September 2007

Commentary accompanying British Medical Journal's Clinical Evidence Handbook, September 2007.

"It's Time to Give Evidence the Funding It Deserves"

Mary Woolley, President and CEO, Research!America

 

Even as public attention to health care issues intensifies, physicians, public agencies and hospital systems are experiencing increasing strain. The obesity epidemic continues apace, and it is likely that, for the first time, a generation of children will not outlive or be as healthy as their parents[1]. If that one prediction doesn't constitute a call to action, how about the rising toll of chronic disease, the inevitability of natural disasters, the likelihood of infectious disease pandemics and the possibility of biological or chemical terrorism?

 

PARADE magazine recently asked its 74 million weekly readers to suggest what Congress should do about health care. The editors tell us that they experienced the highest-ever response by readers. People are anxious-in many cases angry-and want Congress to act. The 2008 presidential campaign has already sharpened policy positions on health topics and are raising public expectations for system change. This sense of urgency is also reflected in a new Research!America public opinion poll in which just 24% of Americans say the health care system is working and needs only minor adjustments[2]. Everyone else wants significant change or total overhaul.

 

Change for its own sake won't cure our ills, however. One of the problems the public is not well aware of-indeed I sometimes think that all but policy analysts may be in denial about it-is that we don't know enough about what works and what doesn't when it comes to diagnosis and treatment and especially prevention. We don't know enough about how to consistently and effectively deliver what has been demonstrated to work. Add to this the fact that on average it takes 17 years for a new research finding to come into practice.[3]

 

The outcome of this perfect storm of foot-dragging, denial and lack of agreement about how to accomplish effective change, has resulted in rising costs, higher numbers of uninsured, little or no post-market surveillance of new drugs and devices, no interoperable electronic medical record system and no health outcomes tracking system. It's almost as though we're afraid to find out just how truly dysfunctional our current system really is.

 

The tried and true first step in any formula for improving the status quo is obtaining solid data. Yet our nation has so consistently avoided obtaining this data that we are funding the federal agency in charge of doing so, the Agency for Health Research and Quality, at about $1 a year for each American! Compare that to the $6,700 a year we are spending per person on health care. AHRQ's budget has remained essentially flat for more than 10 years, even as the cost of health care as a percent of the GNP has ballooned from 9% in 1980 to 16% now and a projected 20% in the next 10 years.

 

This is the time to invest more in AHRQ. The 2008 presidential campaign is estimated to have a price tag of $1 billion. For the cost of all that bluster, we could take AHRQ to scale and start making evidence-not anecdote-the standard by which health care is delivered in timely, effective ways to more people more of the time.

 

What are we waiting for? Every survey reveals overwhelming public support for higher federal investment in research that will lead to better health. Even in the face of competing national priorities, a plurality of Americans say more investment should be undertaken now.

 

As physicians you hold more than the lives of your individual patients in your hands. You also command tremendous respect among policy makers because they recognize that you are the ones who struggle to provide the best care to all patients, including those who can't afford it; you are the ones on the front lines. Physicians and researchers must join, patients and their families-as well as insurers, employers and hospitals-to remind today's policy makers and those who aspire to serve the public's interest, to invest more now in what we already know to help people live, work and play in better health.

 

Here's what you can do:

 

  • Write, or better yet, visit your member of Congress and your Senators, as well as candidates for President, to deliver a simple message and offer your own expertise in helping their staffs develop a rationale for more federal support of research, and of AHRQ in particular. It's time to take that agency to scale. Nothing less than our nation's health security is at risk.

 

  • Speak before community organizations or go on local talk shows to explain the importance of seemingly dry federal research investment policy to the health of your neighbors.

 

  • Agree to sign letters to the editors, op-eds or widely circulated professional statements when asked by your medical society, your institution or a national advocacy organization.

 

  • Keep the message nonpartisan but also very specific so policy makers and the public understand better how sometimes risky or abstract-sounding research does pay off in better health for everyone, regardless of income, class or party.

 

The benefits of public and policy emphasis on stronger federal support for research will be improved individual health of American citizens, increased attraction of the best and the brightest to careers in research and clinical care, and a stronger health care system for our nation.


[1] Olshanksy, S. Jay et al., "A Potential Decline in Life Expectancy in the United States in the 21st Century," New England Journal of Medicine 352: 1138-1145.

[2] Research!America, Your Congress-Your Health survey (Charlton Research Company), May 2007.

[3] Balas E, Boren S. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer; 2000.