U.S. INVESTMENT IN RESEARCH: ASSURING DOMESTIC AND GLOBAL DIVIDENDS
MARY WOOLLEY: Following lunch, we will be opening our 2007 National Forum. This will be, I'm confident, a most stimulating panel discussion with opportunities for everyone who's present who might like to weigh in to do so.
Our panel will address a range of issues regarding our nation's need to sustain global leadership and research and to assure that health dividends of research contribute to a healthier and more stable American community and a healthier and more stable global community.
I want to thank and recognize the sponsors of our national forum whose generosity and support allow us to present programs we are proud to offer to the members of Research America and other stakeholders in research.
Our sponsors for the forum include GlaxoSmithKline, the university of Notre Dame, Pfizer, Infocast, Bristol Meyers Squib, the March of Dimes Birth Defects Foundation, Abbott, the Pharmaceutical Research and Manufacturers Association and our media sponsor for today's program, The Hill.
We're pleased that leadership representing all of our supporting partners are with us this afternoon and we're most grateful for your support.
I also want to acknowledge and recognize a contingent of 25 business and economic development leaders from the Aurora, Denver, Colorado area who are with us today. They're on their way here. It's really quite an extraordinary group.
Twenty five business and economic development leaders who are in Washington, D.C. to meet this week with their members of Congress to advocate for medical and health research -- emphasizing the economic benefits of research investment. It is in fact one of our key objectives of our strategic plan to do more of this kind of work with business leaders from around the country.
Following lunch, Research America's chair, the Honorable John Edward Porter, will kick off our forum program. In the meantime please enjoy your lunch and the company of those who share your commitment to making research a higher national priority.
[LUNCH BREAK]
JOHN PORTER: Thank you all for being here. I'm John Porter, the chair of Research!America and I want to welcome you all on this first day of spring. I think we have an exciting panel presentation for you.
At our annual meeting this morning, Mary Woolley and I noted that these very challenging and promising times for research -- that it is critical as a community of advocates -- we work with a unified voice to take action and convey messages to the public, to opinion leaders, decision makers in the media that demonstrate the life saving and economic value of research to improve health. And our panel discussion this afternoon will reflect these values to our nation and to the world.
The theme of our 2007 Forum is U.S. Investment in Research Assuring Domestic and Global Dividends. We have convened an exceptionally distinguished panel of leaders to share their thoughts and insights with us this afternoon.
Our panel will discuss a range of issues addressing our nation's need to sustain global leadership and research and to assure that the health dividends of research contribute to a healthier and more stable American Community and healthier and more stable global community. Sustaining our nation's world leadership in publicly and privately supported research is the smart thing to do for America and the right thing to do for the world.
It is our good fortune this afternoon to have not only an exceptional panel but also one of America's preeminent commentators and author as our moderator, David Gergen. For 30 years, David Gergen has been an active participant in American national life and American policy.
He served as director of communications for President Reagan and held positions in the administrations of Presidents Nixon and Ford. In 1993 he put country before political when he agreed to serve as counselor to President Clinton on both foreign policy and domestic affairs, then as special international adviser to the President and to the secretary of state, Warren Christopher.
David currently serves as editor in large of U.S. News & World Report. He is a professor of public service and director of the Center for Public Leadership at the John F. Kennedy School of Government at Harvard University. He's a native of North Carolina, an honor graduate of Yale University and the Harvard Law School and he served for three and a half years in the US Navy.
This is a man who has for his entire career made a difference for all of us in America and we're very very pleased to have David Gergen act as our moderator.
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DAVID GERGEN: Good afternoon and thank you very much. We all here on the panel and in the audience want to give a special salute and thank you to Research America for the work you're doing. A number of you here are on the board and we thank you for the service. This is an important effort and the fact that you could assemble this panel I think speaks volumes about not only how hard you've worked but how respected you are as an organization.
So, it's good to be back. I was here last year. And maybe we see, as John Porter said earlier, a little more light at the end of the tunnel than we did a year ago. That will be one of the subjects for discussion.
A couple of years ago at Easter service at Memorial church at Harvard, just before we passed around the collection plates, the Reverend Peter Gomes looked out at the congregation and he said, I have good news today and that is that this church has all the money that it will ever need. We are taken care of from now until perpetuity. The bad news is that it's all in your pockets. [Laughter]
And so it is I think we think about research and investment in the future, especially in health care here in America. We have all the money we need, but it's just somewhere else. And the issue before us today is how we mobilize this country both politically in terms of the public to insure that America remains at the cutting edge of research and that in fact, we -- I'm pleased that this year we're broadening the conversation.
So, Dr. Atkinson is here form the State Department to talk about how that goes -- those powers of research here and the strength we have in can also be shared around the world to -- as my colleague Joe Nye would say -- employ health care research as one of the many diplomatic weapons in this "war on terrorism."
I sometimes think we should call it a struggle against terrorism because war implies that the only tool at your command is the military. And, in fact, we know that's the hard power, but soft power has been neglected too much. And it may well be that there are ways that health care can serve as a form of diplomacy. And we want to explore that here today as well.
So, we have a broad agenda and we have a wonderful panel. The thought is that we would have a conversation here among the panel for probably and hour, hour and 15 minutes, and then we would open this up. And we will be out of here by a prompt three o'clock.
So, I would like to open with a journalist who can perhaps speak more candidly sometimes that people can in government about where we find ourselves at this moment. And I'm going to turn to Susan Dentzer, who is an old friend and colleague. Susan, for the last seven years has been at the News Hour with Jim Lehrer, where she is the chief correspondent on issues relating to health care policy, research in that area and Social Security.
Prior to that time we were colleagues at US NEWS where she was the chief economics columnist and correspondent. She is a very smart lady. And she also knows something about research in universities.
She served on the board of her Alma Mater, Dartmouth, on the board of trustees, and was the first woman to chair the board and she's now on the board of overseers for the medical school there, as well as the global health council board. So, Susan, tell us where we find ourselves.
SUSAN DENTZER: Thank you very much, David. It's a great pleasure to be here with you. I think where we find ourselves today is, as was referenced earlier, probably in a little bit rosier situation than many people perceived a year ago. Because a year ago, if we just take strictly speaking the National Institutes of Health budget as our indicator of where we are in terms of progress we know that last year for the first year in 36 years the NIH budget actually fell.
And we know that if we look at it this year in an environment of what at the moment appears to be a flat funded situation, we are -- if we actually adjust that for inflation and bio-medical research, we're actually at the level that we were back in the 1990's at about 19 billion dollars.
So, strictly speaking from that metric, we are not in very good shape and this is at a period in time which I think we would all acknowledge the promise of much of the investment that has been in made in this country science, in biomedical science in particular is unprecedented.
We are on the precipice of being able to capture a lot of the fruits of the genetics and genomics revolution and just to give you an example from my own experience, we have a piece that we're waiting to air now on bio markers for cancer.
Biomarkers, as many of you know, are genes or changes in genes or changes in protein levels that could be an early kind of red flag that cancer was developing in the body.
Now, at a time when one in three Americans face cancer today and the actually number of cancer cases is likely to double as my friend John Seffrin would assure us from the American Cancer Society -- the number likely to double in the space of about 10 or 15 years. This is a critical problem.
Because we know we can cure many cancers if they're detected at the early stages. So, if you had even better biomarkers than we have now -- for example now we have PSA, we have CA 125 for ovarian cancer. Often these are problematic biomarkers.
But if we had really terrific biomarkers -- ability to measure the changes in proteins in genes at a very early stage, we could obviously intervene much earlier in cancer and save a lot more people.
This is something the American public would really cotton on to if the American public understood truly the promise of it. And we have to do a mind boggling amount of scientific research to bring this promise to fruition.
So, I think where we are is a point in time where the Congress with a clear bipartisan sense -- that we need to go back to a point of making more investments in biomedical research. And now in the hands of the Democratic majority which was more inclined to do that any way.
But now there's a point in time when there's a little bit more excitement about the possibility of getting the NIH budget back on a trajectory of possibly doubling again over perhaps a longer period of time than the last doubling. But at least beginning to make some more of these investments that hold tremendous fruit and tremendous promise for the American public.
DAVID GERGEN: That's very helpful, Susan. How much of a problem do you think it is that we are spending 3 billion dollars in Iraq, how much of a problem is that for health care research dollars?
SUSAN DENTZER: I guess that's a figure David Walker from GAO said we're spending in terms of direct and indirect costs on the war. It's obviously a huge problem. It's also a problem -- the new democratic majority has come back into power -- having discovered its own inner fiscal rectitude again -- and wants to put out balanced budgets.
So, that constraint up against the very large expenditures on the war plus the tax cuts and leftover effect of the weaker economy earlier in this decade -- all of that conspires to make this difficult, but no impossible.
Just to make the obvious point -- three billion dollars a week -- NIH budget is now 28 billion -- nine weeks of the war in the Iraq is what we're talking about in the entirety of the budget of the National Institutes of Health.
So, these things can be done. It's going to take will. It's going to take serious -- part -- many in Congress to look for offsets now, because they do want -- they state that they want to adhere to pay/go rules. So, we'll see what happens.
But obviously where there is a will there is a way. And I think it's pretty clear, if you look at the polls that Research America has undertaken as well as others -- that the American public is for biomedical research. Because it understands intuitively that there will be an enormous payoff for it in the long run.
DAVID GERGEN: That is a good segue to the Director of the NIH, Dr. Elias Zerhouni, many of you have known him, saw him here in previous conferences. He was confirmed as NIH Director in 2002. IN that first year -- I think that was your first year -- a 2003 appropriation. But these last couple of years have been a real slowdown. Tell us how much of a challenge that is. What you're facing this year.
ELIAS ZERHOUNI: Clearly it's been a challenge because I think we have to really think about the century and we can't really under emphasize the importance of the conversation you're leading here today.
If you look at our societal challenges, if you look at the cost of health care for example and how it's evolving -- if you look at the cost of programs like Medicare, by 2013 -- this is what I call one of these budgetary explosive devices -- by 2013 something is going to happen. The Medicare receipts are going to be lower than the Medicare outlays. And 2018 Social Security is going to do the same thing.
