Health­care ROI

Med­i­cal re­search, com­par­a­tive-ef­fec­tive­ness stud­ies de­serve in­vest­ment

Modern Healthcare - - OPINIONS | EDITORIALS - DAVID MAY As­sis­tant Man­ag­ing Ed­i­tor/Features

As the count­down to the launch of painful fed­eral bud­get cuts nears the zero hour, it would be fool­ish to ex­pect new al­lo­ca­tions of government fund­ing for any­thing, in­clud­ing med­i­cal re­search. But then who needs the feds when we have the deep pock­ets of Google and Face­book—specif­i­cally two founders of those techno giants. Last week brought the an­nounce­ment of the first win­ners of the Break­through Prize in Life Sciences, which will award $3 mil­lion each to 11 sci­en­tists, “rec­og­niz­ing ex­cel­lence in re­search aimed at cur­ing in­tractable dis­eases and ex­tend­ing hu­man life.” Face­book founder Mark Zucker­berg and Google co-founder Sergey Brin are help­ing to bankroll the ef­fort (For more, see p. 36).

Given what the fed­eral “se­ques­tra­tion” pro­jec­tions por­tend for med­i­cal re­search ex­pen­di­tures and the vi­tal work that the money sup­ports—bar­ring in­ter­ven­tion from Congress—that rel­a­tively pal­try $33 mil­lion might sud­denly look a lot larger to the sci­en­tific com­mu­nity.

The au­to­matic bud­get cuts set to take ef­fect March 1 would slash some $85 bil­lion from over­all fed­eral dis­cre­tionary spend­ing for 2013 alone and more than $1 tril­lion over the next 10 years. While health­care en­ti­tle­ments are es­sen­tially pro­tected, ev­ery­thing else is in harm’s way. In health­care, that in­cludes the Na­tional In­sti­tutes of Health, the Cen­ters for Disease Con­trol and Preven­tion and other HHS agen­cies.

Pres­i­dent Barack Obama last week de­cried what he called a “meat cleaver” ap­proach to ad­dress­ing our na­tional debt and bud­get deficits. But Mr. Pres­i­dent, we haven’t seen much ag­gres­sive ac­tion on your part to wres­tle that cleaver away. Mean­while, House Speaker John Boehner blamed the White House for first ad­vanc­ing the con­cept of se­ques­tra­tion and then telling Obama to clean up the mess. Of course, he ig­nored the role of Repub­li­can law­mak­ers’ in sign­ing off on the law.

Re­gard­less of how or if se­ques­tra­tion can be avoided, spend­ing re­duc- tions are coming. The dis­cus­sion has to fo­cus on what should be spared the deep­est cuts. The Pen­tagon cer­tainly can lose some of its bloat, but De­fense cuts at ex­pected lev­els, $46 bil­lion this year alone, are too deep. The same is true for other sec­tors where sus­tained in­vest­ment is im­per­a­tive. They in­clude pub­lic safety and ed­u­ca­tion. And health­care re­search.

Ac­cord­ing to Re­search Amer­ica, a not-for-profit or­ga­ni­za­tion that ad­vo­cates for med­i­cal re­search, fund­ing for the NIH has re­mained es­sen­tially flat in re­cent years, to­tal­ing $30.9 bil­lion for 2012. But in­fla­tion has sig­nif­i­cantly eroded the agency’s pur­chas­ing power, by about 3% in each of the past two years based on a mea­sure called the Bio­med­i­cal Re­search and Devel­op­ment Price In­dex. Se­ques­tra­tion is now ex­pected to re­quire 5% across-the-board spend­ing cuts, threat­en­ing the value of cut­ting-edge re­search in progress as well as fu­ture grants.

While the NIH’s work is vi­tal to univer­si­ties and re­search or­ga­ni­za­tions na­tion­wide and es­sen­tial to dis­cov­er­ies that might fi­nally end so many hor­rific dis­eases, the agency also could ben­e­fit from step­ping up over­sight of grants al­ready awarded, re­as­sur­ing tax­pay­ers about the ste­ward­ship of its lim­ited fund­ing (See com­men­tary, p. 24). Trans­parency is the name of the game in government and es­pe­cially in health­care, given the un­re­lent­ing cost spi­ral that’s suck­ing so many dol­lars out of the trea­sury. With those costs in mind, an­other area where sus­tained in­vest­ment makes sense is the realm of com­par­a­tive ef­fec­tive­ness. The goal is to find out which medicines, de­vices and treat­ments ac­tu­ally work. If such stud­ies re­sult in health­care “ra­tioning” —that is, weed­ing out in­ef­fec­tive care and the re­sult­ing waste­ful spend­ing—then let the ra­tioning be­gin.

The Agency for Health­care Re­search and Qual­ity as well as the Pa­tient­Cen­tered Out­comes Re­search In­sti­tute—man­dated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act—are charged with much of this work. They have com­par­a­tively small bud­gets that are wor­thy of in­creased in­vest­ment, es­pe­cially given the task at hand.

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