SEASON 1, EPISODE 5
In the first of this two-part episode of “Beyond the White Coat,” David Skorton, AAMC president and CEO, talks with Sen. Roy Blunt (R-MO) to discuss how the coronavirus has forced us to look at health care policy in different ways. It has exposed the weaknesses in our current health care system and opened up new opportunities for us to create a system that works even better for everyone.
David Skorton: I’m David Skorton, president and CEO of the Association of American Medical Colleges. And today I’m joined in "Beyond the White Coat" by Missouri Senator Roy Blunt, Chairman of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education.
We’ve come together today to talk about how the coronavirus has forced us to look at health care policy in different ways. It has exposed the weaknesses in our current health care system and opened up new opportunities for us to create a system that works even better and for everyone. Right now, many states and cities are starting to reopen everything from businesses to beaches. As this is happening, lawmakers have the challenge of exploring how this extraordinary experience will transform health care for the country, for patients, and yes, for health care providers.
In particular, the pandemic has shown us how health care delivery needs to change, especially for the underserved and vulnerable individuals in both urban and rural communities who have been particularly hard hit by the pandemic. For example, telemedicine has become key in reaching Americans where they are for those with reliable Internet access. Yet, around a quarter of adults don’t have broadband Internet service at home. And roughly 20% of whites, blacks, and Hispanics do not have a smart phone.
How do we enhance our infrastructure to support this medium, which has experienced unprecedented growth in use over the last six months, so that all Americans can benefit? How will we approach medical research in the future, knowing what we do today about how crucial and how time-consuming that research can be? And how do we ensure we have workforce in place to address these types of challenges in the future?
This conversation is part of a two-part episode, and I encourage listeners to also check out my conversation with Congresswoman Donna Shalala of Florida.
Senator Roy Blunt is a longtime champion of biomedical research and led the historic funding increases the National Institutes of Health has received over the past five years. Over the past several weeks, he has championed relief for hospitals and other health care providers on the front line of the COVID-19 fight. Senator Blunt, thank you for joining us today on "Beyond the White Coat."
Senator Roy Blunt: Great to be with you, David. Thanks for your leadership and your friendship, which started when you were leading the Smithsonian Institutes and continues right up to the important work you’re doing now as we work to prepare health care providers in the future.
David Skorton: Thank you so much. Well, I’d like to start off by personally thanking you for supporting research funding increases over the past few years. This very pandemic has illuminated the fact that we need medical research now more than ever. In fact, I’ve said this could be the finest hour for scientific research. But all of us want the research to happen quickly. We want a vaccine now, for example.
Senator, in your view, are there any ways of speeding up discovery in our great institutions of research, federal or otherwise. Not just by increasing funding, but by reviewing processes that might lead to better outcomes. For example, what can we do to develop new generations of researchers, or to inspire public/private partnerships that can work quickly on specific research goals?
Senator Roy Blunt: Well, I think all those things are happening. And I think that we are in an incredibly important moment for the opportunity for health research, because of just the general discoveries that are happening, what’s happening to change health research. I started chairing that committee five years ago and as you know, made it a priority to get back to where research was a priority. If everything’s a priority, nothing’s a priority.
And we decided that health care research, which for a decade had no increase and what you were seeing happen as a result of that was research dollars were basically buying 22% less than they had bought ten years earlier. Young researchers were leaving research, because they were really challenged to get a grant, to get those things that initially get you into this research community at a time when so many things are happening, from immunotherapy to CRISPR technology to things that ten years ago were not on the, part of the discussion, have become part of the checklist of, "Let’s look and see if this will work for this patient."
And then, on the new ways of looking at things front, I think we’re seeing happen with the response to the coronavirus, particularly at Health and Human Services, led in many ways by the National Institutes of Health, a new view of this. Senator Alexander, who’s the authorizing chairman, Lamar Alexander from Tennessee, and I have worked together. I'm the appropriating chairman. We have a great working relationship. We’ve spent so much time over the last three months in phone calls with various agency leaders trying to find out, what can we do to make this work better.
And we came up with a concept in the last CARES Act, the CARES Act 3.5, I think sometimes we call it. What we call the Shark Tank at NIH. And we talked more about that with the Shark Tank at NIH, the very similarly patterned organization of a warp speed effort on vaccines are truly writing a new book on how we look at health research and how we, with all of the safeguards we previously had, can figure out ways to shorten the time it takes to get a vaccine available or a test available or a therapeutic available.
David Skorton: Now, in addition to implementing these new ideas, public/private partnerships to spur rapid research developments, are there other ways that the public and private sectors could come together to help us do better when we face future public health challenges?
Senator Roy Blunt: Let me talk in a little more depth about the Shark Tank idea that Senator Alexander and I put in place. We put a billion dollars behind Shark Tank at the National Institutes of Health. Dr. Collins, Francis Collins, the person who led the effort to discover how we map the human genome, a great leader, a great scientific mind, is in charge of that. But he’s reached out in a very short period of time.