At the same time, I think this century is going to be science driven, much more than any other century. It is absolutely essential that we understand that many of the solutions are not going to come from reorganizations of our concepts of the world, or global concepts.
It's going to come from our ability to understand the natural world to affect outcomes in health, in the environment and energy. At the core of this is going to be advances in the life sciences, life sciences understood in the new phase where we are today -- and that is that it has to be a combination, interdisciplinary combination between physical quantitative sciences and biological sciences in ways we've never combined them together before.
So, we have to have a sense historically of where we are in science. I think the 20th Century has been extremely important for life sciences. We've sort of discovered the pieces and the elements of the complex biological systems that we will have to deal with if we're going to overcome global health issues or overcome chronic diseases and I would say that the 20th Century was our discovery of the hardware of life: genes, proteins, and so on.
The 21st Century is going to be understanding the software of life. How is all this organized. And there is no clear solution to doing this except sustaining a wide range of approaches in research, in life sciences. In fact, if we don't that means that we will practice medicine 25 years from now the way we practice it today.
This will be an utter failure. There is no hope in my view to address the issues -- and environmental degradation, of energy, a generation of health unless we have a compelling vision for this century. Not just for the next five years, but for this century.
And I think at the core of that is going to be this continued focus on the essential. And that is knowledge generation. We do not have the knowledge today we need to affect the cancer rates that John Seffrin was talking about.
So, from my standpoint, I think the conversation should really focus on not just return investment, not just economic impact, but on the strategic implications of not sustaining the race to knowledge that this century is going to be characterized by.
DAVID GERGEN: The vision that you have is essentially a 21st Century in which mankind will be in a race for knowledge and there are great strategic implications if the United States is not running as fast as it can. Is that what you're essentially arguing?
ELIAS ZERHOUNI: I think I'm very worried about it. Because if you look at the 2013 -- I'm using the BED -- an unexpected budgetary explosive device [Laughter] and that is a real deadline. I mean it's going to happen.
So, at some point, unless we're going to really pass all the bills to our great grandchildren at some point we're going to have to find solutions to that. There's no escaping that reality.
And I think that today we do not have enough of these -- enough knowledge to really impact that outcome in the best way possible and that is through understanding at the deepest level our ability to affect outcomes in health, in environmental issues, whether it be -- or energy generation for example through bio fuels. I think the research on the human genome is going to have an impact.
Now globally I think you are absolutely correct, David. If you look at publications worldwide, I think the share of the US publication market, if you will, is decreasing relative to the others.
I just came back from Europe. There was an interesting meeting. I would like to report that, because there was a presentation by a commissioner from the European Union that decided to spend 57 billion dollars over the next five years on research and creating research infrastructure. They have created a structure that is almost a copy of the NIH there.
And we're making a presentation about how important it was to emulate the American system of research. And they describe the impact of the NSF and NIH and all the agencies. And someone said, well, as far as I am concerned NIH comes as close to heaven as possible for -- [Laughter] And I was looking at her and I said, well... [Laughter]
But the fact is that they're trying to emulate our successful formulas that have been -- and they are trying to put the investment in there. So, there is going to be in this century I think a greater sense of race towards the goal that I think will determine in great ways the welfare of nations. And I think we can't afford to be second best.
DAVID GERGEN: To go back to something Susan DENTZER suggested, clearly it's one way of measuring how much you invest in health, how much you increase or decrease it every year, but the other part of this is well, how much are opportunities going up for good investment versus are they leveling off. As more discoveries come on line is this in effect an accelerating process where more opportunities open up -- wise investments could go up more rapidly or is that not the case or is that not the case.
ELIAS ZERHOUNI: Well, it's absolutely the case. There's no doubt that if you look at the NIH research over the past ten years -- I just showed that at a hearing yesterday -- between 2004 and this year, we identified 1800 what you call molecular targets.
Each one of them requires maybe two - three scientific teams to work on for probably 10 to 15 years to try and understand the fundamental mechanism. And then that will translate into synergies between industry, bio tech companies, pharma companies, universities -- so the scope and range of research that we are observing and the demand for that we are witnessing is much wider than what it was ten years ago, simply because you're going from understanding simple hardware to understanding complex software of how all these molecules are interacting. That revolution is as big and important as the information revolution at the end of the 20th Century.
DAVID GERGEN: Dr. Gerberding, as you know, runs the Center for Disease Control in Atlanta, and she has been a very strong advocate for more research funding, as well as dealing, as she and I have dealt with together, with questions of homeland security. Dr. Gerberding was first Director of the Agency for Toxic Substances and Disease Registry and CDC Director since 2002. So the two of you came essentially the same time. And as you know, Dr. Gerberding was previously at UCSF. So, from your perspective on these questions and if you could get us a little bit above the tree line, a bigger picture, Julie
JULIE GERBERDING: Thank you when we look at the world at CDC we see a world that has some pretty big problems and in our view bigger problems than we probably in our scope of vision up until the beginning of this century. We were talking about problems like climate change, the extreme poverty that still is pervasive in many parts of our very globalized world now and the impact that has on us here in the United States and elsewhere and also the big problem of ideological conflict and what that really mean in terms of our ability to actualize the promises that our research brings to some people in a world that's increasingly unpredictable and potentially characterized by terrorism threats, by emerging infectious diseases that the confluence of these problems create.
And certainly the national disasters and social disruption -- that all of this macro change is creating for a larger and larger portion of our population globally.
So, that the above 40 thousand foot view here, the Google earth view is a future that's very uncertain, but certainly a future characterized some macro challenges to health and economics and security of an increasing proportion of the world's population.
CDC has a stake in that as do my colleagues at the podium here today, but I think we're also recognizing that this is happening in an environment where people have enormously high expectations, high expectations of what science can do for them. High expectations of how government agencies will perform flawlessly and really high expectations about the time line for research to actualize its potential for change to occur, for results to be evident to Dr. Mom at the family level wherever she lives.
And then I think the last piece of that is that -- like Dr. Zerhouni said, at least as government agencies, we were having to respond to these big problems and these high expectations and environment where we're under intense competition for resources and that competition is going to get tougher and tougher in the United States as our discretionary resources come under greater and greater demands from competing priorities.
So, this is an environment that is very challenging and very exciting in a lot of ways and one in which the drive to science and knowledge management has to be a national imperative. But I think also we have to perhaps rethink the relationship between Dr. Mom and that science in ways that allow us to bring science to the customer.
Ultimately, if we really want people to prioritize what we're doing we have to be sure that it means something to them personally. They're going to take more money out of their pocketbooks and put it into science -- it better be science that they can appreciate and realize has a practical value and really addresses the household that Dr. Mom and Dr. Dad care about every day across our country.
I think that the trend nationally toward consumer driven acts is one that probably has to move to consumer driven science in a way that I think opens some new possibilities and new partnerships and alliances and potentially more power for us to be able to do the kinds of things we'd like to.
DAVID GERGEN: Both you and Dr. Zerhouni talked about the need for the country to invest in other forms of science regarding -- and knowledge regarding climate and regarding energy and health. You singled those out.
How do we think about the balance among the spending investment on energy, environment and health. Should one be privileged above the others and why? I mean this is a health care research group, what is in the nation's interest in terms of how one tries to balance those questions?
JULIE GERBERDING: I'll start because climate change is an issue that CDC is increasingly recognizing as a platform for us to really build a whole set of environmental sciences and environmental programs. I don't think you can exclude one of those three domains.
They are highly interrelated. We can't be successful in one without addressing the other and I think the science portfolio has to be balanced.
Obviously I'm a health science advocate, but I know that you can't win if you don't really fundamentally make the appropriate investments in all three areas.
DAVID GERGEN: If any panel members wish to comment on any issue that's arisen, please feel welcome to do that. But let's turn to the third director that's on this panel today and that's Carolyn Clancy. Dr. Clancy is the director of the Agency for Health Care Research and Quality and she has been in that position since 2002. All of you now are real veterans.
I must tell you from the country's standpoint it's going to be helpful to have someone stay in these jobs for more than a turnstile kind of operation. So, we welcome the fact that each of you has been that.
Dr. Clancy was previously a general internist and has done work in health services in the university setting. We welcome you here. Your perspective on these questions?
CAROLYN CLANCY: Well, just to build on what my colleagues said -- first let me say what a privilege it is to work with them. I don't get a chance to hear them often enough and it is a reminder of what terrific people they are.
In terms of the nation's interest, I think what we saw in the 20th Century was this unprecedented extension of longevity, which is really incredible. But what we haven't kept up with necessarily is the disability that accomplishes that longevity, particularly for women.
And I think that in building on Dr. Zerhouni's comments about the expansion of knowledge and the strategic opportunities that we have in this century, we have to keep our eyes squarely focused on the application and the distribution of that knowledge in equitable fashion.
And what I mean by that is it has been estimated that it takes on average about 17 years to turn funded research to the benefit of patient care. So, earlier today, across the hall in this building, we were celebrating, I'll use that word cautiously, improvements in the quality of care in America's hospitals.
And what that means that patients who are admitted with a heart attack now have about a 90 percent chance of getting evidence based care and that's really a terrific thing and it hasn't always been 90 percent.
But that's a long long way and quite a bit of time since the evidence came out of the National Institutes of Health clinical trials. So, I think in addition to thinking about strategic advances in the life sciences, we also have to be thinking about strategic linkages between the generation of that science and its application in the health care delivery system.
What that means is that as new breakthroughs are tested in clinical trials and then applied in health care there's a really important opportunity to think about the health care delivery system as a platform for discovery or an extension of the laboratory if you will. And it's also because of advances in health information technology, and so forth, I think it will also be a chance to make sure that everyone who can benefit actually receives the benefit of these new interventions. And I think that is truly a global challenge.
DAVID GERGEN: Julie Gerberding raised a question of the consumer. For most Americans they think a lot less about research than they do about the exploding cost of health care. And the growing number who do not have access, the number of corporations now that are trying to get out from under the growing costs.
