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AAMC Reporter: April 2006
A Word from the President:
"Capturing the Promise of Research in a Bleak Fiscal Climate"
We've got good news and bad news. Good news is we're facing the most exciting prospects since the dawn of
science for advancing human health through research. Bad news is we're also facing the most dismal prospects in the history of the National Institutes of Health (NIH) for securing the investments that might enable us to realize those advances.
As a measure of our challenge, since 2003 (the end
of the doubling), annual NIH appropriations have
not even kept pace with the rate of medical inflation.
And the president's 2007 budget proposal would freeze NIH at this year's level, which is 11 percent less than the 2003 funding level in constant dollars. What's more, current prospects for the out years are similarly bleak. Controlling federal deficits in the face of Iraq, homeland security, Hurricane Katrina, mounting Medicare costs, and Social Security obligations, not to mention more tax cuts, leaves the entire domestic discretionary budget, including NIH, in an exceedingly vulnerable state.
Given this climate, what are our options? First and foremost, as never before, we've got to marshal every argument, organize every constituent, and assemble every stakeholder we can to bring reason and pressure to bear on Congress — especially the appropriators. The AAMC is doing its part. In addition to our traditional role as a driving force in the Ad Hoc Group for Medical Research, we have convened a group of academic leaders to help formulate and deliver our messages to Congress firsthand; we have beefed up our Project Medical Education to encourage more key policymakers to familiarize themselves with our missions through intensive on-site immersion in the work of academic medical centers; and we have inaugurated the Fulfilling the Promise Campaign to educate Hill staffers about the critical partnership between NIH and medical schools and teaching hospitals.
But no matter how successful these and other efforts might be in securing additional NIH funding, prudence demands that we prepare ourselves for the realistic possibility that incremental federal investments in medical research may not be forthcoming for quite some time. One response is to seek more state funds, foundation grants, private philanthropy, and proceeds from commercialized intellectual property. But, even in the
aggregate, these sources are unlikely to yield the kind
of dollars we're accustomed to seeing from annual increases in the NIH budget.
There is another more radical way to respond that,
in my view, is worth pursuing even if the NIH picture turns out better than expected. And that's to transform our model for doing medical research to make it even more productive than it's been and, while we're at it, more credible to an increasingly skeptical Congress.
Our current research model can be characterized broadly as one in which myriad individual investigators and scores of independent institutions compete with one another for peer-reviewed federal (and other) support for their individual initiatives. No one in his right mind would question the genius of this model, given its astonishing and unrivaled record of success. The question
I would raise is not whether to abandon this well-established avenue to creative advances but whether to
augment it with a more strategic approach that is both
better aligned with today's realities and better able
to answer Congress's calls for greater accountability
in the use of public funds.
The realities to consider include not only the prospect of severely limited growth in NIH funding but also the rising costs of doing cutting-edge research and the increasing dependency on multidisciplinary teams to perform that research. And in responding to calls for greater accountability, we can't and shouldn't promise specific cures, but we can and should seek more ways to reassure Congress that our efforts to solve pressing medical problems are as cost-effective as possible.
What's needed is for academic medicine to adopt
a much more coordinated approach to its research
mission. Imagine how much more productive and accountable we might be if a consortium of our research-intensive institutions agreed, for example, to establish a central purchasing mechanism for negotiating volume discounts, or to much greater sharing of expensive research tools and high-end equipment, or, even more daring, to large-scale collaborations in attacking major unsolved problems (e.g., obesity, diabetes, Alzheimer's disease).
I realize that individual investigators already collaborate a lot to enhance their productivity, which I applaud enthusiastically. I also realize, by contrast, that institutions may be disinclined to collaborate for fear that their "NIH ranking" will suffer (a regrettable manifestation of the current competitive climate!). What I'm advocating is the abandonment of that paradigm and the adoption of a more strategic alignment across large segments of the academic research enterprise. Such an alignment would set forth a prospective agenda and help orchestrate a coherent action plan to take full advantage of the vast capability that exists across our individual institutions.
The NIH is making a concerted effort to encourage more collaboration at both the individual and institutional levels. As the NIH Roadmap notes: "The scale
and complexity of today's biomedical research problems increasingly demand that scientists move beyond the confines of their own discipline and explore new organizational models for team science.... Many scientists will continue to pursue individual research projects; however, they will be encouraged to make changes in the way they approach the scientific enterprise."
In my opinion, academic medicine would do well to adopt its own strategic "Roadmap" to complement the NIH's initiatives. At the same time, taking a strategic look at how we "do business" can assure potential critics that we are making the best use of the public funds entrusted to us. There is much more we can (and should!) do with the resources we have. We just need to learn, over the coming years, how to collaborate with one another as well as we've learned, over the past years, how to compete with one another.
Jordan J. Cohen, M.D.
AAMC President
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