2007 National Health Research Forum — Transcript
U.S. INVESTMENTIN RESEARCH: ASSURING DOMESTIC AND GLOBAL DIVIDENDS
MARY WOOLLEY: Followinglunch, we will be opening our 2007 National Forum. This will be, I’m confident,a most stimulating panel discussion with opportunities for everyone who’spresent who might like to weigh in to do so.
Our panel will address a range ofissues regarding our nation’s need to sustain global leadership and researchand to assure that health dividends of research contribute to a healthier andmore stable American community and a healthier and more stable globalcommunity.
I want to thank and recognize thesponsors of our national forum whose generosity and support allow us to presentprograms we are proud to offer to the members of Research America and otherstakeholders in research.
Our sponsors for the forum include GlaxoSmithKline,the university of Notre Dame, Pfizer, Infocast, Bristol Meyers Squib, the Marchof Dimes Birth Defects Foundation, Abbott, the Pharmaceutical Research andManufacturers Association and our media sponsor for today’s program, The Hill.
We’re pleased that leadershiprepresenting all of our supporting partners are with us this afternoon andwe’re most grateful for your support.
I also want to acknowledge andrecognize a contingent of 25 business and economic development leaders from theAurora, 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 economicdevelopment leaders who are in Washington, D.C. to meet this week with theirmembers of Congress to advocate for medical and health research — emphasizingthe economic benefits of research investment. It is in fact one of our keyobjectives of our strategic plan to do more of this kind of work with businessleaders from around the country.
Following lunch, Research America’schair, the Honorable John Edward Porter, will kick off our forum program. Inthe meantime please enjoy your lunch and the company of those who share yourcommitment to making research a higher national priority.
JOHN PORTER: Thankyou all for being here. I’m John Porter, the chair of Research!America and Iwant to welcome you all on this first day of spring. I think we have anexciting panel presentation for you.
At our annual meeting this morning, MaryWoolley and I noted that these very challenging and promising times forresearch — that it is critical as a community of advocates — we work with aunified voice to take action and convey messages to the public, to opinion leaders,decision makers in the media that demonstrate the life saving and economicvalue of research to improve health. And our panel discussion this afternoonwill 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 convenedan exceptionally distinguished panel of leaders to share their thoughts andinsights with us this afternoon.
Our panel will discuss a range ofissues addressing our nation’s need to sustain global leadership and researchand to assure that the health dividends of research contribute to a healthierand more stable American Community and healthier and more stable globalcommunity. Sustaining our nation’s world leadership in publicly and privatelysupported research is the smart thing to do for America and the right thing todo for the world.
It is our good fortune thisafternoon to have not only an exceptional panel but also one of America’spreeminent commentators and author as our moderator, David Gergen. For 30years, David Gergen has been an active participant in American national lifeand American policy.
He served as director ofcommunications for President Reagan and held positions in the administrationsof Presidents Nixon and Ford. In 1993 he put country before political when heagreed to serve as counselor to President Clinton on both foreign policy anddomestic affairs, then as special international adviser to the President and tothe secretary of state, Warren Christopher.
David currently serves as editor inlarge of U.S. News & World Report.He is a professor of public service and director of the Center for PublicLeadership at the John F. Kennedy School of Government at Harvard University. He’sa native of North Carolina, an honor graduate of Yale University and theHarvard Law School and he served for three and a half years in the US Navy.
This is a man who has for his entirecareer made a difference for all of us in America and we’re very very pleasedto have David Gergen act as our moderator.
DAVID GERGEN: Goodafternoon and thank you very much. We all here on the panel and in the audiencewant to give a special salute and thank you to Research America for the workyou’re doing. A number of you here are on the board and we thank you for theservice. This is an important effort and the fact that you could assemble thispanel I think speaks volumes about not only how hard you’ve worked but howrespected you are as an organization.
So, it’s good to be back. I was herelast year. And maybe we see, as John Porter said earlier, a little more lightat the end of the tunnel than we did a year ago. That will be one of thesubjects for discussion.
A couple of years ago at Easterservice at Memorial church at Harvard, just before we passed around thecollection plates, the Reverend Peter Gomes looked out at the congregation andhe said, I have good news today and that is that this church has all the moneythat it will ever need. We are taken care of from now until perpetuity. The badnews is that it’s all in your pockets. [Laughter]
And so it is I think we think aboutresearch and investment in the future, especially in health care here inAmerica. We have all the money we need, but it’s just somewhere else. And theissue before us today is how we mobilize this country both politically in termsof the public to insure that America remains at the cutting edge of researchand that in fact, we — I’m pleased that this year we’re broadening theconversation.
So, Dr. Atkinson is here form theState Department to talk about how that goes — those powers of research hereand the strength we have in can also be shared around the world to — as my colleagueJoe Nye would say — employ health care research as one of the many diplomaticweapons in this “war on terrorism.”
I sometimes think we should call ita struggle against terrorism because war implies that the only tool at yourcommand is the military. And, in fact, we know that’s the hard power, but softpower has been neglected too much. And it may well be that there are ways thathealth care can serve as a form of diplomacy. And we want to explore that heretoday as well.
So, we have a broad agenda and wehave a wonderful panel. The thought is that we would have a conversation hereamong the panel for probably and hour, hour and 15 minutes, and then we wouldopen this up. And we will be out of here by a prompt three o’clock.
So, I would like to open with ajournalist who can perhaps speak more candidly sometimes that people can ingovernment about where we find ourselves at this moment. And I’m going to turnto Susan Dentzer, who is an old friend and colleague. Susan, for the last sevenyears has been at the News Hour with Jim Lehrer, where she is the chiefcorrespondent on issues relating to health care policy, research in that areaand Social Security.
Prior to that time we werecolleagues at US NEWS where she was the chief economics columnist andcorrespondent. She is a very smart lady. And she also knows something aboutresearch in universities.
She served on the board of her AlmaMater, Dartmouth, on the board of trustees, and was the first woman to chairthe 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 findourselves.
SUSAN DENTZER: Thankyou very much, David. It’s a great pleasure to be here with you. I think wherewe find ourselves today is, as was referenced earlier, probably in a little bitrosier situation than many people perceived a year ago. Because a year ago, ifwe just take strictly speaking the National Institutes of Health budget as ourindicator of where we are in terms of progress we know that last year for thefirst year in 36 years the NIH budget actually fell.
And we know that if we look at itthis year in an environment of what at the moment appears to be a flat fundedsituation, we are — if we actually adjust that for inflation and bio-medicalresearch, we’re actually at the level that we were back in the 1990’s at about19 billion dollars.
So, strictly speaking from thatmetric, we are not in very good shape and this is at a period in time which Ithink we would all acknowledge the promise of much of the investment that hasbeen in made in this country science, in biomedical science in particular isunprecedented.
We are on the precipice of beingable to capture a lot of the fruits of the genetics and genomics revolution andjust to give you an example from my own experience, we have a piece that we’rewaiting to air now on bio markers for cancer.
Biomarkers, as many of you know, aregenes or changes in genes or changes in protein levels that could be an earlykind of red flag that cancer was developing in the body.
Now, at a time when one in threeAmericans face cancer today and the actually number of cancer cases is likelyto double as my friend John Seffrin would assure us from the American CancerSociety — 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 manycancers if they’re detected at the early stages. So, if you had even betterbiomarkers than we have now — for example now we have PSA, we have CA 125 forovarian cancer. Often these are problematic biomarkers.
But if we had really terrificbiomarkers — ability to measure the changes in proteins in genes at a veryearly stage, we could obviously intervene much earlier in cancer and save a lotmore people.
This is something the Americanpublic would really cotton on to if the American public understood truly thepromise of it. And we have to do a mind boggling amount of scientific researchto bring this promise to fruition.
So, I think where we are is a pointin time where the Congress with a clear bipartisan sense — that we need to goback to a point of making more investments in biomedical research. And now inthe hands of the Democratic majority which was more inclined to do that anyway.
But now there’s a point in time whenthere’s a little bit more excitement about the possibility of getting the NIHbudget back on a trajectory of possibly doubling again over perhaps a longerperiod of time than the last doubling. But at least beginning to make some moreof these investments that hold tremendous fruit and tremendous promise for theAmerican public.
DAVID GERGEN: That’svery helpful, Susan. How much of a problem do you think it is that we arespending 3 billion dollars in Iraq, how much of a problem is that for healthcare research dollars?
SUSAN DENTZER: Iguess that’s a figure David Walker from GAO said we’re spending in terms ofdirect and indirect costs on the war. It’s obviously a huge problem. It’s alsoa problem — the new democratic majority has come back into power — havingdiscovered its own inner fiscal rectitude again — and wants to put outbalanced budgets.
So, that constraint up against thevery large expenditures on the war plus the tax cuts and leftover effect of theweaker 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 ofthe war in the Iraq is what we’re talking about in the entirety of the budgetof the National Institutes of Health.
So, these things can be done. It’sgoing to take will. It’s going to take serious — part — many in Congress tolook for offsets now, because they do want — they state that they want toadhere to pay/go rules. So, we’ll see what happens.
But obviously where there is a willthere is a way. And I think it’s pretty clear, if you look at the polls thatResearch America has undertaken as well as others — that the American publicis for biomedical research. Because it understands intuitively that there willbe an enormous payoff for it in the long run.
DAVID GERGEN: Thatis a good segue to the Director of the NIH, Dr. Elias Zerhouni, many of youhave known him, saw him here in previous conferences. He was confirmed as NIHDirector in 2002. IN that first year — I think that was your first year — a2003 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: Clearlyit’s been a challenge because I think we have to really think about the centuryand we can’t really under emphasize the importance of the conversation you’releading here today.