This whole Shark Tank idea was set up within five days of the time that the president, from the time the president signed the bill. Something Dr. Collins said would in the past have generally about a year to put this in place. I reached out, brought in more than 100 outside advisors to be the, to populate the Shark Tank and then have reached out at the end of that fifth day, when it was up. And they said, we’re ready to entertain ideas.
Almost immediately had over 1000 responses from great research institutions, the individuals who had an idea. And the Shark Tank will now take those ideas and try to narrow it down to the ones that are most likely to meet in the testing world, easily taken, quickly responded to test. Take the best of those, make a public investment with a private sector partner, and once we get to the point that we think say five of those are likely to be successful or have a good chance of being successful, go all the way into the manufacturing phase of this as we complete the other public health and public safety phases.
And David, it’s endemic to understanding this, that we’re willing to fail here. In fact, if we don’t have some failures, we’re not trying hard enough. So let’s say we take those five things and move them toward production and by the end of that production, two of them we might have determined just didn’t meet the standards. Don’t work. Are never going to work. Nobody’s ever going to use them. We eat that risk. The government steps in and says okay, we’re taking care of that. That’s our part of the partnership.
But the three that did work are available in big numbers weeks and months earlier than they would have been. And I think we’re going to see the same thing happen in vaccines. Dr. Fauci said in January, when we really all began to engage around the idea that there may be a pandemic ahead of us, and it turned out there was, that we’re going to start working on a vaccine.
If we get one in 18 months, it’ll be the U.S. record on established vaccine for a new novel virus. And now we’re talking about the real likelihood we might get that done in 12 months. But only because we’ve taken this Shark Tank kind of approach and using an organization set up a decade and a half ago, BARDA, as government investor, as a government partner to hopefully have a vaccine available months ahead of when it would have been.
And in doing that, we’re almost certain to produce at least one vaccine that will never be used because it’s going to turn out in the triple and dual tracking that by the time you get that vaccine produced, you decide no, it didn’t check the right boxes. Wouldn’t be a vaccine that we would have used. But, this is a time where time really matters. Vaccine, really important. And if you can get it out there, it’s worth the investment of moving forward on what you hope to be a likely success.
David Skorton: What a cool and exciting idea. We’re all standing by to watch the success of this. I want to change gears and think about public health and some of the specific patients that we’re all serving. And as the pandemic has taken hold across the U.S., the plight of vulnerable populations has become even more evident. And we all see this in the disparities among people who are homeless, poor, those who are living with mental illnesses, addictions, other challenges. What can we at the health care community do to help these individuals working together with our colleagues in government?
Senator Roy Blunt: Well, I do think one of the problems that many people in challenged communities have is a behavioral health problem that they never dealt with adequately or had the kind of help that they needed to have. They’ve been working very hard in our committee and I think the federal government has stepped out in a bipartisan way. Senator Stabenow in Michigan and I have worked together on these mental health issues, being sure that we have the availability of mental health help to people needing, treating mental health like all other health is important.
So doing what you’re doing at the teaching institutions of the country to bring people into the health care system that have a heart for reaching out to unserved communities. Bringing people into the system who understand the importance of connectedness. Looking at how we can better use things like telemedicine, including tele-behavioral health.
David Skorton: That’s a very, very important point you made about what we call the continuum of medical education. That we spend a few years in college, a few years in medical school, a few more years in residency or fellowship training, and then hopefully we have decades to practice. And it’s during those decades that the continuing education is such a challenge, just as you’ve said.
Now, speaking of workforce, if we can continue that conversation. It’s really critical, the size and qualifications of the health care workforce in combating this and really all the health care challenges that you’ve mentioned. Now I must say under your subcommittee’s leadership, funding for graduate medical education, for the listeners, that education that occurs after the MD has been given, at children’s hospitals, has increased greatly in recent years. But health care workforce issues are still challenging, as we continue to face shortages of physicians, both for kids and adults. What do you think our workforce should look like in a new normal, senator?
Senator Roy Blunt: Well, I think that’s, looking at probably the mix of that workforce. Now I’m clearly not a doctor, not a researcher, not a scientist. But looking at the right mix of that workforce in the future, I think really important, having a research community that supports the future development having more people that can have direct contact with patients. Having more of a, maybe a team approach. And more of an equitable team approach, where there are MDs and specialists of various kinds in that team.
But there are also other providers that have a clear place to be sure that we’re dealing with the individual needs better than we have in the past. I think that could be an important part of it, David. And on graduate medical education, really an important thing we continue to remember, you mentioned children’s hospitals. As you so well know, the children’s hospitals, graduate medical education is part of the Medicare program. But children’s hospitals aren’t part of the Medicare program and have never been included in that. So we have to fund that differently and have funded it with I think appropriate increases, but with still goals out there to be sure that those hospitals are treated the same way.