There's a growing movement among any number of corporations who would like to turn this all over to the government. There's a lot of converts to single payer I've noticed in recent years, people who some years ago thought it was such an idea [unintelligible] in the Soviet Union now seem a little more interested than they once were.
How does this fit together -- the research agenda fit together with the need to reform a health care delivery system which many believe is in meltdown?
CAROLYN CLANCY: Well, I would start this and ask my colleagues to jump in. First I would say the health care delivery system in this country now is sufficiently challenged, that we're not going to be able to handle the breakthroughs that are coming out of NIH. We don't have good information for consumers and their clinicians to try to figure out which is the best intervention for them that meets their needs, preferences and so forth. And that I think is a huge challenge.
So, I think the success of bringing the fruits of science to the customer or the consumer, as Julie said, actually depend on our making critical improvements in the health care system itself. And that health care -- making those improvements, investing in and building the science of quality improvement, actually also is going to have big payoffs in terms of what Dr. Zerhouni referred to as the BED, the budget explosives device.
I think lots of policy makers are focused on what this is going to mean for public programs and I know that every governor, you know, lies awake at night worrying about the Medicaid budget. So, I think these things all fit together.
DAVID GERGEN: Do you see a series of BEDs out there so to speak?
CAROLYN CLANCY: Yes, I think clearly the impact on public programs -- the government is the biggest payer of health care no matter how you cut it, which is why there has been a huge focus on trying to figure out how can we improve the delivery of evidence that we have right now so that we can get better value for what we're spending.
DAVID GERGEN: You said something really interesting that I had never heard before and that is that the delivery system in the country is so flawed that it will be unable to bring the benefits of new discoveries coming out of NIH to patients. Could you explore that just a little more, that's a quite stunning statement.
CAROLYN CLANCY: Dr. Von Eschenbach, when he was running the National Cancer Institute used to say that he had a goal of making cancer a chronic illness by 2015 which I -- that was a goal that many people got very excited about.
But he also said that if we don't couple that and link it with improvements in how health care is provided, were not going to have a system that will be able to handle that. So, again, today we're celebrating that the nation's hospitals got it right 90 percent of the time for heart attack care. But what we're measuring is fairly straightforward care. And I don't mean to minimize the efforts of those who are at the bedside and in the front lines providing care. Hospitals can be pretty chaotic fragmented places these days, they're under a lot of stress.
But nonetheless if you can imagine that we're now going to be seeing more individualized treatments I think that ups the ante in terms of the kind of infrastructure that we need to make sure that we get the right care to the right patient at the right time every time.
SUSAN DENTZER: David, could I Just build on that?
DAVID GERGEN: Yes, please.
SUSAN DENTZER: To make the obvious point, one of the scientific findings of the last few years is that all Americans have genes. And all -- and we increasingly understand that genes are -- changes in genes are at the core of all diseases.
So, everything that happens that we label a disease is at root a change in a gene. It's either a hereditary change or mutation or it's something that goes on instead of environmental exposure.
So, if all Americans have genes and all diseases are diseases of genes, then why don't all Americans have health care for starters. [Laughter] To speak about the broadest essential reform that must be enacted in order to realize the fruits of this broadly and equitably across the whole population -- as Carolyn says -- delivery system -- the insurance system is not set up to deliver maximally the benefits of the genetic revolution to all individuals.
So that is clearly a critical part of the reforms that must be had going forward if we want to live, in my view, in a just society.
DAVID GERGEN: I want to turn to the representative from private industry before I turn our esteemed colleague from the State Department. Christopher Viehbacher who is the President of U.S. pharmaceutical for GlaxoSmithKline and has been in that position since 2003. All you people started in 2003. I don't know quite what happened.
But we welcome you, sir. And you've been involved in all sorts of efforts, a lot beyond your company to work with other companies in this field. So, tell us the perspective now from the private sector -- why don't you guys go out and invest all the money. Why do we have to keep squeezing money out of the government. [Laughter]
CHRIS VIEHBACHER: I'd like to respond to actually respond to something you said in your introduction, first. Because I'm a Canadian and German citizen and spent over four years outside the U.S.
DAVID GERGEN: You have two passports?
CHRIS VIEHBACHER: I do.
DAVID GERGEN: You don't have a US passport?
CHRIS VIEHBACHER: I have a green card, working on the third one. [Laughter]
DAVID GERGEN: Is that called a trifecta?
CHRIS VIEHBACHER: [Laughter] But it does give the perspective of different health care systems around the world. It also gives me the perspective of an American. You talked about the soft diplomacy.
And I'd just like to say that most countries have a much different level of expectation from the US than other countries and those expectations are much higher. And I would also tell you that I would bet you in the countries widely, certainly Canada, France and Germany, that more people could tell you who the CDC, the FDA and the NIH are than the same institutions in their own countries.
These are institutions which have global remits[?], not just American remits. And if you talk about doing something positive to meet the expectations of others -- and those expectations are very hard to achieve. And I think through research, through the Center for Disease Control, through the FDA the US can have a very positive impact globally.
It is also true to say what Dr. Zerhouni said, others are trying to catch up. When I was in Europe I represented France in a high level working group operated by two European commissioners, which had the objective of trying to restore Europe's competitiveness in research. That followed a study that had been done that showed that 80 percent of the referenced patents which this group had used as a surrogate for groundbreaking science were filed in the US.
And I was part of a group that recommended changes in New York to try to achieve that. One of which was actually to create a European version of the NIH. It's actually interesting to hear that they are following through on it.
I can tell you certainly that as a company that operates on a global basis -- there's something like three or four times as many PhD's now starting to be graduating from China as from the United States. India is certainly trying to catch up in the bio pharmaceutical sphere.
So, there is a race. It doesn't necessarily have to be a threat. It should be an encouragement. Because I think if everybody starts to invest, all of mankind will do better. But the US has clearly been a leader here and I think it's worrying to someone who's only spent four years in the US to see these institutions like the NIH and CDC not getting the funding that they deserve.
As for our part of private industry, we are continuing to invest. Those costs continue to rise. It's anywhere from 800 to a billion dollars to develop a new drug. I can tell you certainly in the area of clots that cause stroke and heart attacks we are now looking at no one company that is going to be able to bring a product through to market.
As we look at some of the new agents, like Factor 10A's, those development costs are exceeding a billion dollars, just to get into phase three, the final phase of development, a billion six in some cases. And that's getting to be a huge expense.
But the other thing I would say is that the spending wise do is not a replacement for the NIH. One of things I think really gives the US so much competitive advantage is the public private partnership.
The cancer does studies that this industry could never do. It is the groundbreaking science that really discovers how diseases are created that we then act upon.
So, it's not if the NIH reduces its funding that the pharmaceutical industry or any other private sector can step in. The NIH fulfills and extremely important part of science that all of us can take and turn it into an implied technology and then ultimately into a medicine.
And then, of course, everybody's struggling with cost. I would just say having living in a single [unintelligible] systems all my life, you don't want to go there. [Laughter]
We have what it takes to do this. If we could -- we could talk more about health and less about health care and do research into prevention -- you know, so much of our disease costs now goes to chronic diseases. Seventy-five percent of our health care costs are chronic diseases many of which are preventable.
Seventy-five percent of cancer preventable. Type 2 Diabetes which is a true pandemic hitting our country, with over a million new cases diagnosed every year, could be prevented with diet and exercise.
I think what Carol talked about in terms of better quality, in terms of managing those chronic diseases -- we have cities like Ashville in my home state of North Carolina -- it is shown that you can reduce those costs.
And finally innovation is so important. You look at the Alzheimer's disease -- how much money that will cost unless we can come up with some new [Inaudible] which would dramatically reduce our costs. And then we can start to reinvest in the CDC and the NIH.
DAVID GERGEN: There's as story out there that says if you exercise more, it helps your brain. Is that true?
CHRIS VIEHBACHER: If you exercise more, it's going to do a lot for you. It's going to help your brain, it's going to help you [unintelligible]
DAVID GERGEN: So, we should send all scientists into physical fitness programs. [Laughter]
CHRIS VIEHBACHER: I think most of them are.
DAVID GERGEN: Out of GlaxoSmithKline you do that internationally, it's a collaborative effort that goes across borders. Is that not right? Almost all of the research you would do, I would think, would be shared research across many borders. How does that work with the NIH. How much of your research is collaborative international -- in fact, funds may come in from other government sources and that sort of thing.
CHRIS VIEHBACHER: It's actually increasingly collaborative because the scope of problems that we deal with, for example -- Susan was making the point that genes and the interaction of genes with the environment was probably driving a lot of pathologies that we see.
Swell, to study that you have to have a different environment, different gene pool, and so on, so that we're increasingly collaborating. Obviously we've always collaborated on global health.
But just to give you an idea, NIH's funding of collaborative endeavors between US universities and scientists around the world has quadrupled in the past six years.
DAVID GERGEN: How does the Congress respond to that. If you take American funds and fund Chinese science.
CHRIS VIEHBACHER: I think the Congress by and large has really understood the importance of doing that when you're dealing with infrastructure to prevent SARS -- and by the way I'd like to recognize CDC's terrific leadership in protecting the country from SARS.
If you explain to them the importance of tracking pandemic food, having collaborations in 85 countries, with laboratories that are equipped and connected and networked with our scientists here in the US -- if you also make the point that we have a choice and we can in source today, out source tomorrow.
It is important to have connections with laboratories around the world, because this is exactly where I think the synergy that we need in science occurs. So, by and large, I found the US Congress under spending -- the need for us to do that.
Also, I think it relates to what you said and that is that this aspect of America is probably the most admired part of our world relationship and we do have the high ground on the issue of health diplomacy, science diplomacy.
So, I'm a strong advocate of it and I think it's been a great boon for our science to be able to benefit from these relationships over time. Congress understands that so far.
FEMALE: Since Congress made its first ever non-categorical investment and global disease detection which has allowed us to really build a network of laboratories and infrastructure around the world that is serving as a great platform for private industry and philanthropic organizations like the Gates to come in and build their own research enterprises.
So, that single investment which was groundbreaking for Congress has leveraged a huge amount of international science, including that with the NIH and the Fogarty -- but also in the private sector.
