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A Word from the President: A New Climate in Washington For Research

AAMC President and CEO, Darrell G. Kirch, M.D.

In contrast to the sometimes contentious debate we saw around health care reform legislation, there are encouraging signs of a renewed commitment "on both sides of the aisle" to the vital role research plays in health care. While this important work historically has enjoyed strong bipartisan support, policymakers are beginning to appreciate the potential held by a broadened spectrum of discovery research. In line with creating a better health care system, emphasis is being placed on research that leads to better health outcomes, promotes prevention, improves the public health, and systemically addresses community-based health issues.

Spurred by the advancement of health care reform into the implementation phase, this heightened awareness may provide academic medicine with unprecedented opportunity to demonstrate its leadership. Despite the fiscal constraints we face as a nation (and within our own institutions), the growing recognition that a science-based system leads to effective, coordinated, and patient-centered care is serendipitous for our research advocacy. What are the signs of this new climate in Washington, and how can academic medicine work to maximize this awareness?

Since taking office 16 months ago, President Barack Obama consistently has demonstrated his view that "science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before." On a personal level, I have been privileged to hear his enthusiastic support in meetings at both the White House and on the National Institutes of Health (NIH) campus. Importantly, he is turning to academic medicine by encouraging us to expand our research horizons and study the health care system itself.

The president's support for research also has been evident in the two-year funding made possible by the American Reinvestment and Recovery Act of 2009 and his proposed budgets for FY 2010 and FY 2011. While the president's suggested increases for certain health care agencies would not return us to the days of vigorous growth, he has sent a clear message that the winds of change have shifted more favorably in Washington. It is notable that, despite the daunting current deficit problem, the proposed FY 2011 increase for the NIH 3.2 percent is equivalent to the FY 2011 projected biomedical research and development price index, or BRDPI.

Looking more broadly across the federal government, we see positive signs of increased collaboration among the several federal agencies charged with health care research. In various ways, new initiatives are linking the NIH, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and U.S. Food and Drug Administration (FDA). For instance, the NIH and the FDA recently announced a joint initiative to "fast-track" innovative medical therapies, i.e., to reduce the time it takes for scientific findings to make their way into practice and therefore benefit patients. In addition to better integrating translational science and regulatory science, the initiative will focus on the important issue of ensuring a pipeline of future clinical investigators.

This collaborative spirit is also at work within academic medicine, and it has been encouraging to see how institutions that once competed with one another for NIH rank now work together. Additionally, given the ongoing challenges of fragile clinical margins, declining federal and state support, and decreased endowments, academic medical centers (AMCs) have become more strategic and innovative. Some are forming partnerships with closely affiliated or parent academic institutions to share bridge funding, facilities, or grants management. Others are entering into regional or statewide alliances with colleges, universities, or related industries for shared investment. Still others are making better use of scarce resources through strategic purchasing, regional resource sharing, or by letting go of practices that no longer align with institutional mission.

At the AAMC, we have been seeking to capitalize upon the more favorable research climate in several ways. In April, the Group on Research Advancement and Development (GRAND) 2010 spring meeting included a special session on implementation science and the implications of health care reform for research. This month, the AAMC Advisory Panel on Research will meet in Washington to consider what the new era of health care delivery means for research. Specifically, the panel will assess institutional readiness to engage in the full scope of research, work as multidisciplinary teams, and transition from a growth model to a quality model.

Second, we are working to hone our messaging in a way that resonates more clearly with policymakers' new appreciation for research. In particular, we are looking at ways to show the positive and direct impact of research on the health of individuals and communities, as well as on the health of local and regional economies.

Finally, as we continue to promote the concept of healthcare innovation zones (HIZs), we are highlighting the research role of AMCs in redesigning health care delivery systems. As the training grounds for new physicians, AMCs work to strengthen the clinical investigator workforce and also promote "change agents" who will mentor future generations. As part of larger university systems, our institutions are able to draw upon the knowledge of numerous disciplines and foster integrated approaches to complex research issues. And with a built-in capacity to conduct health services research, AMCs are uniquely suited to collect and analyze data on new care delivery models taking place within their respective HIZ.

In contrast to the dark clouds that gathered several years ago to create what former NIH Director Elias Zerhouni, M.D., called "the perfect storm," the forecast today for research appears more promising. Notwithstanding our substantial fiscal challenges, the political climate may be warmer than it has been in years to show how reliable, timely, and relevant evidence meets America's evolving health care needs. It is a role in which academic medicine can shine.

Darrell G. Kirch, M.D., AAMC President and CEO