Sunday, January 23, 2011

Encouraging news from the National Institutes of Health. Could this be the beginning of a new focus on cures?

The New York Times reports this morning that Dr. Francis Collins, director of the National Institutes of Health, is planning on creating a new National Center for Advancing Translational Sciences, aimed, as the Times' Gardiner Harris explains, at creating "a billion-dollar government drug development center to help create medicines."  The key phrase here is "translational."  That is, the conversion, or translation, of scientific insights into actual cures--the kind that a patient can actually receive from a doctor or hospital.  

For too long, the rap on the NIH has been that it funds "curiosity studies," in the mordant phrase of Lou Weisbach, co-founder of the American Center for Cures, a Chicago-based advocacy group.   In the past, Weisbach has estimated that the translational research at the NIH has amounted to no more than $40 million--that's out of a $30 billion budget.    It's that "lost in non-translation" problem that explains why NIH funding can double, as it has in the past decade, and yet the results can be so disappointing.

But all that could be changing, thanks to Dr. Collins.  And with that change comes perhaps the realization that if the goal, in these tough fiscal times, is to reduce spending, deficits, and debt, well, there are two ways to do that.  The first way is to chop.  (An approach not without its downsides.)  And  the second way is to solve the problem.    If we were ever to cure cancer, for instance, the government wouldn't spend much on cancer, and neither would the rest of us.

Out of that change could come a larger change: A shift at the NIH to a more DARPA-like mission of actually determining what needs to get done and then doing it, e.g. deciding, a half-century ago, that the nation needs a survivable communications network, and then funding the research for a decade. That research, of course, gave us the freely available Internet--a perfect example of public support for a project that was eventually turned over to the private sector and became one of the greatest boons to humanity ever.   If the NIH could play a DARPA-like mission, strategizing on translational medical research, we could see effective mobilization for cures, with an Internet-like impact.

So it will be interesting, of course, to see how the political community reacts to this news.  Will politicians oppose it for one reason or another? Applaud it?  The best of them, of course, will seek to up the ante.  If a billion dollars is good, ten billion is better.

And of course, the government itself doesn't have to spend this money--the needed capital is sitting, in stagnant pools, one might say, waiting to be activated for a good purpose.  Indeed, the legendary medical philanthropist Mary Lasker once referred to money as "frozen ideas."  Those ideas can be used for good or ill, but it's hard to think of a better good than medical research that alleviates suffering for all humanity.   So by all means, let's unfreeze money from around the planet to work on a planetary objective.

Of course, such mobilization would require much more than NIH activism: It would require a rethinking of our whole system.   These charts here show that the once-robust pipeline of new drugs has petered out, and research money from the big Pharma companies has peaked out, as this graphic in the Times this morning illustrates:

What's needed is much more--more of everything, as Samuel Gompers might have said.  For example, we not only need more capital going into the medical sector, we also need better regulation of the medical sector.   We could start with reforming the FDA; it doesn't make sense for the Food and Drug Administration to be dually mandated to focus on salmonella in spinach and at the same time, the safety and effectiveness of a cancer drug. The two skill sets are simply much different, and the regulators should be the best at both, with a clear understanding of the differences between monitoring food safety and facilitating safe new cures. And if that means separating the "F" from the "D," so be it. Once upon a time, the federal Departments of Labor and Commerce were the same agency, and that evidently didn't make a lot of sense, either.

And of course, we might add that it's crazy to tolerate litigation as a horrendous burden on the cure sector.  It's not just the cost of litigation, in malpractice and settlements; as Jim Wootton, a longtime litigation expert in DC observes, the real cost of the trial lawyers is gumming up the work of research, by stifling the free flow of data across silos.    If the American people understood that the likes of John Edwards were imposing a low ceiling on the cure horizon, they would demand political action to open up more space for an ambitious effort.  Which, of course, would in turn bring in new capital to the medical sector.

And so out of all those necessary changes could come the largest change of all: The idea that paying for health care is not as smart, or compassionate, as paying for a health cure.   Care for the afflicted is always right and necessary, but cure is always better.

1 comment:

  1. It is certainly true that the government has its priorities wrong in this area as it does in so many others, but you seem to be accepting a common premise between the two positions which is that the government's job is to provide for our medical wellbeing in the first place. Why not be fully consistent can just say that the government should stay out of both individual medical care decisions as well as medical research decisions? It is just as ill-informed and wrongly motivated in both cases and likely to be just as wasteful and dangerous either way.

    That of course leaves aside the fact that from a purely legal point of view the federal government has no authority to provide for our medical care or medical research and that from a purely moral point of view it has no business taking our money for either one either.