DAVID GERGEN: How much do you worry that the more you fund international science that America corporations will take their jobs -- R&D operations and put them over in those other countries and take the jobs out of here?
MALE: I would just say from our point of view science will always follow the people and that's one of the main reasons for investing in research is we create the human capital that will keep us here. And that's the main driver, where the people are.
DAVID GERGEN: But what if there are a lot more scientists in China that we agree funding through our research -- is that a double edged sword?
FEMALE: I see just the opposite. I think it's a real advantage to us. I think that it's science diplomacy in a sense, but you build relationships one person at a time or one project at a time. And that in and of itself can feed forward into a very different level of understanding and opportunity. But we have to be able to think globally scientifically in the same way we think globally a lot of other health issues.
MALE: There's not a finite amount of science.
JULIE GERBERDING: Science is not a pie. If somebody gets a big piece it doesn't mean somebody gets a smaller piece.
DAVID GERGEN: But if there's a growing piece of R&D that is done India and China, isn't there a legitimate concern that a growing number [unintelligible] jobs in that areas [unintelligible] the cutting edge jobs will also be there and not here.
SUSAN DENTZER: Only if we fail to invest here commensurately.
CHRIS VIEHBACHER: I'd like to put in a personal note here. If you look historically at science, the greatest gift America ever received was the scientists that left Germany because that were discriminatory and frankly abhorrent, but that was probably the greatest gift, transfer of wealth the United States ever received.
If you look over the past 50 years, about 40 percent of the Nobel prizes are in fact, scientists who came from other countries and then worked here.
I think if you look at science what's really key is not just the mass of scientists but that very thin layer of superbly creative scientists who really make a difference and make the breakthroughs because they are in an environment that networks with other scientists.
You know, I'm not born in the United States. I'm born in Algeria. And I had the opportunity to basically immigrate to Europe or immigrate here and I preferred here. And let me tell you I think you're better off having me on your side than on the other side.
[LAUGHTER] [APPLAUSE]
DAVID GERGEN: We agree wholeheartedly but there is this issue now that the [unintelligible] of the next generation who come here to study and get a doctorate are going home at an increasing rate. And we're losing some of there people. We're not giving them the visas. We've got these other issues that we're facing.
CHRIS VIEHBACHER: And you're absolutely right and that's why I would echo what Susan said, it all depends on what we do and what we -- how we react to those realities. That's why your conversation and the debate you're organizing is strategic in nature and that's the intent of my comments. IS we can't sleep on this.
DAVID GERGEN: Craig Barrett of Intel argues that every time we give out a PHD in science or technology we ought to staple to it a green card. Just make that part of the package.
Dr. Martin Mackay, Vice President for Pfizer Global Research and Development and the Senior Vice President for Worldwide Development, please join in.
MARTIN MACKAY: I'll just mention a couple things about this topic and then try to tie some of the pieces together. The great thing about the United States -- people still want to come here and we find funding folks in China in Europe in great laboratories that want to end up coming here.
A much bigger worry for me is the number of American children that want to become scientists. Maybe that's another topic that we could take up. We have four children all remarkably well adjusted considering their father --
[LAUGHTER]
MARTIN MACKAY: Not one of them nor any of their friends want to become scientists. So, that's another topic.
I fully reinforce what Christopher said. It's different for even a Scotsman to plead poverty with a budget seven billion dollars as we have that Pfizer and although we try to do that with our board -- we have magnificent resources -- what we lack though is enough knowledge to do the work.
I'll give a great example, and Susan mentioned this, about oncology. We launched a terrific compound last year called Suten [Phonetic]. It's a vascular endothelial growth factor. Essential tumors need blood vessels to grow. This prevents the growth of those blood vessels, hence you get tumor shrinkage. Absolutely marvelous compound.
And some people we miraculous recoveries. Now in a lot of people we see excellent remission. It doesn't work in everybody and it's essentially because we don't have the basic knowledge to know which patients it's going to work in.
That's why partnerships with the NIH are just absolutely essential. An initiative we did last year, the genetic association information network is a perfect example of harvesting the information to our drugs are going to be working in much more of the population. They're excellent compounds.
The other piece I'd mention in terms of the CDC part, again, where I think we're going to have to develop more partnerships. We're about to launch an anti-HIV compound called Maravarok [Phonetic]. It's a CCR5 antagonist. It's the first anti-HIV compound that rather than attacking the virus prevents the virus getting into the cells in the body. So, actually works on the human receptor.
Terrific piece of science from the basic genetics that were done by basic scientists. This definitely has a place in the developing world. So, we have to -- we can cure poverty at Pfizer, but we should be working in closer partnership to be able to make that medicine available to many more people in the world.
DAVID GERGEN: Let's bring in Dr. Freda Lewis Hall who joined Bristol Myers Squib in 2003. She is the senior Vice President of US Pharmaceutical Medical Affairs for Bristol Myers Squib. Your perspective.
FREDA LEWIS-HALL: Thank you. One of the good things about being close to last you can basically just say what they said is right.
[LAUGHTER]
FREDA LEWIS-HALL: But, you know, we've been talking about the competitive advantage, but I really think at the end of the day the win will be in the cooperative advantage. So, if we think about aligning across all of these resources, that to me is really where the win is.
So, between companies who have a legacy of competition who are now cooperating to bring important medicines to the forefront, public and private, across the globe -- so with that geographic I guess preventions against pulling resources together -- you started with a good news/bad news. And I actually was thinking here as I was making my notes about a bad news/good news scenario.
So, [Inaudible] years ago when I started medicine --
[LAUGHTER]
FREDA LEWIS-HALL: Thirty years ago when I started in medicine as a freshman after -- at the end of my first year at medical school, I watch my mother die of a stroke. We did not have the data or the information that was available around her risk factors which would have allowed her to prevent a stroke. Nor did we have medicines. So, for all I knew and all I had learned, there was nothing I could do.
And soon after I watched friends and relatives and patients die from an unnamed disease which we soon named and turned into a chronic illness. So, if I think about what 30 years ago looked like in the back wards of St. Elizabeth's hospital where I could not fathom the strength of people who may never know their names again and certainly wouldn't recognize the value of their lives -- and think about what those three groups of people have access to today, I'm in awe of what our research has actually won us in 30 years. And, so, if all of those things that happened 30 years ago are the bad news, then the good news is all that we've been able to bring to bear in our partnerships, with our innovation, with clever people from around the world working to solve these huge problems.
My mamma used to say never put only in front of [unintelligible] the money. And I've added where able hands to work. And, so, if we really think about what we're trying to get done here, we still have medical needs. We still have translational issues, how to get from the bench to the bedside and to allow everyone to have access to our discoveries.
We still have timing issues. I was looking at a PhRMA report from 2004, we're still fighting leprosy. And while we're looking back to fight unmet needs, some things are catching up with us.
Bacteria and viruses seem to be outsmarting us by the day. And we ought to have a sense of urgency about catching up and keeping up with them. And there are still illnesses that, yes, we've made people -- we've allowed people to live longer in some cases, but in some cases we've only allowed them to take longer to die.
So, you know, I think there's still some very real urgency to the work that we do. And at the end of the day if I think about where those solutions are, it's across this table, around the room in terms of the toil [unintelligible] in getting a sense of urgency. Certainly the money and I'm sure we'll have a way to empty pockets as folks leave the room. And we've talked about the fact that there are able hands all around the world.
DAVID GERGEN: Is there attention in your mind, from your perspective in life, between your -- you work in a private corporation that does great research. And at the same time you must be deeply concerned about the inequality of access and the inability of many citizens to afford some of the breakthrough drugs that are coming out and the problems that are faced around the world with HIV/AIDS, for example.
How in your mind should we reconcile the profit needs for corporations that are doing research in drugs versus the issue of quality of opportunity.
FREDA LEWIS-HALL: First of all I think you can do good and do well at the same time I'm not sure that there's necessarily a trade off in that. First of all I think access for many is certainly financial, but I've spent much of my career looking at the other kinds of inequities and disparities that exist in the access to or the delivery of health care that has little if anything to do with money.
It has to do with picking the right physician who understands and applies the guidelines and understands evidence based medicine. It has to do with whether or not you're a woman and the research was done in a way that is directly applicable to you, so you really know whether or not you get the full benefit of that research.
It's being an ethnic minority and, you know, this same issue around research and it's applicability to you as an individual. So, I absolutely agree with the need to deal with the financial access issue, but I still don't think that the war is won until we deal with the entire spectrum. And, in fact, deal with some of the other ways in which they disenfranchised people from care. If we started to deal with those that some of the financial issues would become a lesser burden.
DAVID GERGEN: John Porter told us earlier that the Democratic Party tends to be more sympathetic towards research. It is also less sympathetic to large corporate profits and the pharmaceutical industry.
FREDA LEWIS-HALL: [picks up mid-sentence] -- characterize it that way. [LAUGHTER] You know I have one of the best jobs in house I think, because I'm allowed to use some of the wonderful resources both human and financial to apply to solving these issues. And I don't take those resources for granted having worked at Howard University, St. Elizabeth's and DC General Hospital and understanding what disparity looks like up close and very personal.
I think it's incredible to have the resource dollars that are generated to apply to solving these disease issues, so again I -- I think we can all enter the debate from a number of places, but from where I sit, I think it's really important for us to apply -- to be able to apply the billion dollars that it takes to get a drug from a great idea into the treatment environment.
DAVID GERGEN: Let's turn to Father Thomas Streit who comes to us from the University of Notre Dame -- we're sorry you didn't make the sweet sixteen. [LAUGHTER] On the other hand I have alliances with Duke, we didn't even make it out of the top 64. [LAUGHTER] Father Streit has started and is now director of the Haiti program for the Center for Global Health and Infectious Diseases at the University. Tell us a little bit about the program and your perspective of working in Haiti.
FATHER STREIT: I'm happy to do that and thank you, David. I guess I'd like to challenge [unintelligible] for the best job in the house. I have pinched myself, because I trained for a long time first to become a priest and then for my PhD.