And then looking at, I’m sure what you’re talking about, what professionals are talking about is, they’re in training now, is what are the different ways to reach out to people? Telemedicine has made a huge surge in just the last 90 days. You know, so many ways the pandemic has required us to take advantage of technology in ways that we previously weren’t. Everybody was suddenly working at home and had been on a Zoom conversation before or some kind of conversation like that, is beginning to think well, gee, this is pretty efficient and I didn’t have to travel all day to be part of this 30 minute meeting.
But telemedicine makes so much sense. I was talking to the Medicaid Director today again about this very topic that, we don’t, when we get through the pandemic we should be absolutely committed not to slip back but to continue to think, how do we move forward? And how many contacts can you have with patients?
David Skorton: Yes, thank you. I certainly agree with what you’ve said. And the explosion, we have to call it an explosion in telehealth, has been very, very impressive.
Senator Roy Blunt: Absolutely.
David Skorton: And all of us have to work on the roughly quarter of the population that doesn’t have access to broadband Internet at home. And I know you're working on that, and may of us are. Now, we just talked about your efforts on behalf of children’s hospitals, something I know we both have a keen interest in. In this crisis, academic health centers’ role in community care and services really is growing quite dramatically. I know you're in constant effective touch with your constituents. Are there any stories of hope or heroic efforts that you’ve heard from your own constituents that you might share with our listeners, senator?
Senator Roy Blunt: You know, there are so many stories of people who are dealing with their own challenges. Somebody in their family is also not well. The daycare center isn’t as available as it might have been. Where do you leave your kids?
I’ve talked to a few health care providers who really more and more have felt the burden of being the emotional contact with people who are isolated from their own family at this incredibly challenging time in their life. And so you know, there’s a case where many of our providers carry some of the greatest behavioral health burdens that anybody carries right now. Because they’re asked to do so much and to provide so many different kinds of support to patients that in other situations would have somebody there in the room with them to hold their hand, to let you know that somebody cares.
And our health care providers are having to do that and at the same time, often feeling that they have not given the, they’re not giving the kind of support to their own families in whatever their stay at home struggles were. So this is a time where many, many people have really found heroic parts of themselves and pushed that part of who they are to the forefront. And a lot of times their own families don’t understand why they have suddenly begun to feel like they’re second rather than first in that line of priorities.
David Skorton: You bet. Very, very true. I’m going to try to sneak a real quick one in if we have time. So senator, some listeners may be aware, but you and I are both former university presidents. And I’d love to hear your opinion about the stresses the pandemic has wrought on higher education, and how the presence of COVID-19 may have changed our views about virtual curricula.
Senator Roy Blunt: Well, I think there have been lots of stresses. There was never a course that I’m aware of anybody could take to prepare for this exact set of circumstances. And suddenly you’ve got students who have left the campus and gone home for a break who just simply don’t come back. You’ve got to figure out how to get their things out of the dorm room. You’ve got to figure out how to quickly transition to another kind of teaching for them. You’re trying to have your recruiting discussions with students at a time when your campus isn’t open. You’re refunding money that was essential for you to continue to maintain the dorms and things that are very dependent on that kind of income. And then you’ve got students who may have been very dependent on a counselor on the campus who are suddenly three states away and maybe still trying to deal with that counseling situation that many students need today.
Trying to determine how to start, again Senator Alexander and I, both university presidents along with your background, David. And we spent a lot of time on testing as an important tool for people to be comfortable to go back to school. And so that’s one of the reasons we’ve been so focused on, one of the many reasons we’ve been so focused on easily taken, quickly responded to tests. People in higher education looking at really new ways to think about this.
I was interested just this week that Notre Dame announced they’d be starting August the 10th, weeks earlier than they would normally start. They’ll finish that semester by Thanksgiving. And you know, when you talk to the scientists and researchers that you and I talk to, if there’s a second wave, post-Thanksgiving is the most likely time for that second wave. We hope to have a vaccine by then. But they’re thinking, and we won’t bring anybody back until January. So buying a little time.
So I think a lot of things are going to change in a significant way, and college campuses not only are going to be leaders in that, but they’re going to be required to be leaders in that. Or they’re going to be left behind.
I've thought for a long time that the biggest competitor to traditional college campuses were going to be other colleges and universities who decided they were going to launch out into this new field that everybody’s been forced into. So I think we’re going to see lots of patterns change. And we’ve been required to catch up with the technology in a way that is going to be with us, I think in a positive way for a long time.
David Skorton: Well, I’m going to thank Senator Blunt for joining me today, as we all move into our new normal. Members of Congress can help those of us in academic medicine make an even greater and more positive impact. Together, we can make our nation a model of excellent patient care, innovative research, medical education and meaningful community collaborations that enable and support the health care workers of tomorrow. Thank you very much, senator.
Senator Roy Blunt: Thank you, David. Great to be with you.
David Skorton: Thank you for listening. I hope you’ll also check out the companion episode with Representative Donna Shalala from Florida. And I’ll see you next time for another episode of "Beyond the White Coat."
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