If you look at our societalchallenges, if you look at the cost of health care for example and how it’sevolving — if you look at the cost of programs like Medicare, by 2013 — thisis what I call one of these budgetary explosive devices — by 2013 something isgoing to happen. The Medicare receipts are going to be lower than the Medicareoutlays. And 2018 Social Security is going to do the same thing.
At the same time, I think thiscentury is going to be science driven, much more than any other century. It isabsolutely essential that we understand that many of the solutions are notgoing to come from reorganizations of our concepts of the world, or globalconcepts.
It’s going to come from our abilityto understand the natural world to affect outcomes in health, in theenvironment and energy. At the core of this is going to be advances in the lifesciences, life sciences understood in the new phase where we are today — andthat is that it has to be a combination, interdisciplinary combination betweenphysical quantitative sciences and biological sciences in ways we’ve nevercombined them together before.
So, we have to have a sensehistorically of where we are in science. I think the 20th Century has beenextremely important for life sciences. We’ve sort of discovered the pieces andthe elements of the complex biological systems that we will have to deal withif we’re going to overcome global health issues or overcome chronic diseasesand I would say that the 20th Century was our discovery of the hardware oflife: genes, proteins, and so on.
The 21st Century is going to beunderstanding the software of life. How is all this organized. And there is noclear solution to doing this except sustaining a wide range of approaches inresearch, in life sciences. In fact, if we don’t that means that we willpractice medicine 25 years from now the way we practice it today.
This will be an utter failure. Thereis 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 thiscentury. Not just for the next five years, but for this century.
And I think at the core of that isgoing to be this continued focus on the essential. And that is knowledgegeneration. We do not have the knowledge today we need to affect the cancerrates that John Seffrin was talking about.
So, from my standpoint, I think theconversation should really focus on not just return investment, not justeconomic impact, but on the strategic implications of not sustaining the raceto knowledge that this century is going to be characterized by.
DAVID GERGEN: Thevision that you have is essentially a 21st Century in which mankind will be ina race for knowledge and there are great strategic implications if the UnitedStates is not running as fast as it can. Is that what you’re essentiallyarguing?
ELIAS ZERHOUNI: Ithink I’m very worried about it. Because if you look at the 2013 — I’m usingthe BED — an unexpected budgetary explosive device [Laughter] and that is areal deadline. I mean it’s going to happen.
So, at some point, unless we’regoing to really pass all the bills to our great grandchildren at some pointwe’re going to have to find solutions to that. There’s no escaping thatreality.
And I think that today we do nothave enough of these — enough knowledge to really impact that outcome in thebest way possible and that is through understanding at the deepest level ourability to affect outcomes in health, in environmental issues, whether it be –or energy generation for example through bio fuels. I think the research on thehuman genome is going to have an impact.
Now globally I think you areabsolutely correct, David. If you look at publications worldwide, I think theshare of the US publication market, if you will, is decreasing relative to theothers.
I just came back from Europe. Therewas an interesting meeting. I would like to report that, because there was apresentation by a commissioner from the European Union that decided to spend 57billion dollars over the next five years on research and creating researchinfrastructure. They have created a structure that is almost a copy of the NIHthere.
And we’re making a presentationabout how important it was to emulate the American system of research. And theydescribe 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 tryingto emulate our successful formulas that have been — and they are trying to putthe investment in there. So, there is going to be in this century I think agreater sense of race towards the goal that I think will determine in greatways the welfare of nations. And I think we can’t afford to be second best.
DAVID GERGEN: Togo back to something Susan DENTZER suggested, clearly it’s one way of measuringhow 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 forgood investment versus are they leveling off. As more discoveries come on lineis 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 thatnot the case.
ELIAS ZERHOUNI: Well,it’s absolutely the case. There’s no doubt that if you look at the NIH researchover the past ten years — I just showed that at a hearing yesterday — between2004 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 andunderstand the fundamental mechanism. And then that will translate intosynergies between industry, bio tech companies, pharma companies, universities– so the scope and range of research that we are observing and the demand forthat we are witnessing is much wider than what it was ten years ago, simplybecause you’re going from understanding simple hardware to understandingcomplex software of how all these molecules are interacting. That revolution isas big and important as the information revolution at the end of the 20thCentury.
DAVID GERGEN: Dr.Gerberding, as you know, runs the Center for Disease Control in Atlanta, andshe has been a very strong advocate for more research funding, as well asdealing, as she and I have dealt with together, with questions of homelandsecurity. Dr. Gerberding was first Director of the Agency for Toxic Substancesand Disease Registry and CDC Director since 2002. So the two of you cameessentially the same time. And as you know, Dr. Gerberding was previously atUCSF. So, from your perspective on these questions and if you could get us alittle bit above the tree line, a bigger picture, Julie
JULIEGERBERDING: Thank you when we look at the world at CDC we see a world that hassome pretty big problems and in our view bigger problems than we probably inour scope of vision up until the beginning of this century. We were talkingabout problems like climate change, the extreme poverty that still is pervasivein many parts of our very globalized world now and the impact that has on ushere in the United States and elsewhere and also the big problem of ideologicalconflict and what that really mean in terms of our ability to actualize thepromises that our research brings to some people in a world that’s increasinglyunpredictable and potentially characterized by terrorism threats, by emerginginfectious diseases that the confluence of these problems create.
And certainly the national disastersand social disruption — that all of this macro change is creating for a largerand larger portion of our population globally.
So, that the above 40 thousand footview here, the Google earth view is a future that’s very uncertain, butcertainly a future characterized some macro challenges to health and economicsand security of an increasing proportion of the world’s population.
CDC has a stake in that as do mycolleagues at the podium here today, but I think we’re also recognizing thatthis is happening in an environment where people have enormously highexpectations, high expectations of what science can do for them. Highexpectations of how government agencies will perform flawlessly and really highexpectations about the time line for research to actualize its potential forchange to occur, for results to be evident to Dr. Mom at the family levelwherever she lives.
And then I think the last piece ofthat is that — like Dr. Zerhouni said, at least as government agencies, wewere having to respond to these big problems and these high expectations andenvironment where we’re under intense competition for resources and thatcompetition is going to get tougher and tougher in the United States as ourdiscretionary resources come under greater and greater demands from competingpriorities.
So, this is an environment that isvery challenging and very exciting in a lot of ways and one in which the driveto science and knowledge management has to be a national imperative. But Ithink also we have to perhaps rethink the relationship between Dr. Mom and thatscience in ways that allow us to bring science to the customer.
Ultimately, if we really want peopleto prioritize what we’re doing we have to be sure that it means something tothem personally. They’re going to take more money out of their pocketbooks andput it into science — it better be science that they can appreciate andrealize has a practical value and really addresses the household that Dr. Momand Dr. Dad care about every day across our country.
I think that the trend nationallytoward consumer driven acts is one that probably has to move to consumer drivenscience in a way that I think opens some new possibilities and new partnershipsand alliances and potentially more power for us to be able to do the kinds ofthings we’d like to.
DAVID GERGEN: Bothyou and Dr. Zerhouni talked about the need for the country to invest in otherforms of science regarding — and knowledge regarding climate and regardingenergy and health. You singled those out.
How do we think about the balanceamong the spending investment on energy, environment and health. Should one beprivileged above the others and why? I mean this is a health care researchgroup, what is in the nation’s interest in terms of how one tries to balancethose questions?
JULIE GERBERDING:I’ll start because climate change is an issue that CDC is increasinglyrecognizing as a platform for us to really build a whole set of environmentalsciences and environmental programs. I don’t think you can exclude one of thosethree domains.
They are highly interrelated. Wecan’t be successful in one without addressing the other and I think the scienceportfolio has to be balanced.
Obviously I’m a health scienceadvocate, but I know that you can’t win if you don’t really fundamentally makethe appropriate investments in all three areas.
DAVID GERGEN: Ifany panel members wish to comment on any issue that’s arisen, please feelwelcome to do that. But let’s turn to the third director that’s on this paneltoday and that’s Carolyn Clancy. Dr. Clancy is the director of the Agency forHealth Care Research and Quality and she has been in that position since 2002. Allof you now are real veterans.
I must tell you from the country’sstandpoint it’s going to be helpful to have someone stay in these jobs for morethan a turnstile kind of operation. So, we welcome the fact that each of youhas been that.
Dr. Clancy was previously a generalinternist and has done work in health services in the university setting. Wewelcome you here. Your perspective on these questions?
CAROLYN CLANCY: Well,just to build on what my colleagues said — first let me say what a privilegeit is to work with them. I don’t get a chance to hear them often enough and itis a reminder of what terrific people they are.
In terms of the nation’s interest, Ithink what we saw in the 20th Century was this unprecedented extension oflongevity, which is really incredible. But what we haven’t kept up withnecessarily is the disability that accomplishes that longevity, particularlyfor women.
And I think that in building on Dr.Zerhouni’s comments about the expansion of knowledge and the strategicopportunities that we have in this century, we have to keep our eyes squarelyfocused on the application and the distribution of that knowledge in equitable fashion.
And what I mean by that is it hasbeen estimated that it takes on average about 17 years to turn funded researchto the benefit of patient care. So, earlier today, across the hall in thisbuilding, we were celebrating, I’ll use that word cautiously, improvements inthe quality of care in America’s hospitals.
And what that means that patientswho are admitted with a heart attack now have about a 90 percent chance ofgetting evidence based care and that’s really a terrific thing and it hasn’talways been 90 percent.