And now I'm working in a setting where there's so much need and there's so much reward and every little thing I do [unintelligible] as it can be day in and day out bears quite a bit of fruit.
I know we mentioned three ways in which I see this. Obviously there's sort of public health science that we do. We're doing operational research and a program that delivers benefits that will be lasting in perpetuity into the future in that we're working to eliminate the disease lymphatic filariasis or elephantiasis as it's more commonly known.
At the same time we're reducing the burden due to intestinal ailments and because we're adding the drug for filariasis to the salt supply we're also among the first to address iodine deficiency in Haiti.
Well, these are problems which in this country were address 100 years ago, iodine deficiency and lymphatic filariasis disappeared from the US a hundred years ago.
So, it's exciting in the sense -- to have the opportunity to make that historic contribution. It's probably a little bit easier in terms of the science because we all know -- many of us at the table and some in the room -- know that basic research doesn't always bear fruit when you're just adapting or tweaking approaches that have already been used in our country and in other settings for use in the developed world. Hey, we have a higher chance of finding success, if we can overcome the usual sorts of obstacles and third world corruption, the brain drain, et cetera.
Which brings me to my second real pleasure in the work and that is today we've got the opportunity in global -- sort of global [unintelligible] where the news has been kind of mixed or negative on funding for research here over the last decade or so.
As so many of us know here, the contributions of philanthropy of Gates and Buffet and so many others, as well as corporate philanthropy -- all three of the drug companies represented here -- providing drugs free of charge or at low cost in third world settings -- all this has so much changed the perspective -- the old 90 - 10 rule of only ten percent of research dollars going towards problems of the third world -- I think that's really starting to change.
The job is huge that we have to do, but some of the benefits -- the two other things that are so exciting -- is again whether it's driven by the sorts of new philanthropy both corporate and private into the third world health problems -- or whether it's driven as I find among our young people a sort of despair about the future.
You know the worry that terrorism represents -- I find our students just pounding our doors down, those of us working in the global health wanting to go and work in the field, whether it's medical students or undergraduates or grad students, numbers like we've never seen before.
DAVID GERGEN: This interest in global public health that is really capturing the younger generation which I happen to think can be real allies in this larger struggle to insure the investment -- we take science [unintelligible] seriously in the 21st Century. Tell us a little bit more about that.
FATHER STREIT: Yeah, I'm not exactly sure of the causes as I propose those two -- that the funding picture has picked up -- things have -- we've never been busier with the kind of things we can do.
And then I also -- I really do think it's kind of the -- a way to express our national idealism and a way to express our technical savvy in a way in which the Peace Corps obviously was set up to do but may not have been quite so technically oriented.
I'll speak even for my own institution, the Catholic Church. One of the groups I had the most trouble with in Haiti are the nuns.
[LAUGHTER]
DAVID GERGEN: They tell me the priests are the real problem.
[LAUGHTER]
FATHER STREIT: I think one of the things that they don't appreciate so much is the importance of public health science, of applying science, of doing the prevention. They say to me you've got four doctors working on this project, they should be in the clinic.
And we all know that prevention is much better than clinical care, in terms of the benefit per dollar invested, so I have to tell the sisters when they say Jesus didn't -- Jesus didn't do public health.
[LAUGHTER]
FATHER STREIT: He spent his time healing directly, but they claim he didn't do public health. Well, I argue with that.
DAVID GERGEN: Do you argue with that, Julie?
JULIE GERBERDING: I definitely argue with it, but I couldn't agree with you more with the absolute ground swell in the interest of young people in careers in global public health and public health more generically.
And I think one of the missed opportunities right now in terms of conversation about investment has to do with the training and the career development of people who already have the passion. But we don't have the means or the mechanism to get these trainees out.
CDC has a miniscule amount of money for that kind of research training for T grants and K awards and so forth. And the number of letters of intent that we're receiving for these very limited opportunities is absolutely skyrocketing. There's now way we can meet the demand.
I'm going to try to find out how to spend Dr. Zerhouni's money [LAUGHTER] because I need to get these people trained. But I go back and take care of patients at San Francisco General every year.
And the students and the residents there are now allowed a special in global health where they come from -- whether they're pediatrics or OB or medicine, whatever field -- surgery -- they come together, they have a special track of training in global health and they're just dying for the resources to support their field placements and their opportunities to do field research.
So, it's a very exciting environment where we don't have a problem with the work force, but we do have a problem with the support and the ability to mentor them in the field and bring them around in their careers.
ELIAS ZERHOUNI: I would like to suggest to Julie to talk to Roger Glass. He's right in the audience. He's the Director of the Fogarty International Center. That's where all the money is, Julie.
[LAUGHTER]
ELIAS ZERHOUNI: The Fogarty Center is one of the 27 centers and institutes of the NIH.
JULIE GERBERDING: As you know, Dr. Zerhouni, Roger still wears his CDC hat as well and we have talked.
[LAUGHTER]
DAVID GERGEN: We have some universities that would like to share in that fund.
ROGER GLASS: [Inaudible] universities campuses around the country. I call it our piranha grant. We have the smallest grants on the NIH campus, but for 100 thousand dollars we can get campuses to come together, medical schools, schools of public health, business schools, law schools, schools of journalism and undergraduate curricula, to try to get curricula together so that these students who have been mentioned have a pathway to get involved -- and I think this idealism -- and the American ideal of helping others. So, these are fabulous grants.
We also have a granting program for medical students -- Twenty-five medical students between their third and fourth year to go overseas. It's applied to -- it takes ten applications for one that's filled. We have almost 200 applications for 25 slots.
We could filled this many times over and we don't yet have a program at the fellowship resident or junior faculty level -- that would allow residents to go overseas. And this something that we'd really like to boost.
So, I think that developing the next generation of people involved in global health is key and I think the CDC's efforts and our efforts at NIH are all going in that direction.
DAVID GERGEN: Our next panel member is Dr. Atkinson. He is a science and technology adviser to the Secretary of State. Dr. Atkinson holds 66 US and foreign patents. He knows whereof he speaks. So, we've been looking forward to your thoughts, your reflections.
GEORGE ATKINSON: Well, I come to the podium with some degree of nervousness having been referred to several times by David in some degree of actually being able to provide solutions today.
Approaching the last few days of my position, I'd like to introduce a new definition of candor today.
[LAUGHTER]
DAVID GERGEN: Oh, good, let us get our pens.
[LAUGHTER]
GEORGE ATKINSON: And I'd also point out during those six years, I've maintained my tenured academic position at a university. The only way to give advice in Washington on science is to have another job.
[LAUGHTER] [APPLAUSE]
GEORGE ATKINSON: But I would like to make a few observations. I think the issue of scientific research has always been global. We know the sources of intellectual successes and pursuits have always been intellectual from the intellectual community globally. It has been very difficult to find any area of research and bio chemistry, health, physics and so forth that hasn't built on the successes and failures of scientists around the world.
So, we shouldn't be surprised. And to give you a data point or two, in major journals of physics, the physical review, physical review letters -- twenty years ago the United States contributed more than 75 percent of all the articles. Today it's less than 30 percent.
More than 53 percent of all the students in science and engineering programs in United States graduate schools are from outside the country. That's the face of the American system if you will.
So, we shouldn't be surprised nor should I in my opinion be depressed by this. This is a reflection of several decades of success in the American system. Many of these students who have gone home, who reside in other countries have been educated in the United States. That's not necessarily bad.
My students think the US has led the scientific and technology parade for 2000 years. We know and it was referred to earlier that in the mid 20th Century the United States took leadership out of catastrophic events. So, you should be mindful of that. It happened a relatively short time ago. And I would suggest that the future is absolutely a collaborative model. Whatever the model will be, it will be collaborative.
Why did the US get to be so good at this race. We got out in front very quickly. I think we might think of several items -- I'll select three. First we made a long term consistent commitment to education, particularly with research run universities, where research really blossoms.
Consistent may mean the first four or five decades. I think the discussion today has said that might be open for debate again. Are we making consistent long term commitments in that arena.
We also secondly had an environment which was extremely welcoming to the international community. The place to come was the US. Many examples in this room reflect that type of welcoming environment. That is open for debate apparently today. And, finally, there was a private sector community well represented at this table that turned these scientific advances done in darkrooms, no lights, no windows by scientists devoted to subjects of excellence. And they did a great job, but we turned them into global economies and global benefit.
I think at the Department of State we find the consequences of four or five decades coming into the arena of how we use this enormous talent and advantage. And we have a lot to learn yet. We make great progress, but we have a lot to learn.
We haven't learned yet how the US should define itself in terms of being a champion for science, not just being a leader of science, but a champion for using the value of these events for the benefit of a global community. And that is perhaps a controversial thing to say.
I did learn also in Washington that the appropriate -- in these remarks to always quote famous dead people so at the end I'll try to turn that remark into a famous dead person's quote.
[LAUGHTER]
GEORGE ATKINSON: At state it is particularly challenging. There are so many very talented devoted people who are committed to addressing the great issues of our times in the foreign policy arena, but very few have science backgrounds. So, it's like not having the right language training, if you will.
Nobody comes to my office and wants to talk to me about quantum computing or gene research. They come to talk about the most recent crisis on their computer or the one that came across on the cable.
And in that environment it is extremely difficult to be anticipatory of the nature of this conversation today. Do we need to do it, I would say absolutely. And in fact, part of our challenge in the 21st Century is if we're going to learn how to do it.
I think others will learn how to do it. They come with different criteria to start with, different starting conditions. For example I go back to the historical perspective, in the 50's, 60's and 70's when the US made its big move there were a lot fewer people. There were a lot fewer older people.
The aging population presents a tremendous burden on society in the social context. What do you do with 800 million people in India who live on less than $200 a day [SIC]. That's a real number. Those are the numbers that I think in fact, the scientific community within foreign policy.
And lastly, I would point to the fact that scientists have a big role to play in this conversation. Very few scientists were ever trained to get involved in politics. Look what happened to me. I'm still hoping to go home some time soon.
