The US could lose its leadership in space, education, health and science research if changes to how those key areas are funded are not made soon, according to experts who convened in Washington, DC, for a Research!America forum.
Elsevier Education President John Danaher, MD (pictured above) was one of more than a dozen panelists at the National Health Research Forum, called “Straight Talk: New Thinking on Tough Challenges.”
Gathered at the Newseum, within sight of the Capitol, researchers, policymakers, educators and funders discussed the need for increasing research funding.
Participants included Commissioner of Food and Drugs Robert M. Califf, MD; the director of the Agency for Healthcare Research and Quality, Andrew B. Bindman, MD; former US Congressman Kweisi Mfume; and the global head of research of Janssen Research & Development, one of the Janssen Pharmaceutical Companies of Johnson & Johnson, William N. Hait, MD, PhD.
Presidential election years create even shorter Congressional sessions to discuss the country’s budgets, and assuring that critical research funding is included and budgets will be approved at this time of transition seems to be a tall order this fall. Research!America, one of Elsevier’s partners, has called on Congress to resist “flat-funding” for research through a continuing resolution.
Twenty-five years ago, when Danaher was a White House Fellow working with Dr. Louis W. Sullivan at the Department of Health and Human Services, they were asking these same questions, Danaher recalled: “How can we make the national health agenda less reactive, more proactive and insure that it wasn’t affected by the political process and funding was robust? It was a very political time.”
Back then, it was less about prioritizing funding for disease research initiatives and more about assuring that the country’s research agenda was understood by the American people and how could we demonstrate those metrics for success.
“The Affordable Care Act has changed the financing of our health care system," Dr. Danaher said. “The ACA will have an impact on basic research, clinical research and health services research. Its central tenet is patient engagement, patient involvement which will help us engage the American public in their pursuit of wellness.
“At that time it was about HIV and not having the framework to think it through and gain consensus. How much do we fund breast cancer or AIDS research, how much do you put in a rainy day fund for Zika or other unforeseen crises?
“There is a need for the government to do cost effectiveness analysis, but we don’t have a structure to do it, which is why we run into these problems,” he explained. “In the absence of these decision-making frameworks, it becomes very political.”
The value of data and, more importantly, sharing data was stressed. Some speakers lamented about the level of protectiveness that researchers have about the use of their data, but all agreed that creating ways to encourage sharing is incredibly important. Dr. Danaher said:
STM education of healthcare professionals and researchers are of particular concern to Elsevier. We are studying the significant supply and demand and balance between nurses, doctors and allied health professions and what we need to provide for care. And the other is the promise of big data of unlocking and enhancing precision medicine. Google and others are doing it and those of us who have been committed to this are looking to big data to provide parallel insights for scientists and researchers.
Participants said the United States is danger of losing its leadership position in so many areas – space, education and health. They discussed emerging medical innovations such as the Cancer Moonshot and BRAIN initiatives, as well as how basic, clinical and health delivery research can help reach these breakthroughs. Questions regarding how innovation is valued by policymakers and citizens brought recommendations for a wide-ranging communications campaign.
Dr. Fauci said:
We need to pay closer attention to the stability of research funding in general. We get enthusiastic about individual initiatives; they spur ideas. But we can’t lose sight of the funding of research as a whole.
While there were disparate points of view on how to break the Congressional stalemate, ideas emerged about engaging the American public to help inform the agenda and advocate for research funding. Both Dr. Danaher and Donna Cryer, President and CEO of the Global Liver Institute, agreed on this position. “We need to meet people where they are,” said Cryer. “The onus is on us to show how research affects their lives.”
Dr. Yamamoto added:
The public must be involved and engaged. In fact they own the process and the data is theirs. To gain something from this process they need to advocate for their representatives to do the right thing.
To drive this point home Dr. Córdova told a story about being on a plane and overhearing a passenger saying that the best thing the federal government has done is fund the national parks. She captured the essence of the forum by saying that she hopes someday to hear a similar declaration that “the best thing the federal government did was fund basic science research.”
A new report from Research!America shows that federal and industry investments fluctuated over the 3-year period, likely reflecting destabilizing forces like sequestration, automatic spending cuts and the medical device excise tax. Meanwhile, foundations, voluntary health associations and professional societies increased their level of spending over the 3-year period. Despite overall growth in investments, the US currently spends less than 5 cents of each health dollar on R&D (4.93%). For the full report, click here.
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