But that’s a long long way and quitea bit of time since the evidence came out of the National Institutes of Healthclinical trials. So, I think in addition to thinking about strategic advancesin the life sciences, we also have to be thinking about strategic linkagesbetween the generation of that science and its application in the health caredelivery system.
What that means is that as newbreakthroughs are tested in clinical trials and then applied in health carethere’s a really important opportunity to think about the health care deliverysystem as a platform for discovery or an extension of the laboratory if youwill. And it’s also because of advances in health information technology, andso forth, I think it will also be a chance to make sure that everyone who canbenefit actually receives the benefit of these new interventions. And I thinkthat is truly a global challenge.
DAVID GERGEN: JulieGerberding raised a question of the consumer. For most Americans they think alot 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 nowthat are trying to get out from under the growing costs.
There’s a growing movement among anynumber of corporations who would like to turn this all over to the government. There’sa lot of converts to single payer I’ve noticed in recent years, people who someyears ago thought it was such an idea [unintelligible] in the Soviet Union nowseem a little more interested than they once were.
How does this fit together — theresearch agenda fit together with the need to reform a health care deliverysystem which many believe is in meltdown?
CAROLYN CLANCY: Well,I would start this and ask my colleagues to jump in. First I would say thehealth 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 outof NIH. We don’t have good information for consumers and their clinicians totry to figure out which is the best intervention for them that meets theirneeds, preferences and so forth. And that I think is a huge challenge.
So, I think the success of bringingthe fruits of science to the customer or the consumer, as Julie said, actuallydepend on our making critical improvements in the health care system itself. Andthat health care — making those improvements, investing in and building thescience of quality improvement, actually also is going to have big payoffs interms of what Dr. Zerhouni referred to as the BED, the budget explosivesdevice.
I think lots of policy makers arefocused on what this is going to mean for public programs and I know that everygovernor, you know, lies awake at night worrying about the Medicaid budget. So,I think these things all fit together.
DAVID GERGEN: Doyou 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 biggestpayer of health care no matter how you cut it, which is why there has been ahuge focus on trying to figure out how can we improve the delivery of evidencethat we have right now so that we can get better value for what we’re spending.
DAVID GERGEN: You said something reallyinteresting that I had never heard before and that is that the delivery systemin the country is so flawed that it will be unable to bring the benefits of newdiscoveries coming out of NIH to patients. Could you explore that just a littlemore, that’s a quite stunning statement.
CAROLYN CLANCY: Dr.Von Eschenbach, when he was running the National Cancer Institute used to saythat he had a goal of making cancer a chronic illness by 2015 which I — thatwas a goal that many people got very excited about.
But he also said that if we don’tcouple that and link it with improvements in how health care is provided, werenot going to have a system that will be able to handle that. So, again, todaywe’re celebrating that the nation’s hospitals got it right 90 percent of thetime for heart attack care. But what we’re measuring is fairly straightforwardcare. And I don’t mean to minimize the efforts of those who are at the bedsideand in the front lines providing care. Hospitals can be pretty chaoticfragmented places these days, they’re under a lot of stress.
But nonetheless if you can imaginethat we’re now going to be seeing more individualized treatments I think thatups the ante in terms of the kind of infrastructure that we need to make surethat 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: Tomake the obvious point, one of the scientific findings of the last few years isthat all Americans have genes. And all — and we increasingly understand thatgenes are — changes in genes are at the core of all diseases.
So, everything that happens that welabel a disease is at root a change in a gene. It’s either a hereditary changeor mutation or it’s something that goes on instead of environmental exposure.
So, if all Americans have genes andall diseases are diseases of genes, then why don’t all Americans have healthcare for starters. [Laughter] To speak about the broadest essential reform thatmust be enacted in order to realize the fruits of this broadly and equitablyacross the whole population — as Carolyn says — delivery system — theinsurance system is not set up to deliver maximally the benefits of the geneticrevolution to all individuals.
So that is clearly a critical partof the reforms that must be had going forward if we want to live, in my view,in a just society.
DAVID GERGEN: Iwant to turn to the representative from private industry before I turn ouresteemed colleague from the State Department. Christopher Viehbacher who is thePresident of U.S. pharmaceutical for GlaxoSmithKline and has been in thatposition since 2003. All you people started in 2003. I don’t know quite whathappened.
But we welcome you, sir. And you’vebeen involved in all sorts of efforts, a lot beyond your company to work withother companies in this field. So, tell us the perspective now from the privatesector — why don’t you guys go out and invest all the money. Why do we have tokeep squeezing money out of the government. [Laughter]
CHRIS VIEHBACHER:I’d like to respond to actually respond to something you said in yourintroduction, first. Because I’m a Canadian and German citizen and spent overfour years outside the U.S.
DAVID GERGEN: Youhave two passports?
CHRIS VIEHBACHER:I do.
DAVID GERGEN: Youdon’t have a US passport?
CHRIS VIEHBACHER:I have a green card, working on the third one. [Laughter]
DAVID GERGEN: Isthat called a trifecta?
CHRIS VIEHBACHER:[Laughter] But it does give the perspective of different health care systemsaround the world. It also gives me the perspective of an American. You talkedabout the soft diplomacy.
And I’d just like to say that mostcountries have a much different level of expectation from the US than othercountries and those expectations are much higher. And I would also tell youthat I would bet you in the countries widely, certainly Canada, France andGermany, that more people could tell you who the CDC, the FDA and the NIH arethan the same institutions in their own countries.
These are institutions which haveglobal remits[?], not just American remits. And if you talk about doingsomething positive to meet the expectations of others — and those expectationsare very hard to achieve. And I think through research, through the Center forDisease Control, through the FDA the US can have a very positive impactglobally.
It is also true to say what Dr.Zerhouni said, others are trying to catch up. When I was in Europe Irepresented France in a high level working group operated by two European commissioners,which had the objective of trying to restore Europe’s competitiveness inresearch. That followed a study that had been done that showed that 80 percentof the referenced patents which this group had used as a surrogate forgroundbreaking science were filed in the US.
And I was part of a group thatrecommended changes in New York to try to achieve that. One of which wasactually to create a European version of the NIH. It’s actually interesting tohear that they are following through on it.
I can tell you certainly that as acompany that operates on a global basis — there’s something like three or fourtimes as many PhD’s now starting to be graduating from China as from the UnitedStates. India is certainly trying to catch up in the bio pharmaceutical sphere.
So, there is a race. It doesn’tnecessarily have to be a threat. It should be an encouragement. Because I thinkif everybody starts to invest, all of mankind will do better. But the US has clearlybeen a leader here and I think it’s worrying to someone who’s only spent fouryears in the US to see these institutions like the NIH and CDC not getting thefunding that they deserve.
As for our part of private industry,we are continuing to invest. Those costs continue to rise. It’s anywhere from800 to a billion dollars to develop a new drug. I can tell you certainly in thearea of clots that cause stroke and heart attacks we are now looking at no onecompany that is going to be able to bring a product through to market.
As we look at some of the newagents, like Factor 10A’s, those development costs are exceeding a billiondollars, just to get into phase three, the final phase of development, abillion six in some cases. And that’s getting to be a huge expense.
But the other thing I would say isthat the spending wise do is not a replacement for the NIH. One of things Ithink really gives the US so much competitive advantage is the public privatepartnership.
The cancer does studies that thisindustry could never do. It is the groundbreaking science that really discovershow diseases are created that we then act upon.
So, it’s not if the NIH reduces itsfunding that the pharmaceutical industry or any other private sector can stepin. The NIH fulfills and extremely important part of science that all of us cantake and turn it into an implied technology and then ultimately into amedicine.
And then, of course, everybody’sstruggling 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. Ifwe could — we could talk more about health and less about health care and doresearch into prevention — you know, so much of our disease costs now goes tochronic diseases. Seventy-five percent of our health care costs are chronicdiseases many of which are preventable.
Seventy-five percent of cancerpreventable. Type 2 Diabetes which is a true pandemic hitting our country, withover a million new cases diagnosed every year, could be prevented with diet andexercise.
I think what Carol talked about interms of better quality, in terms of managing those chronic diseases — we havecities like Ashville in my home state of North Carolina — it is shown that youcan reduce those costs.
And finally innovation is soimportant. You look at the Alzheimer’s disease — how much money that will costunless we can come up with some new [Inaudible] which would dramatically reduceour costs. And then we can start to reinvest in the CDC and the NIH.
DAVID GERGEN: There’sas story out there that says if you exercise more, it helps your brain. Is thattrue?
CHRIS VIEHBACHER:If you exercise more, it’s going to do a lot for you. It’s going to help yourbrain, 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: Outof GlaxoSmithKline you do that internationally, it’s a collaborative effortthat goes across borders. Is that not right? Almost all of the research youwould do, I would think, would be shared research across many borders. How doesthat work with the NIH. How much of your research is collaborativeinternational — in fact, funds may come in from other government sources andthat sort of thing.
CHRIS VIEHBACHER:It’s actually increasingly collaborative because the scope of problems that wedeal with, for example — Susan was making the point that genes and theinteraction of genes with the environment was probably driving a lot ofpathologies that we see.
Swell, to study that you have tohave a different environment, different gene pool, and so on, so that we’reincreasingly collaborating. Obviously we’ve always collaborated on globalhealth.
But just to give you an idea, NIH’sfunding of collaborative endeavors between US universities and scientistsaround the world has quadrupled in the past six years.
DAVID GERGEN: Howdoes the Congress respond to that. If you take American funds and fund Chinesescience.
CHRIS VIEHBACHER:I think the Congress by and large has really understood the importance of doingthat when you’re dealing with infrastructure to prevent SARS — and by the wayI’d like to recognize CDC’s terrific leadership in protecting the country fromSARS.