The fact of the matter is scientists need to come to places like the Department of State and be heavily involved on a day to day basis. I've participated in wonderful panels in Washington and gave great advice along with my colleagues. Went home thinking somebody was going to do something with that great advice. Very rarely was it utilized.
So, within the halls of a place like the Department of State more scientists have to show up on a daily basis. I think those are admonitions that are worth considering in this context.
The final point I would leave you with is that point about a quote. In 1939 Berthold Brecht wrote a play called The Life of Galileo. I suspect many people have not read the play. But it has Galileo say something quite interesting that's useful for policy makers.
Policy makers always seemed in my opinion to want a yes or no answer. What Berthold Brecht had Galileo say was the role of science is not to provide perfect infinite wisdom. It's to put a limit on infinite error. And that's really what we find in many cases our dilemma is when we wind our way into the halls of policy.
We want people to listen to issue, but we can't give them definitive answers with no degrees of uncertainty. So, I would just use that as perhaps a contribution to the conversation.
DAVID GERGEN: We were told that more than half the people in our universities studying science, technology, engineering at the graduate level are from other lands. What is the State Department doing to open up and raise the number of visas that are available to those people instead of having them reduced as they have been in recent years.
GEORGE ATKINSON: Well, as you know there's a wide range of opinion about what the goal should be. The question might be asked in reverse, is 53 percent the right ratio. Is it -- should it be a different ratio.
DAVID GERGEN: It might be very desirable to have a ratio of 70 percent Americans but that's a long term proposition. What do we do over the next five to ten years.
GEORGE ATKINSON: That's exactly right. And I think people at this table know that over these years -- people like myself who have worked very hard to try to liberalize the interpretation of the visa policy -- so there are many people who would like to do this --
DAVID GERGEN: Is it the position of the administration that this ought to be changed?
GEORGE ATKINSON: I think it's the position of the administration that we should have a balanced policy which reflects the needs of the country. And right now the needs of the country are to have large numbers of foreign nations participate in the program.
However, there are other parts of the administration who would see this quite differently. The security of the United States remains one of the most primary responsibilities of the government and there are many who see this as an important way of securing the country from other outside influences, nefarious ones.
Now, I would be the last one in this room to say this is an easy way to balance it. I certainly personally believe we should liberalize the policy for including many many more talented young people. As you travel the world, as it has been said, many people want to come to the United States. It's the place to come. Is it easy, absolutely not. It is very difficult these days for people to get visas to come.
And if you put in your resume biology, physics, chemistry, y you will get a special treatment in the visa process. I'm afraid that's not a very good answer.
DAVID GERGEN: Do the corporate representatives here we have as many visas as we should or do you think the numbers ought to go up?
CHRIS VIEHBACHER: I'll speak to it having gone through the process and I can attest to the fact that it isn't easy and it is dissuasive. And I think that's at a cost to the United States.
MARTIN MACKAY: I would agree with that. I go back to my point, I think we need to do more with American children and bring them into science. And not in the health care, the scientists.
QUESTION: [Holbrook, Pres of OSU] [Mostly inaudible -- question about visas]
GEORGE ATKINSON: I agree, the system has improved enormously over the last three years and I certainly watched it and worked with the system to do so. But you might ask a different question of the State Department. How many of the people apply in our sciences, engineers and technologies in those percentages.
DAVID GERGEN: But you're talking about the numbers who come here to study.
QUESTION: [Holbrook] Right.
DAVID GERGEN: What about the numbers who come here to work.
QUESTION: [Holbrook] That's a different story.
DAVID GERGEN: Isn't that where the bottleneck is right now?
QUESTION: [Holbrook] I think so, but I'm [Inaudible]
GEORGE ATKINSON: But in fairness it should be said that it is true that it has improved enormously from what it was, say three years ago. Three years ago -- much different situation.
DAVID GERGEN: Right on the study, but the number of B1 visas is down -- that's allowed in here from what it was. And yet the needs have gone up. That's what is persuading some companies to invest more overseas.
GEORGE ATKINSON: Again, the science is going to go follow the people and if there aren't enough people here then companies will go find them elsewhere. So, that's why I think it is at a cost to the US that we can't bring those folks in the numbers that we need.
SUSAN DENTZER: But to go back to Martin's point about developing more young scientists, I think this also gets us back to the issue of the NIH budget. I mean it is, as I understand it now virtually impossible for many young investigators to even dream of getting initial awards to fund their research.
And this is a horrible pipeline problem. If you want to send a signal to people how not to have careers in science you tell them that there's really no way that they're ever going to be able to transition from their doctoral program into a fellowship or into a research program of any sort and that is the signal that we're sending now.
DAVID GERGEN: Thank you for raising that, Susan. Dr. Zerhouni could you respond to that?
ELIAS ZERHOUNI: I think it's clear that when you look at the demographics of the scientific work force in the 50's and 60's, we really had an influx of science and technology graduates. And if you look at that over -- different departments of the government and the private sector -- you realize that there is [Inaudible] sort of collision here because at the same time you have decreased funding, you have essentially still the cohort of scientists -- still in activity -- will retire in ten years time.
And yet at the same time, you have sort of a strangulation of the beginning of the pipeline. So that what we're trying to do at NIH is really to mitigate that. About 1500 new investigators get their major grants a year. Last year we dropped to 1400, changed policy so that we mitigate this.
Why? Because the pump essentially of science is primed essentially on the basis of talent. If you lose talent in 2007 and you don't have that pipeline in 2017, it's predicted that about 50 percent of our scientists will retire and then all of a sudden you have a deficit.
And if that deficit is there, then the scenario that you just heard -- science -- and companies will go where the talent is. So, our strategy has been to look at demographic projections, look at forecasts. And we've implemented policies for example -- we try to maintain the 1500 average per year that we've had during the doubling. We created new programs, Pathway to Independence Awards.
One of the other issues that people don't appreciate is the aging curve. It takes longer now for a young investigator to really get tenured. It used to be that you get tenured at the universities at thirty-two, thirty three now, it's 38.
And the same thing is true as far as NIH grants. Twenty-seven percent of our grantees were 35 years younger two years ago. Today, it's more like five - six percent. So, it's the demographic effect but it's also a rigidity of the system.
So, what I think is important is to realize that any successful system -- and god knows we've been extremely successful over the past 50 years -- does build up [unintelligible] sclerosis, rigidities and bureaucratic difficulties. Universities are not exempt, companies are not exempt.
The biggest danger for the young investigators, the young scientists is when they see their career prospects and their career pathways -- they're smart people. They do a relative analysis and [Inaudible] and benefit. And when you paint the picture of see-sawing support, not a real strong national commitment that says science and technology is the bread and butter of this country -- and as I said at the beginning this is the century that will be drive by science. It's the science dependent century if you will.
As long as we don't say that and we don't mean it and we don't practice it, I think young people are going to understand that Wall Street is more interesting than Science Street.
DAVID GERGEN: It's my understanding that the percentage of investigators applying for NIH grants, who actually get the grants, has gone down sharply. Is that what you were driving at?
FEMALE: Well, we should go to the source.
ELIAS ZERHOUNI: I think you have to be careful with percentages as a matter of principle. The percentage went down, the number of applicants doubled. So, it went from 30 to 20th Century percent, but the number of applications doubled as well.
That's good in a sense because the doubling of the NIH budget really generated what I though we are all in engaged in when I became [unintelligible]. Finally we got it.
What is important here is to tell the country that we need more science, we need more research across a wider range. Universities responded. They built over 17 billion dollars worth of research laboratories. Philanthropy responded.
Everyone basically relied on the sense that NIH funding was going to be the platform on which companies will be created and more knowledge will be generated. And that happened. And it happened really at the end of the doubling. It takes four or five years to develop that. So, just simple statistics.
Twenty four thousand applications in 1999, 46 thousand last year, probably 49 thousand this year. And clearly the inflation costs of research increases should actually have a decrease in the success rate.
It's true. It doesn't mean that we are doing less research as a country. But here's the issue. The issue is that the impact of that is pernicious in a way. Because [a] it discourages the next generation of scientists, because they see this as a much more competitive environment. They are less able to compete with the established scientists who are there.
But the second is that it tends to drive people toward conservative research, not willingness to say let me just break the mold here. Let me not do what everybody's done before me. But let me do what my professor says will be funded.
So there are effects. It's not like we're doing less science, we're doing more science but we're not doing the science that in the long, in my view, will need to be sustained to really lead to those discoveries.
You hear about 1.2 billion dollars in pharmaceutical companies research. Let me just posit for all of us that perhaps the reason why it's so hard, because our science has not progressed. We don't have the bio markers. We don't have the predictive capabilities that say this drug won't work. At the 50 million dollar mark, not the 1.2 billion dollar mark. So, science has to really do this.
And this is why I believe that the demands -- and this is the question you ask -- are the demands of science the same as they were ten years ago. Is the need for science the same as it was -- we just need to go forward.
My answer is no. IN fact, if you really look at the questions that we have in the front and the time sensitive answers that we need -- because we have these devices in front of us -- means there is a race that needs to go on. That means also that you can't discourage young investigators. Because if you do you'll pay the price [unintelligible].
DAVID GERGEN: Is the bottom line that instead of looking at a process now on budgeting for NIH, for CDC or NSF, other agencies -- that instead of thinking -- it's going to be two percent of an increase or one percent. Are we going to be able to hold our own against the rate of inflation. The conversation we've been having the last couple of years -- is the real issue to get back on a doubling pace, a pace that doubles every X number of years. Is that the real challenge.
ELIAS ZERHOUNI: My sense is we need to go back to the people. A country is only as rich and as smart as its people are able to work together, to create new ideas and create innovation.
Innovation is the key. Innovation is a culture and to me innovation means that all of us decision makers -- everyone in the society America is great, that's why I love my career here and I love this country. Because we have what I call the culture of the why not.
Most people come to you and you say I have an idea. Most responders will say, why not. In Europe and the old world I think it's the culture of the why and we don't want to lose that. Well, you can only say why not so many times to bright young people unless -- if you don't have the resources to do that.
