Valuing Evidence-Based Research and Enhancing Its Impact
Research!America National Forum 2008
National Press Club, Washington, DC
March 18, 2008
Government and private sector health leaders, convening at Research!America'sannual National Forum, laid out a future of transformational change in whichthe best use of evidence-based medicine and technology will empower consumersto take more responsibility for managing their own health.
Panelist Carolyn M. Clancy, MD, Agency forHealthcare Research and Quality director, summed up the challenge: "It takesway too long to apply evidence in health care. There's no question. We can dothis (speed up application of evidence)."
Centers for Disease Control and Prevention Director Julie Louise Gerberding, MD, MPH, agreed,"The tragedy ... is that it's one thing to not know what to do ... but an even bigger tragedy is to not do what we know."
While the five top federal medical officials on the panelwere circumspect about the political nature of health care reform, Research!America'schair, The Honorable John Edward Porter,a former Illinois congressman, was blunt about the challenges facing evidence-basedmedicine.
"Clearly this administration has allowed science littleplace at its table and has put America's great research engine at substantialrisk. It has had a devastating effect on the science community, the researchinstitutions ... and on young investigators and their families. It has slowedappreciably our move toward greater discoveries that can improve human health onthis planet," Porter said at the outset of the forum.
William D. Novelli,chief executive officer of AARP, perhaps the nation's leading social marketer,said it will take voters turning their "angst into anger" to force politiciansto make the tough choices required to base our health policies more soundly onevidence.
Research!America President Mary Woolley noted the importance of gauging public opinion onthese issues: "Research can best serve the public interest when we know whatthe public is thinking, when we are able to answer questions raised by thepublic."
Panel moderator SusanDentzer, of the "NewsHour with Jim Lehrer" on PBS, askedparticipants to put themselves in the year 2030 and look back to assess whatopportunities were lost due to the failure of the health care system to makefull use of evidence.
Elias A. Zerhouni, MD,National Institutes of Health director, said the dilemma is that in many fields- medicine, economics and social sciences - evidence is collected but notdisseminated because the research is divorced from policymaking "in a patternof decisional gridlock, gripping society at large."
He said while the solutions of 2030 are being developed now,"we have germinating seeds [of great discoveries] that are being essentiallykilled by the system ... and there's no amount of testimony or charm oranything we do that will change the fundamental physics (of) limitlessentitlements and promises that essentially squeeze the degrees of freedom to dowhat you need to do, which is feed and fertilize the germinating seeds of successfulexperiments."
Novelli, a public relations guru, anti-tobacco advocate andnow head of one of the nation's most powerful advocacy groups, said the biggestproblem in health care today "is not at the bench but on the Hill." Heexplained, "The American public is extremely worried ... I feel it is AARP'sresponsibility ... to turn that angst into anger ... When the middle class gets mad... the politicians listen."
Zerhouni later observed, "It's going to take fundamental redrawingof our political and policy decisional making processes" to achieve betterhealth outcomes and more cost efficiency.
Novelli and GarryNeil, MD, Johnson & Johnson's corporate vice president for science andtechnology, said advocates should make policymakers aware of the huge "returnon investment" from biomedical research.
"Congress is always thinking cost containment ...and we needto figure out how to frame our arguments in cost containment ways," Neil said. "Wecontinue to see health care as a cost center and a cost driver; instead weshould be seeing it as a productivity generator, as an engine for growth."
Food and Drug Administration Commissioner Andrew C. von Eschenbach, MD,agreed, "Investments in biomedicalresearch ... are going to be the drivers of the economy in the next two decades."He said advocates must argue, "This is not an appropriation-this is aninvestment in our present and in our future."
Clancynoted that when Congressprojects future health spending, "only a small part of that is demographics. Alot of it is misplaced spending in health care." She said the challenge is "buildinga smarter delivery system that's prepared to apply knowledge in a targeted wayto the people who can benefit and to minimize harms."
Joel Kupersmith, MD, chief research and development officer of theDepartment of Veterans Affairs, said transformational change will require "somesort of massive movement. ... I'm not sure it's likely to happen unless peoplestart taking control of their own health care." He forecast the formation oflarge advocacy coalitions developing around the issue of the electronic healthrecord.
Gerberding predicted that when technology allows peoplebetter access to their own health records, "all of a sudden, we will have donewhat Quickendid for taxpayers 20 years ago "by allowing consumers "to make enormousdecisions for themselves."
Download an image-filled summary of the National Forum and 12th Annual Advocacy Awards Gala.