If you explain to them theimportance of tracking pandemic food, having collaborations in 85 countries,with laboratories that are equipped and connected and networked with ourscientists here in the US — if you also make the point that we have a choiceand we can in source today, out source tomorrow.
It is important to have connectionswith laboratories around the world, because this is exactly where I think thesynergy that we need in science occurs. So, by and large, I found the USCongress under spending — the need for us to do that.
Also, I think it relates to what yousaid and that is that this aspect of America is probably the most admired partof our world relationship and we do have the high ground on the issue of healthdiplomacy, science diplomacy.
So, I’m a strong advocate of it andI think it’s been a great boon for our science to be able to benefit from theserelationships over time. Congress understands that so far.
FEMALE: SinceCongress made its first ever non-categorical investment and global disease detectionwhich has allowed us to really build a network of laboratories andinfrastructure around the world that is serving as a great platform for privateindustry and philanthropic organizations like the Gates to come in and buildtheir own research enterprises.
So, that single investment which wasgroundbreaking for Congress has leveraged a huge amount of internationalscience, including that with the NIH and the Fogarty — but also in the privatesector.
DAVID GERGEN: Howmuch do you worry that the more you fund international science that Americacorporations will take their jobs — R&D operations and put them over inthose other countries and take the jobs out of here?
MALE: I wouldjust say from our point of view science will always follow the people andthat’s one of the main reasons for investing in research is we create the humancapital that will keep us here. And that’s the main driver, where the peopleare.
DAVID GERGEN: Butwhat if there are a lot more scientists in China that we agree funding throughour research — is that a double edged sword?
FEMALE: I seejust the opposite. I think it’s a real advantage to us. I think that it’sscience diplomacy in a sense, but you build relationships one person at a timeor one project at a time. And that in and of itself can feed forward into avery different level of understanding and opportunity. But we have to be ableto think globally scientifically in the same way we think globally a lot ofother health issues.
MALE: There’snot a finite amount of science.
JULIE GERBERDING:Science is not a pie. If somebody gets a big piece it doesn’t mean somebodygets a smaller piece.
DAVID GERGEN: Butif there’s a growing piece of R&D that is done India and China, isn’t therea 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: Onlyif 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 Germanybecause that were discriminatory and frankly abhorrent, but that was probablythe 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 fromother countries and then worked here.
I think if you look at sciencewhat’s really key is not just the mass of scientists but that very thin layerof superbly creative scientists who really make a difference and make thebreakthroughs because they are in an environment that networks with otherscientists.
You know, I’m not born in the UnitedStates. I’m born in Algeria. And I had the opportunity to basically immigrateto Europe or immigrate here and I preferred here. And let me tell you I thinkyou’re better off having me on your side than on the other side.
DAVID GERGEN: Weagree wholeheartedly but there is this issue now that the [unintelligible] ofthe next generation who come here to study and get a doctorate are going homeat an increasing rate. And we’re losing some of there people. We’re not giving themthe 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 alldepends on what we do and what we — how we react to those realities. That’s why your conversation and thedebate you’re organizing is strategic in nature and that’s the intent of mycomments. IS we can’t sleep on this.
DAVID GERGEN: CraigBarrett of Intel argues that every time we give out a PHD in science ortechnology we ought to staple to it a green card. Just make that part of thepackage.
Dr. Martin Mackay, Vice Presidentfor Pfizer Global Research and Development and the Senior Vice President forWorldwide Development, please join in.
MARTIN MACKAY: I’lljust mention a couple things about this topic and then try to tie some of thepieces together. The great thing about the United States — people still wantto come here and we find funding folks in China in Europe in great laboratoriesthat want to end up coming here.
A much bigger worry for me is thenumber of American children that want to become scientists. Maybe that’sanother topic that we could take up. We have four children all remarkably welladjusted considering their father —
MARTIN MACKAY: Notone of them nor any of their friends want to become scientists. So, that’sanother topic.
I fully reinforce what Christophersaid. It’s different for even a Scotsman to plead poverty with a budget sevenbillion dollars as we have that Pfizer and although we try to do that with ourboard — we have magnificent resources — what we lack though is enough knowledgeto do the work.
I’ll give a great example, and Susanmentioned this, about oncology. We launched a terrific compound last yearcalled Suten [Phonetic]. It’s a vascular endothelial growth factor. Essentialtumors need blood vessels to grow. This prevents the growth of those bloodvessels, hence you get tumor shrinkage. Absolutely marvelous compound.
And some people we miraculousrecoveries. Now in a lot of people we see excellent remission. It doesn’t workin everybody and it’s essentially because we don’t have the basic knowledge toknow which patients it’s going to work in.
That’s why partnerships with the NIHare just absolutely essential. An initiative we did last year, the geneticassociation information network is a perfect example of harvesting theinformation to our drugs are going to be working in much more of thepopulation. They’re excellent compounds.
The other piece I’d mention in termsof the CDC part, again, where I think we’re going to have to develop morepartnerships. We’re about to launch an anti-HIV compound called Maravarok[Phonetic]. It’s a CCR5 antagonist. It’s the first anti-HIV compound thatrather than attacking the virus prevents the virus getting into the cells inthe body. So, actually works on the human receptor.
Terrific piece of science from thebasic genetics that were done by basic scientists. This definitely has a placein the developing world. So, we have to — we can cure poverty at Pfizer, butwe should be working in closer partnership to be able to make that medicineavailable to many more people in the world.
DAVID GERGEN: Let’sbring in Dr. Freda Lewis Hall who joined Bristol Myers Squib in 2003. She isthe senior Vice President of US Pharmaceutical Medical Affairs for BristolMyers Squib. Your perspective.
FREDA LEWIS-HALL:Thank you. One of the good things about being close to last you can basicallyjust say what they said is right.
FREDA LEWIS-HALL:But, you know, we’ve been talking about the competitive advantage, but I reallythink 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 reallywhere the win is.
So, between companies who have alegacy of competition who are now cooperating to bring important medicines tothe forefront, public and private, across the globe — so with that geographicI guess preventions against pulling resources together — you started with agood news/bad news. And I actually was thinking here as I was making my notesabout a bad news/good news scenario.
So, [Inaudible] years ago when Istarted medicine —
FREDA LEWIS-HALL:Thirty years ago when I started in medicine as a freshman after — at the endof my first year at medical school, I watch my mother die of a stroke. We didnot have the data or the information that was available around her risk factorswhich 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 andrelatives and patients die from an unnamed disease which we soon named andturned into a chronic illness. So, if I think about what 30 years ago looked likein the back wards of St. Elizabeth’s hospital where I could not fathom thestrength of people who may never know their names again and certainly wouldn’trecognize the value of their lives — and think about what those three groupsof people have access to today, I’m in awe of what our research has actuallywon us in 30 years. And, so, if all ofthose things that happened 30 years ago are the bad news, then the good news isall that we’ve been able to bring to bear in our partnerships, with ourinnovation, with clever people from around the world working to solve these hugeproblems.
My mamma used to say never put onlyin front of [unintelligible] the money. And I’ve added where able hands towork. And, so, if we really think about what we’re trying to get done here, we stillhave medical needs. We still have translational issues, how to get from thebench to the bedside and to allow everyone to have access to our discoveries.
We still have timing issues. I waslooking at a PhRMA report from 2004, we’re still fighting leprosy. And whilewe’re looking back to fight unmet needs, some things are catching up with us.
Bacteria and viruses seem to be outsmartingus by the day. And we ought to have a sense of urgency about catching up andkeeping up with them. And there are still illnesses that, yes, we’ve madepeople — we’ve allowed people to live longer in some cases, but in some caseswe’ve only allowed them to take longer to die.
So, you know, I think there’s stillsome very real urgency to the work that we do. And at the end of the day if Ithink about where those solutions are, it’s across this table, around the roomin terms of the toil [unintelligible] in getting a sense of urgency. Certainlythe money and I’m sure we’ll have a way to empty pockets as folks leave theroom. And we’ve talked about the fact that there are able hands all around theworld.
DAVID GERGEN: Isthere attention in your mind, from your perspective in life, between your –you work in a private corporation that does great research. And at the sametime you must be deeply concerned about the inequality of access and theinability of many citizens to afford some of the breakthrough drugs that arecoming out and the problems that are faced around the world with HIV/AIDS, forexample.
How in your mind should we reconcilethe profit needs for corporations that are doing research in drugs versus theissue 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 surethat there’s necessarily a trade off in that. First of all I think access formany is certainly financial, but I’ve spent much of my career looking at theother kinds of inequities and disparities that exist in the access to or thedelivery of health care that has little if anything to do with money.
It has to do with picking the rightphysician who understands and applies the guidelines and understands evidencebased medicine. It has to do with whether or not you’re a woman and theresearch was done in a way that is directly applicable to you, so you reallyknow 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 anindividual. So, I absolutely agree with the need to deal with the financialaccess issue, but I still don’t think that the war is won until we deal withthe entire spectrum. And, in fact, deal with some of the other ways in whichthey disenfranchised people from care. If we started to deal with those thatsome of the financial issues would become a lesser burden.
DAVID GERGEN: JohnPorter told us earlier that the Democratic Party tends to be more sympathetictowards research. It is also less sympathetic to large corporate profits andthe pharmaceutical industry.
FREDA LEWIS-HALL:[picks up mid-sentence] — characterize it that way. [LAUGHTER] You know I haveone of the best jobs in house I think, because I’m allowed to use some of thewonderful resources both human and financial to apply to solving these issues. AndI don’t take those resources for granted having worked at Howard University,St. Elizabeth’s and DC General Hospital and understanding what disparity lookslike up close and very personal.
