Executives at Wake Forest University's Bowman Gray School of Medicine didn't mince words in July 1997 when they declared a crisis in medical research funding and called on American medicine to hold a national summit on clinical research.
Without saying how much funding was needed, the authors contended that a continuing financial erosion would sap the nation's pool of young investigators and delay new medical breakthroughs. "The entire `ecosystem' of clinical research," they wrote, "is in danger of extinction."
That dire warning, published in the Journal of the American Medical Association, got the ball rolling on a massive project aimed at ensuring adequate support for clinical research.
Since September 1997 the Association of American Medical Colleges and the AMA, in collaboration with Wake Forest Vice President and Dean James Thompson, M.D., and Senior Associate Dean Jay Moskowitz, have been working behind the scenes to help craft a national agenda on clinical research. A consensus document is to be presented at a summit scheduled for the summer of 1999.
A March 1998 report by the president's Advisory Commission on Consumer Protection and Quality in the Health Care Industry lays out the problem. Market forces are squeezing clinical revenues once used to subsidize medical research. Meanwhile, more private research centers are competing against academic medical centers for research funding. And with an increase in applications to the NIH, new clinical investigators are finding it harder to secure funding to support their work, it says.
A major source of funding is disappearing without any clearly identified replacement, says David Korn, M.D., the AAMC's senior vice president of biomedical research. The goal, he says, is to develop a strategy to ensure that the U.S. supports a robust clinical research effort well into the future.
President Clinton has called for a fiscal year 1999 increase of $1.15 billion in the NIH's $13.6 billion budget and a 50% increase by 2003. That, says the AAMC, must be accompanied by a strategy for ensuring that the money is wisely spent.
To build a consensus that every stakeholder can support, project leaders are seeking a broad range of opinion. By the end of September, 10 focus groups moderated by an independent facilitator will have deliberated over a common set of questions. A draft consensus plan, to be developed this fall, will draw from reports produced by the individual focus groups.
Not surprisingly, different focus groups express varying opinions on how to fix the problem or whether a funding crisis even exists.
Korn wouldn't reveal specific details of those proceedings but indicated that representatives of industry, for example, questioned whether the existing system of clinical research is lean and mean enough. They likened the troubles of academic medicine to the convulsive changes sweeping corporate America as a global economy becomes a reality.
Most employers believe they already fund clinical research through their premiums, explains Mary Jane England, M.D., president of the Washington (D.C.) Business Group on Health, which represents Fortune 500 and large public employers. Most large purchasers feel consensus-building is important, she says, because it gives employers a voice on how those dollars are to be spent. Of particular interest is research on asthma, diabetes and depression.
The final focus group-a task force of academic medical center representatives-will convene Sept. 25. Then the heavy lifting begins.
"It's going to be . . . a truly major challenge to come out with a viable consensus agenda," Korn says.