Clinical research must be the bedrock of any serious attempt to reform the U.S. healthcare system. Preventing disease, managing chronic illnesses and establishing treatment protocols are all predicated on a base of knowledge about the genetic and environmental events that cause disease and the rigorous testing of intervention options. That's why nickel and diming the National Institutes of Health is so shortsighted.
Last week President Bush laid out an ambitious agenda on healthcare information technology, including nationwide adoption of electronic medical records within 10 years (See story, p. 18). At the same time, his fiscal 2005 budget calls for a measly 2.6% increase for the NIH-not enough for research grants to keep pace with inflation or to expand the number of grantees. Worse, the White House Office of Management and Budget's five-year budget outlook calls for actual reductions in funding. Given that the NIH is also mandated to spend far more in coming years to help defend us against bioterrorism, the net effect would be large cutbacks in basic research.
Although we applaud the president's continuing interest in IT, all the computing power in the world isn't going to do much if there isn't sufficient clinical content to communicate.
The planned penny-pinching at the NIH comes despite the fact that it has been a rare federal healthcare success story. In the past decade its budget has grown more than twofold to nearly $28 billion. That paid for a huge amount of basic research and clinical trials, which in turn led to new drugs and treatments for cancer, HIV/AIDS, heart disease, stroke and many other diseases. Although much of this work is still poorly coordinated, NIH Director Elias Zerhouni has won universal praise for his "Roadmap" initiative to integrate all of its clinical research networks and link them to community physicians and patients through common nomenclature and information systems. "These programs and an array of other infrastructural activities and training mechanisms are aimed at ensuring that the critical mass of highly skilled personnel and state-of-the-art resources necessary for a vigorous clinical research enterprise are available," he recently told a congressional panel.
This is a particularly bad time to hit the brakes on medical progress. The mapping of the human genome has opened up a whole new world of medical science. A host of other developments in biology and neurology are just beginning to come together in a critical mass of achievement. But it will mean little to our healthcare system if this new science can't be turned into new medical interventions.
The other major challenge to our health system is costs. Clinical research, though expensive, pales in comparison to the increases in annual health spending we have witnessed. Donald Berwick, chair of the Institute for Healthcare Improvement, estimates that the U.S. could cut from 15% to 30% of its $1.7 trillion healthcare bill through the use of evidence-based medicine and other efficiencies. In just a micro-example of how this can work, Seattle-based Group Health believes it can save $5 million per year over time by spending $700,000 to treat patients at risk for heart attack with cholesterol-lowering statins. It based the move on positive results of a five-year clinical trial of more than 20,000 patients.
The Senate has already voted an additional $1.3 billion to the NIH budget request, though the House has not, and we are a long way from a final federal budget. Even the Senate figure should be augmented. Meanwhile, our fragmented, inefficient healthcare system continues to deliver mediocre care at world-beating expense. In this climate, the NIH strikes us as a good return on investment.
What do you think?
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