I think it’s incredible to have theresource 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, butfrom where I sit, I think it’s really important for us to apply — to be ableto apply the billion dollars that it takes to get a drug from a great idea intothe treatment environment.
DAVID GERGEN: Let’sturn 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 handI 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 theCenter for Global Health and Infectious Diseases at the University. Tell us alittle bit about the program and your perspective of working in Haiti.
FATHER STREIT: I’mhappy 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, becauseI trained for a long time first to become a priest and then for my PhD.
And now I’m working in a settingwhere there’s so much need and there’s so much reward and every little thing Ido [unintelligible] as it can be day in and day out bears quite a bit of fruit.
I know we mentioned three ways inwhich I see this. Obviously there’s sort of public health science that we do. We’redoing operational research and a program that delivers benefits that will belasting in perpetuity into the future in that we’re working to eliminate thedisease lymphatic filariasis or elephantiasis as it’s more commonly known.
At the same time we’re reducing theburden due to intestinal ailments and because we’re adding the drug forfilariasis to the salt supply we’re also among the first to address iodinedeficiency in Haiti.
Well, these are problems which inthis country were address 100 years ago, iodine deficiency and lymphaticfilariasis disappeared from the US a hundred years ago.
So, it’s exciting in the sense — tohave the opportunity to make that historic contribution. It’s probably a littlebit easier in terms of the science because we all know — many of us at thetable and some in the room — know that basic research doesn’t always bearfruit when you’re just adapting or tweaking approaches that have already beenused 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 sortsof obstacles and third world corruption, the brain drain, et cetera.
Which brings me to my second realpleasure 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 ornegative on funding for research here over the last decade or so.
As so many of us know here, thecontributions of philanthropy of Gates and Buffet and so many others, as wellas corporate philanthropy — all three of the drug companies represented here– providing drugs free of charge or at low cost in third world settings — allthis has so much changed the perspective — the old 90 – 10 rule of only tenpercent of research dollars going towards problems of the third world — Ithink 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 — isagain whether it’s driven by the sorts of new philanthropy both corporate andprivate into the third world health problems — or whether it’s driven as Ifind among our young people a sort of despair about the future.
You know the worry that terrorismrepresents — I find our students just pounding our doors down, those of usworking in the global health wanting to go and work in the field, whether it’smedical students or undergraduates or grad students, numbers like we’ve neverseen before.
DAVID GERGEN: Thisinterest in global public health that is really capturing the youngergeneration which I happen to think can be real allies in this larger struggleto insure the investment — we take science [unintelligible] seriously in the21st 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 fundingpicture has picked up — things have — we’ve never been busier with the kindof things we can do.
And then I also — I really do thinkit’s kind of the — a way to express our national idealism and a way to expressour technical savvy in a way in which the Peace Corps obviously was set up todo but may not have been quite so technically oriented.
I’ll speak even for my owninstitution, the Catholic Church. One of the groups I had the most trouble within Haiti are the nuns.
DAVID GERGEN: Theytell me the priests are the real problem.
FATHER STREIT: Ithink one of the things that they don’t appreciate so much is the importance ofpublic health science, of applying science, of doing the prevention. They sayto me you’ve got four doctors working on this project, they should be in theclinic.
And we all know that prevention ismuch better than clinical care, in terms of the benefit per dollar invested, soI have to tell the sisters when they say Jesus didn’t — Jesus didn’t do publichealth.
FATHER STREIT: Hespent his time healing directly, but they claim he didn’t do public health. Well,I argue with that.
DAVID GERGEN: Doyou argue with that, Julie?
JULIEGERBERDING: I definitely argue with it, but I couldn’t agree with you more withthe absolute ground swell in the interest of young people in careers in globalpublic health and public health more generically.
And I think one of the missedopportunities right now in terms of conversation about investment has to dowith the training and the career development of people who already have thepassion. But we don’t have the means or the mechanism to get these traineesout.
CDC has a miniscule amount of moneyfor that kind of research training for T grants and K awards and so forth. Andthe number of letters of intent that we’re receiving for these very limitedopportunities is absolutely skyrocketing. There’s now way we can meet thedemand.
I’m going to try to find out how tospend Dr. Zerhouni’s money [LAUGHTER] because I need to get these peopletrained. But I go back and take care of patients at San Francisco General everyyear.
And the students and the residentsthere are now allowed a special in global health where they come from –whether they’re pediatrics or OB or medicine, whatever field — surgery — theycome together, they have a special track of training in global health andthey’re just dying for the resources to support their field placements andtheir opportunities to do field research.
So, it’s a very exciting environmentwhere we don’t have a problem with the work force, but we do have a problemwith the support and the ability to mentor them in the field and bring themaround in their careers.
ELIAS ZERHOUNI: Iwould like to suggest to Julie to talk to Roger Glass. He’s right in theaudience. He’s the Director of the Fogarty International Center. That’s whereall the money is, Julie.
ELIAS ZERHOUNI: TheFogarty Center is one of the 27 centers and institutes of the NIH.
JULIEGERBERDING: As you know, Dr. Zerhouni, Roger still wears his CDC hat as welland we have talked.
DAVID GERGEN: Wehave 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 havethe smallest grants on the NIH campus, but for 100 thousand dollars we can getcampuses to come together, medical schools, schools of public health, businessschools, law schools, schools of journalism and undergraduate curricula, to tryto get curricula together so that these students who have been mentioned have apathway to get involved — and I think this idealism — and the American idealof helping others. So, these are fabulous grants.
We also have a granting program formedical students — Twenty-five medical students between their third and fourthyear to go overseas. It’s applied to — it takes ten applications for onethat’s filled. We have almost 200 applications for 25 slots.
We could filled this many times overand we don’t yet have a program at the fellowship resident or junior facultylevel — that would allow residents to go overseas. And this something that we’dreally like to boost.
So, I think that developing the nextgeneration of people involved in global health is key and I think the CDC’sefforts and our efforts at NIH are all going in that direction.
DAVID GERGEN: Ournext panel member is Dr. Atkinson. He is a science and technology adviser tothe Secretary of State. Dr. Atkinson holds 66 US and foreign patents. He knowswhereof he speaks. So, we’ve been looking forward to your thoughts, yourreflections.
GEORGE ATKINSON:Well, I come to the podium with some degree of nervousness having been referredto several times by David in some degree of actually being able to providesolutions today.
Approaching the last few days of myposition, I’d like to introduce a new definition of candor today.
DAVID GERGEN: Oh, good, let us get our pens.
GEORGE ATKINSON:And I’d also point out during those six years, I’ve maintained my tenured academicposition at a university. The only way to give advice in Washington on scienceis to have another job.
GEORGE ATKINSON:But I would like to make a few observations. I think the issue of scientificresearch has always been global. We know the sources of intellectual successesand pursuits have always been intellectual from the intellectual communityglobally. It has been very difficult to find any area of research and biochemistry, health, physics and so forth that hasn’t built on the successes andfailures of scientists around the world.
So, we shouldn’t be surprised. And togive you a data point or two, in major journals of physics, the physicalreview, physical review letters — twenty years ago the United Statescontributed more than 75 percent of all the articles. Today it’s less than 30percent.
More than 53 percent of all thestudents in science and engineering programs in United States graduate schoolsare from outside the country. That’s the face of the American system if youwill.
So, we shouldn’t be surprised norshould I in my opinion be depressed by this. This is a reflection of severaldecades of success in the American system. Many of these students who have gonehome, who reside in other countries have been educated in the United States. That’snot necessarily bad.
My students think the US has led thescientific and technology parade for 2000 years. We know and it was referred toearlier that in the mid 20th Century the United States took leadership out ofcatastrophic events. So, you should be mindful of that. It happened arelatively short time ago. And I wouldsuggest that the future is absolutely a collaborative model. Whatever the modelwill be, it will be collaborative.
Why did the US get to be so good atthis race. We got out in front very quickly. I think we might think of severalitems — I’ll select three. First we made a long term consistent commitment toeducation, particularly with research run universities, where research really blossoms.
Consistent may mean the first fouror five decades. I think the discussion today has said that might be open fordebate again. Are we making consistent long term commitments in that arena.
We also secondly had an environmentwhich was extremely welcoming to the international community. The place to comewas the US. Many examples in this room reflect that type of welcomingenvironment. That is open for debate apparently today. And, finally, there wasa private sector community well represented at this table that turned thesescientific advances done in darkrooms, no lights, no windows by scientistsdevoted to subjects of excellence. And they did a great job, but we turned theminto global economies and global benefit.
I think at the Department of Statewe find the consequences of four or five decades coming into the arena of howwe use this enormous talent and advantage. And we have a lot to learn yet. Wemake great progress, but we have a lot to learn.
We haven’t learned yet how the USshould define itself in terms of being a champion for science, not just being aleader of science, but a champion for using the value of these events for thebenefit of a global community. And that is perhaps a controversial thing tosay.
I did learn also in Washington thatthe appropriate — in these remarks to always quote famous dead people so atthe end I’ll try to turn that remark into a famous dead person’s quote.
GEORGE ATKINSON:At state it is particularly challenging. There are so many very talented devotedpeople who are committed to addressing the great issues of our times in theforeign policy arena, but very few have science backgrounds. So, it’s like nothaving the right language training, if you will.
Nobody comes to my office and wantsto talk to me about quantum computing or gene research. They come to talk aboutthe most recent crisis on their computer or the one that came across on thecable.
And in that environment it isextremely difficult to be anticipatory of the nature of this conversationtoday. Do we need to do it, I would say absolutely. And in fact, part of ourchallenge in the 21st Century is if we’re going to learn how to do it.
