ad Hoc Committee on Health Research. Investing in Health Research & Development. Report of WHO Ad Hoc Committee on Health Research Relating to Future Intervention Options. Geneva: WHO/RPS/ACHR, 1996.

-GFHR. Report of the First Global Forum for Health Research. Geneva, GFHR, 1997.

-Frenk J. Closing the Gaps in Health Research. Keynote Address to the Global Forum for Health Research. Geneva: GFHR, 1997.

-WHO Advisory Committee on Health Research. A Research Policy Agenda for Science and Technology to Support Global Health Development. Geneva: WHO, 1997.

-Stüsser RJ. A Unified Approach to Health & Medical Scientific Research Methodologies. Paper written for WHO/RPS/ACHR. Havana: Clinical Research Centre, 1997.

-WHO. The World Health Report 1998. Life in the 21^st Century. A Vision for All. Geneva: WHO Director-General, 1998.

-GFHR. Agenda for Forum 2. Attacking the 10/90 Disiquilibrium in Health Research. Geneva, GFHR, 1998.

-Gilles HM, Lucas AO. Tropical Medicine: 100 Years of Progress. Br Med Bull 1998; 54:269-80.

-Brundtland GH. Speeches of WHO HQ Director-General in Different Meetings and Places. Geneva: WHO Internet Web Site, 1998-99.

-GFHR. The 10/90 Report on Health Research 1999. Geneva: GFHR, 1999.

-GFHR. Preliminary Agenda for Forum 3. Attacking the 10/90 Disiquilibrium in Health Research. Geneva, GFHR, 1999.

Rodolfo J. Stusser, M.D.

Integration Science Program for Medicine, Nursing, Technology & Health
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