And the sense that I have is that historically when you look -- I'm very interested in these forecasts and looking backwards -- as I testified yesterday, historically NIH, CDC every knowledge organization seems to do well in terms of quality versus innovation. When about 30 percent of the attempts that you make -- you get a why not instead of a why. You get a yes instead of a no.
And if you start going below that too much for too long then you have smart people who really are smart and will go to private equity or other kinds of activities that [Inaudible]. So, my view, to sustain innovation you need to sustain the ability to say why not three times out of ten.
FREDA LEWIS-HALL: We've talked a lot about college age children and young investigators but earlier in the pipeline -- you know, in the K through 12 -- I was always fascinated, I'd go into the kindergarten classes and everybody wanted to be you know something. And I'd go into the 5th grade classes and nobody wanted do to be anything.
[LAUGHTER]
FREDA LEWIS-HALL: It was very interesting, how did you go from want to be something to not having any idea as to what you wanted to be.
One of the things that's been interesting about biomedical research is I'm not sure that young people, K through 12, get their arms around this in the easiest way. Nor does society understand in a way that they can facilitate it. I have three children none of whom were interested in the sciences at all. And they decided that at early ages.
And I am who my family raised me to be and I always harken back to the fact that my mother's mother wanted me to be teacher. She remained disappointed for many years that I had decided to be a doctor. Because to her being a teacher was the most important thing. And it wasn't until I literally took her into the medical school classroom where I was teaching and I was at the chalk board that she kind of got happy.
[LAUGHTER]
FREDA LEWIS-HALL: I'm giving that sample to say I think that we don't apply ourselves in the K through 12, so we really don't have [unintelligible] to move on through the sciences. And, you know, there are probably some things that we can do. I know there are things that we are doing, but we could apply ourselves, I think, a little bit more to those early grades to get the interest up, the understanding, the awareness and some enthusiasm, so that we have people to hop all these hurdles that we're talking about.
JULIE GERBERDING: One of the most important resources for science inspiration is NASA because of the way their finance model works and the way they are required to invest in K through 12 education, the space camps and a lot of other environments. And we ought to be really looking at how to expand that capability into a broader dimension of science because it's enormously successful but they can't do it alone.
QUESTION: [Steve Burrill] Just to follow on a comment that Dr. Zerhouni made. The federal government through the NIH is spending about 30 billion dollars a year on research. The pharmaceutical is spending about 40 billion dollars a year, the bio tech industry about ten. So, the private sector is spending about 50 billion dollars a year in the US.
And increasingly the research that's funded by the private sector is not getting reimbursed. If you look at the pharmaceutical industry -- we've wiped out the profitability of the pharmaceutical industry, we're about to wipe out the profitability of the bio tech industries so we have a very different crisis emerging in that we have tremendous desire for innovation funded both privately and publicly and, yet, there's no return for that investment.
And, so, the challenge to managing health care costs and trying to manage -- a decreasing desire to have health care costs against return on investment is providing a real challenge to the system.
DAVID GERGEN: How much is it increasing the investment?
QUESTION: [Steve] Well, the investment would dry up in a hurry if there's no return, so I happen to make my living a venture capitalist. And if there is no return for the investment there's going to be no investment. And, so, the pharmaceutical industry and the bio tech industry will see reduced investment as return [SPEAKING OVER EACH OTHER] --
DAVID GERGEN: Private companies are making 25 - 35 percent a year.
QUESTION: [Steve] Theoretically.
[LAUGHTER]
DAVID GERGEN: Some are.
QUESTION: [Steve] We'd love that be true.
DAVID GERGEN: What is a reasonable rate of return.
QUESTION: [Steve] Most [unintelligible] are making ten to twenty percent.
DAVID GERGEN: So for a pharmaceutical company investing in drug research, they ought to make ten to twenty percent on it a year?
QUESTION: [Steve] No the pharmaceutical industry is actually almost a non-profit industry right now. You take the aggregate profitability of the pharmaceutical industry it's going absolutely down like that. So, the new crisis that is emerging is this need to find a way to incentivize -- to continue to get the investment that we did or else we're going to end up with increased federal funding for that, because the private sector funding will dry up.
MARTIN MACKAY: It's a pretty simple equation for us. We reinvest 15 percent back into research and as Christopher said, the attrition rate that we face -- and some compounds are costing a billion dollars -- it's the 19 out 20 that fail in development that really kill us and why we need more investment to get in.
So, while I mention two terrific compounds that are successful: [unintelligible - names of compounds] we lost a compound a few months ago called [unintelligible], which we absolutely believed would have revolutionized the way that heart disease is treated in the world. And we lost it in phase three. It was already over a billion invested.
It will still take us another two or three years to work through it, because we have a scientific curiosity now. But for us it's that simple equation. The more that we can bring in, the more that we invest in research.
SUSAN DENTZER: The old pharmaceutical development model is fine that you can sell to 50 million people for many years. And what we're talking about is a whole new era of personalized medicine. You mentioned the cancer compounds that maybe works on 2000 people. It doesn't work on 50 million people.
So, you have got to have that scientific investment from NIH to tell you who it works on, as you said earlier. Increasingly all of your research effort in the future is going to be looking at pockets of drugs that work on small groups of people. That's a whole different economic model that you all have not figured out how to crack yet.
So, to get back to the point about how we're all in this together -- I mean the government as well as everybody else has to think through how this -- your industry transitions to a new economic model and does seize the investment in science at the federal level and becomes a profitable industry going forward. Because right now it's a real problem.
MARTIN MACKAY: We're still looking for medicines to treat broad population and very successfully. I agree with you more and more will be looking to individual treatment.
QUESTION: [Dr. James Goodwin/London] There's been little mention so far of one of the biggest driving forces that affect health issues in the 21st Century and that is population aging. And as Sir [unintelligible] from [unintelligible] aging research eloquently puts it on the 1st of January, 2011, six thousand [unintelligible] will reach the age of 65 and that's going to continue every day for the next 18 years.
In the UK we almost have a reciprocal relationship between the amounts of money that is spent on the science of aging and on these demographics and I'd value some views from the panel on how they see the science of aging as a priority the health of old people in the next 100 years.
MARTIN MACKAY: I would add one point. We see this as a huge issue and we've put more funding into our research dollars in to aging, so when osteoporosis, frailty, neuro degeneration, in general, specifically Alzheimer's disease -- so it's certainly a major issue and a major source of our investment.
CAROLYN CLANCY: I would just add that we have a huge opportunity and -- to make sure that when people do turn 65 that they are a lot healthier than they are today.
Because as Dr. Zerhouni was mentioning the BED if what's facing Medicare as we look at the baby boomers aging, some of that explosiveness is related to the fact that we have huge missed opportunities for prevention across the spectrum.
I mean 50 percent is often what we see when we actually measure the delivery of fairly straightforward intervention, screening and so forth that we know can help us detect disease early or hopefully actually prevent it all together.
So, the good news is while we're improving heart attack care even though it's not perfect, we're actually not doing nearly as well as we could. We're doing a terrible job in preventing people from having heart disease to begin with.
DAVID GERGEN: What's the 50 percent number?
CAROLYN CLANCY: Fifty percent is how often we get it right in terms of delivering [unintelligible] spaced interventions that we make a difference.
We put out an annual report every year to the Congress on quality of care and it's about that ball park, in terms of getting people with diabetes the right care, getting people to do cool rectal cancer screening and so forth, notwithstanding Katie Couric and others who've made fairly heroic --
DAVID GERGEN: Fifty percent of interventions are not appropriate?
CAROLYN CLANCY: No, what I'm saying is 50 percent of the time we deliver what we know to be valid scientifically proven interventions to the people who would benefit, which means that when they get to be 65, they're in worse shape which means that we're not anticipating the need to prevent disability and so forth due to chronic illness.
FEMALE: Seventy percent of the chronic diseases are preventable in our country.
CHRIS VIEHBACHER: If I could carry on from that point, to take off from Steven's original point, which is reward for innovation. Very often health care cost management and innovation are opposed in public policy and that is what happened in Europe, actually, that's why Europe actually declined in terms of its research competitiveness.
It doesn't actually have to be that way. Because we could actually manage those chronic diseases better and to give a very clear example, type two diabetes. If you can keep someone's HPA1C to seven percent or lower, you won't see a progression of that disease.
We could avoid the 225 amputations every day in America because of complication from Type 2 Diabetes. And, yet, even in our employee population, 25 thousand employees in the US, two thousand suffer from Type 2 Diabetes, only a quarter of those have their HPA1C checked twice a year as we should do. Otherwise people are just asking patients how they're doing and if nobody's complaining they're not getting any different therapy.
Those things can dramatically reduce cost. The City of Ashville did this. You can bring the cost of a Type 2 Diabetes patient from around 12 thousands down to six thousands which is the average we spend on health care per person. If you do that and concentrate on the prevention and the quality you can fire up the amount of money that we spend on innovation.
But that's not the way it works. Right now people say it's drug prices that are driving up health care costs, even though they're only ten cents out of every dollar we spend on health care. And those kinds of short term decisions where you actually start to give in to price controls and everything else are going to kill off the innovation, but they won't actually bring the health care costs under. And we need to have different recipes to make sure we still can afford the innovation and can also manage to afford our health care.
GEORGE ATKINSON: About three or four days ago we organized a meeting hosted by Secretary Rice on the question of how global aging is affecting international policy. So, a new initiative has started at the state. I'd be happy to give that information to you.
DAVID GERGEN: You were doing that as the number of people over 65 exceeds the number of people under the age of five.
GEORGE ATKINSON: That's one of many reasons.
DAVID GERGEN: That's the marker we got to work with.
GEORGE ATKINSON: That is one marker. There are quite a few that community brought forward in terms of what the international component is. Especially going toward a world population of nine billion or ten. The very highest percentage of the aging population will be in developing countries, not in developed countries.
The Chinese for example have been leaders in developing new directions in terms of aging policy for public investment of funding, something we'd like to more about and we're engaging them in that. I'd be happy to get [unintelligible].