I think others will learn how to doit. They come with different criteria to start with, different startingconditions. 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. Therewere a lot fewer older people.
The aging population presents atremendous burden on society in the social context. What do you do with 800million people in India who live on less than $200 a day [SIC]. That’s a realnumber. Those are the numbers that I think in fact, the scientific communitywithin foreign policy.
And lastly, I would point to thefact that scientists have a big role to play in this conversation. Very fewscientists were ever trained to get involved in politics. Look what happened tome. I’m still hoping to go home some time soon.
The fact of the matter is scientistsneed to come to places like the Department of State and be heavily involved ona day to day basis. I’ve participated in wonderful panels in Washington andgave great advice along with my colleagues. Went home thinking somebody wasgoing to do something with that great advice. Very rarely was it utilized.
So, within the halls of a place likethe Department of State more scientists have to show up on a daily basis. Ithink those are admonitions that are worth considering in this context.
The final point I would leave youwith is that point about a quote. In 1939 Berthold Brecht wrote a play calledThe Life of Galileo. I suspect many people have not read the play. But it hasGalileo say something quite interesting that’s useful for policy makers.
Policy makers always seemed in myopinion to want a yes or no answer. What Berthold Brecht had Galileo say wasthe role of science is not to provide perfect infinite wisdom. It’s to put alimit on infinite error. And that’s really what we find in many cases ourdilemma 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, Iwould just use that as perhaps a contribution to the conversation.
DAVID GERGEN: Wewere told that more than half the people in our universities studying science,technology, engineering at the graduate level are from other lands. What is theState Department doing to open up and raise the number of visas that areavailable to those people instead of having them reduced as they have been inrecent years.
GEORGE ATKINSON:Well, as you know there’s a wide range of opinion about what the goal shouldbe. The question might be asked in reverse, is 53 percent the right ratio. Isit — should it be a different ratio.
DAVID GERGEN: Itmight be very desirable to have a ratio of 70 percent Americans but that’s a longterm 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 theseyears — people like myself who have worked very hard to try to liberalize theinterpretation of the visa policy — so there are many people who would like todo this —
DAVID GERGEN: Isit 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 balancedpolicy which reflects the needs of the country. And right now the needs of thecountry are to have large numbers of foreign nations participate in theprogram.
However, there are other parts ofthe administration who would see this quite differently. The security of theUnited States remains one of the most primary responsibilities of thegovernment and there are many who see this as an important way of securing thecountry from other outside influences, nefarious ones.
Now, Iwould be the last one in this room to say this is an easy way to balance it. Icertainly personally believe we should liberalize the policy for including manymany 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 iteasy, absolutely not. It is very difficult these days for people to get visasto come.
And if you put in your resumebiology, physics, chemistry, y you will get a special treatment in the visaprocess. I’m afraid that’s not a very good answer.
DAVID GERGEN: Dothe corporate representatives here we have as many visas as we should or do youthink the numbers ought to go up?
CHRIS VIEHBACHER:I’ll speak to it having gone through the process and I can attest to the factthat it isn’t easy and it is dissuasive. And I think that’s at a cost to theUnited States.
MARTIN MACKAY: Iwould agree with that. I go back to my point, I think we need to do more withAmerican children and bring them into science. And not in the health care, thescientists.
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 Icertainly watched it and worked with the system to do so. But you might ask adifferent question of the State Department. How many of the people apply in oursciences, engineers and technologies in those percentages.
DAVID GERGEN: Butyou’re talking about the numbers who come here to study.
DAVID GERGEN: Whatabout the numbers who come here to work.
QUESTION:[Holbrook] That’s a different story.
DAVID GERGEN: Isn’tthat 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 improvedenormously from what it was, say three years ago. Three years ago — muchdifferent situation.
DAVID GERGEN: Righton the study, but the number of B1 visas is down — that’s allowed in here fromwhat it was. And yet the needs have gone up. That’s what is persuading somecompanies to invest more overseas.
GEORGE ATKINSON:Again, the science is going to go follow the people and if there aren’t enoughpeople here then companies will go find them elsewhere. So, that’s why I thinkit is at a cost to the US that we can’t bring those folks in the numbers thatwe need.
SUSAN DENTZER: Butto go back to Martin’s point about developing more young scientists, I thinkthis also gets us back to the issue of the NIH budget. I mean it is, as Iunderstand it now virtually impossible for many young investigators to evendream of getting initial awards to fund their research.
And this is a horrible pipelineproblem. If you want to send a signal to people how not to have careers in scienceyou tell them that there’s really no way that they’re ever going to be able totransition from their doctoral program into a fellowship or into a researchprogram of any sort and that is the signal that we’re sending now.
DAVID GERGEN: Thankyou for raising that, Susan. Dr. Zerhouni could you respond to that?
ELIAS ZERHOUNI: Ithink it’s clear that when you look at the demographics of the scientific workforce in the 50’s and 60’s, we really had an influx of science and technologygraduates. And if you look at that over — different departments of thegovernment and the private sector — you realize that there is [Inaudible] sortof collision here because at the same time you have decreased funding, you haveessentially still the cohort of scientists — still in activity — will retirein ten years time.
And yet at the same time, you havesort of a strangulation of the beginning of the pipeline. So that what we’retrying to do at NIH is really to mitigate that. About 1500 new investigatorsget their major grants a year. Last year we dropped to 1400, changed policy sothat we mitigate this.
Why? Because the pump essentially ofscience is primed essentially on the basis of talent. If you lose talent in2007 and you don’t have that pipeline in 2017, it’s predicted that about 50percent of our scientists will retire and then all of a sudden you have adeficit.
And if that deficit is there, thenthe scenario that you just heard — science — and companies will go where thetalent is. So, our strategy has been to look at demographic projections, lookat forecasts. And we’ve implemented policies for example — we try to maintainthe 1500 average per year that we’ve had during the doubling. We created newprograms, Pathway to Independence Awards.
One of the other issues that peopledon’t appreciate is the aging curve. It takes longer now for a younginvestigator to really get tenured. It used to be that you get tenured at theuniversities at thirty-two, thirty three now, it’s 38.
And the same thing is true as far asNIH grants. Twenty-seven percent of our grantees were 35 years younger twoyears ago. Today, it’s more like five – six percent. So, it’s the demographiceffect but it’s also a rigidity of the system.
So, what I think is important is torealize that any successful system — and god knows we’ve been extremelysuccessful 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 younginvestigators, the young scientists is when they see their career prospects andtheir 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 thebread and butter of this country — and as I said at the beginning this is thecentury that will be drive by science. It’s the science dependent century ifyou will.
As long as we don’t say that and wedon’t mean it and we don’t practice it, I think young people are going tounderstand that Wall Street is more interesting than Science Street.
DAVID GERGEN: It’smy understanding that the percentage of investigators applying for NIH grants,who actually get the grants, has gone down sharply. Is that what you weredriving at?
FEMALE: Well, weshould go to the source.
ELIAS ZERHOUNI: Ithink you have to be careful with percentages as a matter of principle. Thepercentage went down, the number of applicants doubled. So, it went from 30 to20th Century percent, but the number of applications doubled as well.
That’s good in a sense because thedoubling of the NIH budget really generated what I though we are all in engagedin when I became [unintelligible]. Finally we got it.
What is important here is to tellthe country that we need more science, we need more research across a widerrange. Universities responded. They built over 17 billion dollars worth ofresearch laboratories. Philanthropy responded.
Everyone basically relied on thesense that NIH funding was going to be the platform on which companies will becreated and more knowledge will be generated. And that happened. And ithappened really at the end of the doubling. It takes four or five years todevelop that. So, just simple statistics.
Twenty four thousand applications in1999, 46 thousand last year, probably 49 thousand this year. And clearly theinflation costs of research increases should actually have a decrease in thesuccess rate.
It’s true. It doesn’t mean that weare doing less research as a country. But here’s the issue. The issue is thatthe impact of that is pernicious in a way. Because [a] it discourages the nextgeneration of scientists, because they see this as a much more competitiveenvironment. They are less able to compete with the established scientists whoare there.
But the second is that it tends todrive people toward conservative research, not willingness to say let me justbreak the mold here. Let me not do what everybody’s done before me. But let medo what my professor says will be funded.
So there are effects. It’s not likewe’re doing less science, we’re doing more science but we’re not doing thescience that in the long, in my view, will need to be sustained to really leadto those discoveries.
You hear about 1.2 billion dollarsin pharmaceutical companies research. Let me just posit for all of us thatperhaps the reason why it’s so hard, because our science has not progressed. Wedon’t have the bio markers. We don’t have the predictive capabilities that saythis drug won’t work. At the 50 million dollar mark, not the 1.2 billion dollarmark. So, science has to really do this.
And this is why I believe that thedemands — and this is the question you ask — are the demands of science thesame 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 youreally look at the questions that we have in the front and the time sensitiveanswers that we need — because we have these devices in front of us — meansthere is a race that needs to go on. That means also that you can’t discourageyoung investigators. Because if you do you’ll pay the price [unintelligible].
DAVID GERGEN: Isthe 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 betwo percent of an increase or one percent. Are we going to be able to hold ourown against the rate of inflation. The conversation we’ve been having the lastcouple of years — is the real issue to get back on a doubling pace, a pacethat doubles every X number of years. Is that the real challenge.
ELIAS ZERHOUNI: Mysense is we need to go back to the people. A country is only as rich and assmart as its people are able to work together, to create new ideas and createinnovation.
Innovation is the key. Innovation isa culture and to me innovation means that all of us decision makers — everyonein the society America is great, that’s why I love my career here and I lovethis country. Because we have what I call the culture of the why not.
