Challenge and opportunity

How academic medical centers can help reverse disturbing trends

Jeff Balser, M.D., Ph.D.
Dean, Vanderbilt University School of Medicine
Associate Vice Chancellor for Health Affairs
Published: January, 2009

“In the middle of every difficulty lies opportunity.” Albert Einstein

Jeff Balser, M.D., Ph.D.
Photograph by Joe Howell
The nation’s biomedical research community is indisputably experiencing challenging times. The budget of the National Institutes of Health (NIH), the primary source of biomedical research dollars, has not increased for several years; when adjusted for inflation, NIH funding has actually declined by 13 percent over the last five years. This, combined with a decline in U.S. students choosing academic research careers ultimately may have a negative impact on worldwide health and could lead to the erosion of biomedical science as a fundamental pillar of the U.S. economy.

In short, we are sowing the seeds of attrition in a magnificent edifice: our nation’s biomedical research enterprise.

This issue of Lens magazine examines this unprecedented challenge to our future, and explores ways that we -- the research community at Vanderbilt Medical Center with our colleagues throughout the country – can advocate responsibly and effectively for progress.

Why is Vanderbilt raising its voice?

We are among the fortunate academic medical centers that are seamlessly connected to a leading research university, and we have leveraged that overall strength and connectivity to invest in programs that will greatly accelerate the realization of individualized and cost-effective drug discovery, diagnostic testing, and healthcare delivery. It is therefore our responsibility to clearly articulate why expanding biomedical research – even at a time of economic adversity – will allow us to leap forward and dramatically improve both our economy and the treatment and prevention of human disease, while reducing the cost of health care for our nation.

Here’s why. The science funded by NIH has a far broader economic impact than in the long-term improvements in health care and quality of life; broader even than the direct effect of dollars invested across our campuses. Every $1.00 of NIH money spent results in about $2.30 in economic output (increased goods and services) in the local and state-wide economy, according to a June 2008 report by Families USA. In fiscal year 2008, for example, Vanderbilt Medical Center received over $420 million in funds from outside agencies, the majority from the NIH and other government sources. This resulted in over $1 billion of new business activity that created and supported more than 7,000 jobs at wages that greatly exceed that national average.

For the next fiscal year (2009), the national research community is calling for a budget increase of 6.7 percent for NIH, which would keep pace with inflation plus provide an additional 3 percent to begin to make up for recent years in which funding has fallen relative to inflation. Such an increase ($1.4 billion) would translate into approximately $60 million in business activity gains in Tennessee alone, and over 200 new jobs with more than $20 million in wages.

Nationwide, we would see approximately $3 billion in new business activity and over 9,000 additional jobs with $1.1 billion in new wages, according to the Families USA report. This is a minimum economic return of three-to-one even if NO health care benefits resulted from our investment in biomedical science!

But of course the health benefit of biomedical research also can yield an impressive return on investment.

In 2006, University of Chicago economists Kevin Murphy, Ph.D., and Robert Topel, Ph.D., estimated that increases in life expectancy between 1970 and 2000 “added about $3.2 trillion per year to national wealth, with half of these gains due to progress against heart disease alone.” While it is difficult to determine exactly how much of this progress can be attributed to medical research, it is well accepted that the dramatic drop in heart disease mortality in recent decades is due to improved understanding of the role of cholesterol, and resultant changes in diet, interventional procedures and new pharmaceuticals.

Currently there are more than 500 potential drugs for complex diseases in clinical trials in the United States, yet only about 50 percent of the patients enrolled in these trials will experience a positive result, and fewer than 20 new drugs make it to the marketplace every year.

Why is the success rate so low? One reason is that genetic variation has a huge impact on our individual responses to medications. Because of this variability, pharmaceutical trials must be conducted in very large patient populations, at considerable cost (approximately $1 billion per drug), and over a long period of time (it can take a decade to complete some studies). As a result, few novel therapeutic agents make it through the pharmaceutical pipeline. If one could define, in advance, which individuals or populations would be most likely to benefit from a specific therapy, smaller studies at substantially less cost would be required, and the constricted pipeline of new drugs would literally burst open.

Vanderbilt Medical Center is investing heavily in personalized medicine -- that is, identifying and characterizing the molecular diversity among individuals through test results, tissue samples, and an electronic database of health and genetic information. Our “DNA databank” now contains over 60,000 samples, and is among the fastest growing DNA repositories worldwide. Thanks to large-scale, global investments in biomedical informatics over the past decade, information gleaned from samples can be stripped of identifying information to protect patient privacy. This work is laying the foundation for the identification of biomarkers that will dramatically improve the output of new diagnostics and drugs, and at a fraction of the cost.

Vanderbilt also recognizes that in order to maintain and grow a vibrant research enterprise, we need a renewable talent pool entering our institution to innovate and solve big questions about health and disease. Yet the national statistics are disturbing: U.S. students continue to lag behind their peers in other countries in science achievement scores, college completion rates are low, and fewer choose academic research as a career.

It becomes our challenge and opportunity as an institution of higher education to help reverse those trends by supporting programs that provide enhanced, accelerated and engaging science curricula to students in high school and even earlier. Several of these programs are described in this issue.

These are but a small fraction of the many novel initiatives that we and our colleagues in biomedical science across the nation and around the world are undertaking to advance human health. We must commit ourselves to making the case, clear and strong, for increasing our nation’s investment in biomedical research. Together we can turn these uniquely challenging times into ones of great opportunity – for our academic medical centers, our local communities, and for the nation and global community we are privileged to serve.

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