QUESTION: [Michael Halperin] My name is Michael Halperin, with the Scientific Integrity Program at the Union of Concerned scientists. First of all, Dr. Atkinson, thanks for recognizing both the need for a scientist to participate fully in federal agencies and the sensitivity regarding scientists ability to give advice here in Washington. And Dr. Gerberding thank you for your willingness to support the scientists in your agency.
My concern is with the ability of these scientists who dedicate their lives to federal service to be able to participate fully in the scientific process. With the new Congress you've seen a growing interest in investigating a great concern from the scientific community over the past several years which is political interference in science and the inability of federal researchers to present their work regardless of administration or Congressional policies.
So, my question is would each of you support media policies that allow taxpayer funded research to emerge, scientists presenting at conferences, being able to present their research through the media offices regardless of its policy impact.
JULIE GERBERDING: I think this is a subject for an entire panel. But there are a couple of frames on this that I feel very strongly about. One of them is that we must have an intersection of science and policy and I love what you said earlier that we'll have better policy if we have better science in forming it.
And there are a lot of ways to bring science to the table of policy makers. But there's also a mythology that if you have good science you're automatically going to have a good policy because there are a whole lot of other things that influence policy including public opinion and voters and constituencies and advocates and stakeholders and a lot of people who are in this room.
So, you know we believe that the starting point is good science, but what ends up coming out at the other end of the sausage factory is the product of many different kinds of inputs. But having said that it's also important that the science is at the tables when those decisions are being reached and that's something that we believe very strongly in I think at CDC and certainly NIH and other agencies that are in the Department of Health and Human Services.
DAVID GERGEN: Should White House staffers be editing reports from the Environmental Protection Agency before they're made public, reports by scientists.
GEORGE ATKINSON: I would say in great candor that what Dr. Gerberding said was exactly right. The crucible of debate has always been the basis on which scientists narrow that area of the degree of uncertainty.
There's nothing more interesting than getting up as a young professor in front of 200 physicists and talking about your research, because you know that all 200 are smarter than you are.
So the crucible of the debate has got to part of the foreign policy or the domestic policy agenda. But the point is extremely well made, just because you have great science doesn't mean you're going to have great policy. And I think if you learn when you come to Washington you learn that.
[LAUGHTER]
DAVID GERGEN: You initiated the Jefferson Science Fellows Program in 2003. Thomas Jefferson argued that the -- at the heart of the republic was an informed public and that that is what gave -- that's what built strong foreign policy.
If the public is not being told straight hard truths about where -- what we find ourselves in an issue like global climate change, if science is employed by the government or being muzzled in some way, is that furthering the ideals of Thomas Jefferson?
GEORGE ATKINSON: I think clearly the answer is, no, but of course in Thomas Jefferson's day he was concerned about democratic principles, informing the public and not necessarily the issues of physics and chemistry.
Today, I would agree completely that the public has to be well-informed and to some degree that public has to be interested enough to become well-informed. And I'm concerned that the blood public isn't so interested in physics and chemistry. Anybody who gets on an airplane and sits next to somebody and you then tell them you are a physicist, they won't talk to you.
[LAUGHTER]
QUESTION: [Ray Woosley, Critical Path Institute] This is a great discussion and I think it's -- talked a lot about how we want to get that science to the patients. What I would ask is there not an elephant missing in this room or maybe I should call it a filter.
How can -- and actually I think three years ago today Mark McClellan was in this building announcing the Critical Path Initiative and calling attention to the fact that the pharmaceutical R&D had gone up 50 percent, the NIH budget had doubled. We sequenced the human genome. But the number of new products coming to the FDA had fallen about 50 percent.
So, how can we get that kind of science -- the way we did with AIDS. How can we get the science at the table with a regulatory agency that doesn't want to be a filter but has been filtering us. And, yes, we want safe drugs, but we have to have drugs, we have to treatments, we have to have those products with all its science or it's all a waste.
CHRIS VIEHBACHER: I think the issue here is that you're really facing the complexity of biology that has evolved over billions of years. And when I said we really need to understand not just the hardware of biology or the software -- that's really what it is.
The frontier right now is that we do understand the structure of molecules one at a time. We really don't have the wiring of all the components. It is probably the issue there. I mean, yes, you had molecular entities before, because you had simple causes of disease.
There's a sense that what we need right now is more fundamental knowledge about the behavior of biological systems, toxicology. So, we've met with industry. I worked with Mark when he was at the FDA in trying to identify what are the fundamental barriers.
Well, it turns out that we could -- if you could identify them. One is what we call target validation. It's not enough to report in a laboratory that gee whiz A1C [unintelligible] complications in diabetes -- you need to really understand molecular pathways by which that is expressed.
The same thing is true in heart disease. We've made progress in heart disease but frankly we don't understand the fundamental cause of heart disease. So, we need to understand that better.
Predictive toxicology is an area where still as you've heard from my colleague at Pfizer, 1.2 million dollars later with some of the brightest scientists in the world and you still get it wrong.
That's an area of research that needs to be improved and predictability needs to be improved. In addition to that, I think that the connection between what FDA does and what science you need to develop to have increased predictability really requires you to come up with new bio markers. Bio markers in the wide of the world -- word -- that is any biological measurements that have predictive value or diagnostic value or prognostic value.
Those things are fundamental barriers, they're not easy. Anybody who thinks out there that their solutions in the laboratories and they just need to be pulled out and applied is naïve at best.
We know ten percent of what we need to know in biological systems. That is the challenge of the century and we need to continue to do that. Otherwise it won't cost you two and three and four million dollars to get to the next round, because we have a need for more science at the bottom line.
MALE: Very briefly, I agree completely. You are absolutely right. But it's -- I know for a fact there have been bio markers available for over a decade to predict drug response that aren't being used clinically today.
There was a package written in 1998 -- a cancer drug. And it's not being used, because the FDA hasn't had the data on which to make those recommendations. So I would just simply say can some of the science be brought to the FDA so they can understand these new products when they're brought to them.
CHRIS VIEHBACHER: We are working with industry. We created a partnership with Pfizer and other companies through the foundation for NIH to create the gene association information network. We created another [unintelligible] for biomarkers.
What is really key here is to understand that the scientific data that is needed buy companies, by our researchers is too protective. There's too much of it that is not publicly accessible. I think we need to define what I would call a free competitive world where that information can be shared much more freely than it is today. And I think science would advance through that.
QUESTION: I'd like to come back to this issue that was raised during the day, and that is the collaborative effort, collaborative need in education, globally and particularly the between the academy and industry.
With regard to the educational issue, I come back to Dr. Atkinson's point bemoaning the lot of the physicist and yet biology is simply the most elegant expression of chemistry, physics and mathematics.
[LAUGHTER]
And we've done very little to fundamentally change the educational process. But I think more importantly and perhaps where we are in our greatest danger right now is while we both acknowledge the essential roles that the academy and industry have played in bringing us to this state of not only elegant therapeutics, but new diagnostics, which after all biomarkers are, we are really in danger of losing that capacity more and more as the social debate revolves more around industry productivity and their profit and potentially conflicts in industry rather than the true nature of collaborative activity it has to occur not only for the scientific model in terms of the human organism now being the major experimental model. But also in the economic model.
And I would come back to Susan's point in saying that the concept of stratifying geno type and [unintelligible] type with more and more drugs for fewer and fewer people does require a diagnostic for 100 percent of the people.
And as we begin to look at those kinds of biomarkers much of that is coming out of the academic state. And, yet, I would challenge each of you, particularly our industrial partners to say what are the solutions for making a more viable relationship between the academy and industry, both of which I think are going to be absolutely essential in moving this dialogue forward.
MARTIN MACKAY: I absolutely agree with you. And again we've recognized that from being a -- at least I can speak of Pfizer from being a rather insular group of scientists where we did very little collaborations to now having many more collaborations.
But I think it's -- one think that [unintelligible] said, a precompetitive piece, I think we have to engage in more -- I think instead of a lot of runoff collaborations that we do -- have much more meaningful joint collaborations with institutes and companies and then I think companies working together. And we've got many good examples now where we formed consortia to the great benefits of medical science.
CHRIS VIEHBACHER: The only other thing I'd say as we spend more on R&Ds -- companies -- we're typically not hiring our own scientists and building our own labs any more. Most of what we are actually doing is spending more money in those external collaborations.
QUESTION: [Mark Resnick, University of Illinois] I just got back from an NIH study section a little while ago. And one of the problems that I see -- I actually think 80 percent of the science I see is worth doing or has something in it -- 80 percent of the science is worth doing.
Eight percent is going to get funded. If there's a hiccup in a room then something is being pushed into an unfundable region. Innovation is considered by people in study sections to be technical gee whiz and not important science or fundamentally different ideas.
How are we going to fix this. How are we going to get to the point to real innovation. And in fact, in industry trying to get money for something I'm doing on biomarkers -- I'm told you got to talk to the clinical folks, because this isn't something the pre-clinical folks do.
Scientists start as liberal and get into a room and get very conservative [Inaudible]
[LAUGHTER]
How are we going to fix this? [LAUGHTER]
CHRIS VIEHBACHER: Well, I would just say that we've addressed some of these concerns. As you know this notion of peer review, always having this problem too conservative has been around 25 years.
My philosophically has always been the following: Look we can argue about it forever but we're scientists so why don't we do pilots, why don't we do defining experiments. So, we did. We created a pioneer award program just as a pilot, five pages of application and interviewed with a panel of very distinguished scientists.
And lo and behold it does work. I mean you can actually encourage what we would call high risk [unintelligible] research. As a matter of system, it's clear that you need a diversity of approaches to science. You can't just say it's going to be all high risk or all low risk. It's really a portfolio of things and you have to rely on the wisdom of scientists.
So, again, peer review is the worst system until you try the others.
[LAUGHTER]
DAVID GERGEN: [picks up mid-sentence] -- scientific studies and people especially working in health care who have brought enormous advances that all of us here today benefit from.
But it is also apparent that this is a community that faces very difficult challenges in the years ahead to match the promise of science with a kind of investment efforts that are needed to realize that promise.
We're deeply indebted to all of those here and Research America who are making such an effort. And I know that there are so many allies of those on the panel. Let us thank the panel that came here today.
[APPLAUSE]