Most people come to you and you sayI have an idea. Most responders will say, why not. In Europe and the old worldI think it’s the culture of the why and we don’t want to lose that. Well, you can only say why not somany times to bright young people unless — if you don’t have the resources todo that.
And the sense that I have is thathistorically when you look — I’m very interested in these forecasts andlooking backwards — as I testified yesterday, historically NIH, CDC everyknowledge organization seems to do well in terms of quality versus innovation. Whenabout 30 percent of the attempts that you make — you get a why not instead ofa why. You get a yes instead of a no.
And if you start going below thattoo much for too long then you have smart people who really are smart and willgo to private equity or other kinds of activities that [Inaudible]. So, myview, to sustain innovation you need to sustain the ability to say why notthree times out of ten.
FREDA LEWIS-HALL:We’ve talked a lot about college age children and young investigators butearlier in the pipeline — you know, in the K through 12 — I was alwaysfascinated, I’d go into the kindergarten classes and everybody wanted to be youknow something. And I’d go into the 5th grade classes and nobodywanted do to be anything.
FREDA LEWIS-HALL:It was very interesting, how did you go from want to be something to not havingany idea as to what you wanted to be.
One of the things that’s beeninteresting about biomedical research is I’m not sure that young people, Kthrough 12, get their arms around this in the easiest way. Nor does societyunderstand in a way that they can facilitate it. I have three children none ofwhom were interested in the sciences at all. And they decided that at earlyages.
And I am who my family raised me tobe and I always harken back to the fact that my mother’s mother wanted me to beteacher. She remained disappointed for many years that I had decided to be adoctor. Because to her being a teacher was the most important thing. And itwasn’t until I literally took her into the medical school classroom where I wasteaching and I was at the chalk board that she kind of got happy.
FREDA LEWIS-HALL:I’m giving that sample to say I think that we don’t apply ourselves in the Kthrough 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 arethings that we are doing, but we could apply ourselves, I think, a little bitmore to those early grades to get the interest up, the understanding, theawareness and some enthusiasm, so that we have people to hop all these hurdlesthat we’re talking about.
JULIE GERBERDING:One of the most important resources for science inspiration is NASA because ofthe way their finance model works and the way they are required to invest in Kthrough 12 education, the space camps and a lot of other environments. And weought to be really looking at how to expand that capability into a broaderdimension of science because it’s enormously successful but they can’t do italone.
QUESTION: [SteveBurrill] Just to follow on a comment that Dr. Zerhouni made. The federalgovernment through the NIH is spending about 30 billion dollars a year onresearch. The pharmaceutical is spending about 40 billion dollars a year, thebio tech industry about ten. So, the private sector is spending about 50billion dollars a year in the US.
And increasingly the research that’sfunded by the private sector is not getting reimbursed. If you look at thepharmaceutical industry — we’ve wiped out the profitability of thepharmaceutical industry, we’re about to wipe out the profitability of the biotech industries so we have a very different crisis emerging in that we havetremendous desire for innovation funded both privately and publicly and, yet,there’s no return for that investment.
And, so, the challenge to managinghealth care costs and trying to manage — a decreasing desire to have healthcare costs against return on investment is providing a real challenge to thesystem.
DAVID GERGEN: Howmuch is it increasing the investment?
QUESTION:[Steve] Well, the investment would dry up in a hurry if there’s no return, so Ihappen to make my living a venture capitalist. And if there is no return forthe investment there’s going to be no investment. And, so, the pharmaceuticalindustry and the bio tech industry will see reduced investment as return[SPEAKING OVER EACH OTHER] —
DAVID GERGEN: Privatecompanies are making 25 – 35 percent a year.
DAVID GERGEN: Someare.
QUESTION:[Steve] We’d love that be true.
DAVID GERGEN: Whatis a reasonable rate of return.
QUESTION:[Steve] Most [unintelligible] are making ten to twenty percent.
DAVID GERGEN: Sofor a pharmaceutical company investing in drug research, they ought to make tento twenty percent on it a year?
QUESTION:[Steve] No the pharmaceutical industry is actually almost a non-profit industryright now. You take the aggregate profitability of the pharmaceutical industryit’s going absolutely down like that. So, the new crisis that is emerging isthis need to find a way to incentivize — to continue to get the investmentthat we did or else we’re going to end up with increased federal funding forthat, because the private sector funding will dry up.
MARTIN MACKAY: It’sa pretty simple equation for us. We reinvest 15 percent back into research andas Christopher said, the attrition rate that we face — and some compounds arecosting a billion dollars — it’s the 19 out 20 that fail in development thatreally kill us and why we need more investment to get in.
So, while I mention two terrificcompounds that are successful: [unintelligible – names of compounds] we lost acompound a few months ago called [unintelligible], which we absolutely believedwould have revolutionized the way that heart disease is treated in the world. Andwe lost it in phase three. It was already over a billion invested.
It will still take us another two orthree years to work through it, because we have a scientific curiosity now. Butfor us it’s that simple equation. The more that we can bring in, the more thatwe invest in research.
SUSAN DENTZER: Theold pharmaceutical development model is fine that you can sell to 50 millionpeople for many years. And what we’re talking about is a whole new era of personalizedmedicine. 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 thatscientific investment from NIH to tell you who it works on, as you saidearlier. Increasingly all of your research effort in the future is going to belooking at pockets of drugs that work on small groups of people. That’s a wholedifferent economic model that you all have not figured out how to crack yet.
So, to get back to the point abouthow we’re all in this together — I mean the government as well as everybodyelse has to think through how this — your industry transitions to a neweconomic model and does seize the investment in science at the federal leveland becomes a profitable industry going forward. Because right now it’s a realproblem.
MARTIN MACKAY: We’restill looking for medicines to treat broad population and very successfully. I agreewith 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 biggestdriving forces that affect health issues in the 21st Century and that ispopulation aging. And as Sir [unintelligible] from [unintelligible] agingresearch eloquently puts it on the 1st of January, 2011, sixthousand [unintelligible] will reach the age of 65 and that’s going to continueevery day for the next 18 years.
In the UK we almost have areciprocal relationship between the amounts of money that is spent on thescience of aging and on these demographics and I’d value some views from thepanel on how they see the science of aging as a priority the health of oldpeople in the next 100 years.
MARTIN MACKAY: Iwould add one point. We see this as a huge issue and we’ve put more fundinginto our research dollars in to aging, so when osteoporosis, frailty, neurodegeneration, in general, specifically Alzheimer’s disease — so it’s certainlya major issue and a major source of our investment.
CAROLYN CLANCY: Iwould just add that we have a huge opportunity and — to make sure that whenpeople do turn 65 that they are a lot healthier than they are today.
Because as Dr. Zerhouni wasmentioning the BED if what’s facing Medicare as we look at the baby boomersaging, some of that explosiveness is related to the fact that we have hugemissed opportunities for prevention across the spectrum.
I mean 50 percent is often what wesee when we actually measure the delivery of fairly straightforwardintervention, screening and so forth that we know can help us detect diseaseearly or hopefully actually prevent it all together.
So, the good news is while we’reimproving heart attack care even though it’s not perfect, we’re actually notdoing nearly as well as we could. We’re doing a terrible job in preventingpeople from having heart disease to begin with.
DAVID GERGEN: What’sthe 50 percent number?
CAROLYN CLANCY: Fiftypercent 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 everyyear to the Congress on quality of care and it’s about that ball park, in termsof getting people with diabetes the right care, getting people to do coolrectal cancer screening and so forth, notwithstanding Katie Couric and otherswho’ve made fairly heroic —
DAVID GERGEN: Fiftypercent 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 validscientifically proven interventions to the people who would benefit, which meansthat when they get to be 65, they’re in worse shape which means that we’re notanticipating the need to prevent disability and so forth due to chronicillness.
FEMALE: Seventypercent 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 andinnovation are opposed in public policy and that is what happened in Europe,actually, that’s why Europe actually declined in terms of its researchcompetitiveness.
It doesn’t actually have to be thatway. Because we could actually manage those chronic diseases better and to givea very clear example, type two diabetes. If you can keep someone’s HPA1C toseven percent or lower, you won’t see a progression of that disease.
We could avoid the 225 amputationsevery day in America because of complication from Type 2 Diabetes. And, yet,even in our employee population, 25 thousand employees in the US, two thousandsuffer from Type 2 Diabetes, only a quarter of those have their HPA1C checkedtwice a year as we should do. Otherwisepeople are just asking patients how they’re doing and if nobody’s complainingthey’re not getting any different therapy.
Those things can dramatically reducecost. The City of Ashville did this. You can bring the cost of a Type 2Diabetes patient from around 12 thousands down to six thousands which is theaverage we spend on health care per person. If you do that and concentrate onthe prevention and the quality you can fire up the amount of money that wespend 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 toprice controls and everything else are going to kill off the innovation, butthey won’t actually bring the health care costs under. And we need to have different recipes to make sure we still canafford 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 onthe question of how global aging is affecting international policy. So, a new initiativehas started at the state. I’d be happy to give that information to you.
DAVID GERGEN: Youwere doing that as the number of people over 65 exceeds the number of peopleunder the age of five.
GEORGE ATKINSON:That’s one of many reasons.
DAVID GERGEN: That’sthe marker we got to work with.
GEORGE ATKINSON:That is one marker. There are quite a few that community brought forward interms of what the international component is. Especially going toward a worldpopulation of nine billion or ten. The very highest percentage of the agingpopulation will be in developing countries, not in developed countries.
The Chinese for example have been leaders indeveloping new directions in terms of aging policy for public investment offunding, something we’d like to more about and we’re engaging them in that. I’dbe happy to get [unintelligible].
QUESTION:[Michael Halperin] My name is Michael Halperin, with the Scientific IntegrityProgram at the Union of Concerned scientists. First of all, Dr. Atkinson,thanks for recognizing both the need for a scientist to participate fully infederal agencies and the sensitivity regarding scientists ability to giveadvice here in Washington. And Dr. Gerberding thank you for your willingness tosupport the scientists in your agency.
My concern is with the ability ofthese scientists who dedicate their lives to federal service to be able toparticipate fully in the scientific process. With the new Congress you’ve seena growing interest in investigating a great concern from the scientificcommunity over the past several years which is political interference inscience and the inability of federal researchers to present their workregardless of administration or Congressional policies.
So, my question is would each of yousupport media policies that allow taxpayer funded research to emerge,scientists presenting at conferences, being able to present their researchthrough 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 frameson this that I feel very strongly about. One of them is that we must have anintersection of science and policy and I love what you said earlier that we’llhave better policy if we have better science in forming it.
And there are a lot of ways to bringscience to the table of policy makers. But there’s also a mythology that if youhave good science you’re automatically going to have a good policy becausethere are a whole lot of other things that influence policy including publicopinion and voters and constituencies and advocates and stakeholders and a lotof people who are in this room.
So, you know we believe that thestarting point is good science, but what ends up coming out at the other end ofthe sausage factory is the product of many different kinds of inputs. Buthaving said that it’s also important that the science is at the tables whenthose decisions are being reached and that’s something that we believe very stronglyin I think at CDC and certainly NIH and other agencies that are in theDepartment of Health and Human Services.
DAVID GERGEN: ShouldWhite House staffers be editing reports from the Environmental ProtectionAgency before they’re made public, reports by scientists.
GEORGE ATKINSON:I would say in great candor that what Dr. Gerberding said was exactly right. Thecrucible of debate has always been the basis on which scientists narrow thatarea of the degree of uncertainty.
There’s nothing more interestingthan getting up as a young professor in front of 200 physicists and talkingabout your research, because you know that all 200 are smarter than you are.
So the crucible of the debate hasgot to part of the foreign policy or the domestic policy agenda. But the pointis extremely well made, just because you have great science doesn’t mean you’regoing to have great policy. And I think if you learn when you come toWashington you learn that.
DAVID GERGEN: Youinitiated the Jefferson Science Fellows Program in 2003. Thomas Jeffersonargued that the — at the heart of the republic was an informed public and thatthat is what gave — that’s what built strong foreign policy.
If the public is not being toldstraight hard truths about where — what we find ourselves in an issue likeglobal climate change, if science is employed by the government or beingmuzzled 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 hewas concerned about democratic principles, informing the public and notnecessarily the issues of physics and chemistry.
Today, I would agree completely thatthe public has to be well-informed and to some degree that public has to be interestedenough to become well-informed. And I’m concerned that the blood public isn’tso interested in physics and chemistry. Anybody who gets on an airplane andsits next to somebody and you then tell them you are a physicist, they won’ttalk to you.
QUESTION: [RayWoosley, 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 Iwould ask is there not an elephant missing in this room or maybe I should callit a filter.
How can — and actually I thinkthree years ago today Mark McClellan was in this building announcing theCritical Path Initiative and calling attention to the fact that thepharmaceutical R&D had gone up 50 percent, the NIH budget had doubled. Wesequenced the human genome. Butthe number of new products coming to the FDA had fallen about 50 percent.
So, how can we get that kind ofscience — the way we did with AIDS. How can we get the science at the tablewith a regulatory agency that doesn’t want to be a filter but has beenfiltering us. And, yes, we want safe drugs, but we have to have drugs, we haveto treatments, we have to have those products with all its science or it’s alla waste.
CHRIS VIEHBACHER:I think the issue here is that you’re really facing the complexity of biologythat has evolved over billions of years. And when I said we really need tounderstand not just the hardware of biology or the software — that’s reallywhat it is.
The frontier right now is that we dounderstand the structure of molecules one at a time. We really don’t have thewiring of all the components. It is probably the issue there. I mean, yes, you hadmolecular entities before, because you had simple causes of disease.
There’s a sense that what we needright now is more fundamental knowledge about the behavior of biologicalsystems, toxicology. So, we’ve met with industry. I worked with Mark when hewas 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 notenough to report in a laboratory that gee whiz A1C [unintelligible]complications in diabetes — you need to really understand molecular pathwaysby which that is expressed.
The same thing is true in heartdisease. We’ve made progress in heart disease but frankly we don’t understandthe fundamental cause of heart disease. So, we need to understand that better.
Predictive toxicology is an areawhere still as you’ve heard from my colleague at Pfizer, 1.2 million dollarslater with some of the brightest scientists in the world and you still get itwrong.
That’s an area of research thatneeds to be improved and predictability needs to be improved. In addition tothat, I think that the connection between what FDA does and what science youneed to develop to have increased predictability really requires you to come upwith new bio markers. Bio markers in the wide of the world — word — that isany biological measurements that have predictive value or diagnostic value orprognostic value.
Those things are fundamentalbarriers, they’re not easy. Anybody who thinks out there that their solutionsin the laboratories and they just need to be pulled out and applied is naïve atbest.
We know ten percent of what we needto know in biological systems. That is the challenge of the century and we needto continue to do that. Otherwise it won’t cost you two and three and fourmillion dollars to get to the next round, because we have a need for morescience at the bottom line.
MALE: Verybriefly, I agree completely. You are absolutely right. But it’s — I know for afact there have been bio markers available for over a decade to predict drugresponse 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 dataon which to make those recommendations. So I would just simply say can some ofthe science be brought to the FDA so they can understand these new productswhen they’re brought to them.
CHRIS VIEHBACHER:We are working with industry. We created a partnership with Pfizer and othercompanies through the foundation for NIH to create the gene associationinformation network. We created another [unintelligible] for biomarkers.
What is really key here is tounderstand that the scientific data that is needed buy companies, by ourresearchers is too protective. There’s too much of it that is not publiclyaccessible. I think we need to define what I would call a free competitiveworld where that information can be shared much more freely than it is today. AndI think science would advance through that.
QUESTION: I’dlike to come back to this issue that was raised during the day, and that is thecollaborative effort, collaborative need in education, globally andparticularly the between the academy and industry.
With regard to the educationalissue, I come back to Dr. Atkinson’s point bemoaning the lot of the physicistand yet biology is simply the most elegant expression of chemistry, physics andmathematics.
And we’ve done very little tofundamentally change the educational process. But I think more importantly and perhapswhere we are in our greatest danger right now is while we both acknowledge theessential roles that the academy and industry have played in bringing us tothis state of not only elegant therapeutics, but new diagnostics, which afterall biomarkers are, we are really in danger of losing that capacity more andmore as the social debate revolves more around industry productivity and theirprofit and potentially conflicts in industry rather than the true nature ofcollaborative activity it has to occur not only for the scientific model interms of the human organism now being the major experimental model. But also inthe economic model.
And I would come back to Susan’spoint 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 diagnosticfor 100 percent of the people.
And as we begin to look at thosekinds 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 whatare the solutions for making a more viable relationship between the academy andindustry, both of which I think are going to be absolutely essential in movingthis dialogue forward.
MARTIN MACKAY: Iabsolutely agree with you. And again we’ve recognized that from being a — atleast I can speak of Pfizer from being a rather insular group of scientistswhere 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 inmore — I think instead of a lot of runoff collaborations that we do — havemuch more meaningful joint collaborations with institutes and companies andthen I think companies working together. And we’ve got many good examples nowwhere 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’retypically 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 externalcollaborations.
QUESTION: [MarkResnick, University of Illinois] I just got back from an NIH study section alittle while ago. And one of the problems that I see — I actually think 80percent of the science I see is worth doing or has something in it — 80percent of the science is worth doing.
Eight percent is going to getfunded. If there’s a hiccup in a room then something is being pushed into anunfundable region. Innovation is considered by people in study sections to betechnical gee whiz and not important science or fundamentally different ideas.
How are we going to fix this. Howare we going to get to the point to real innovation. And in fact, in industrytrying to get money for something I’m doing on biomarkers — I’m told you gotto talk to the clinical folks, because this isn’t something the pre-clinicalfolks do.
Scientists start as liberal and getinto a room and get very conservative [Inaudible]
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 knowthis notion of peer review, always having this problem too conservative hasbeen around 25 years.
My philosophically has always beenthe following: Look we can argue about it forever but we’re scientists so whydon’t we do pilots, why don’t we do defining experiments. So, we did. Wecreated a pioneer award program just as a pilot, five pages of application andinterviewed with a panel of very distinguished scientists.
And lo and behold it does work. Imean 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 ofapproaches to science. You can’t just say it’s going to be all high risk or alllow risk. It’s really a portfolio of things and you have to rely on the wisdomof scientists.
So, again, peer review is the worstsystem until you try the others.
DAVID GERGEN: [picksup mid-sentence] — scientific studies and people especially working in healthcare who have brought enormous advances that all of us here today benefit from.
But it is also apparent that this isa community that faces very difficult challenges in the years ahead to matchthe promise of science with a kind of investment efforts that are needed torealize that promise.
We’re deeply indebted to all ofthose here and Research America who are making such an effort. And I know thatthere are so many allies of those on the panel. Let us thank the panel thatcame here today.
JOHN PORTER: Thelast word, David is to thank you for the magnificent job you’ve done in guidingthis panel and bringing out real thoughts about how we can address some of theproblems that face our system.
DAVID GERGEN: Thankyou one and all.