An estimated 4,750 Americans will be told today that they have cancer. Another 4,100 will be diagnosed with diabetes, and 2,000 more will have a heart attack. For these patients — and thousands of others who wish to prevent life-threatening and life-changing conditions such as kidney disease, Alzheimer’s disease, or stroke — the best hope lies in the latest advances in medical research.
Most of that research is taking place at academic medical centers, and much of it is supported by the National Institutes of Health (NIH), the world’s largest public funder of medical research.
With the urging of the AAMC, Congress passed a spending bill in late December that provided a $2.6 billion (6.7%) increase in the fiscal year 2020 budget for the NIH, marking the fifth consecutive annual increase of $2 billion or more.
The same package also included a 10-year reauthorization of the Patient-Centered Outcomes Research Institute (PCORI), which funds comparative effectiveness research to help patients and clinicians determine the best treatment options for many conditions, including prostate cancer, diabetes, and chest pain. Since it was first authorized in 2010, PCORI has funded hundreds of studies that are working to improve care and reduce costs to patients and payers. The AAMC was a leading voice in securing the additional decade of funding for PCORI, which will provide a stable foundation for continuing this important work.
Both the NIH and PCORI are key components of the nation’s research continuum, working in partnership with medical schools, teaching hospitals, and other federal agencies to promote better health outcomes for all patients.
For example, because of the federal investment in the NIH over the years, biomedical researchers across the country are revolutionizing cancer treatment through immunotherapy, which harnesses a patient’s own immune cells to attack cancer cells. CAR-T therapy, one of the most advanced forms of immunotherapy, has been approved to treat children with B-cell acute lymphoblastic leukemia — the most common childhood cancer — and adults with advanced lymphomas. Inspired by this finding, other NIH-funded researchers at academic medical centers are exploring whether immunotherapy could work against solid tumors like breast or colorectal cancer, potentially giving rise to alternative treatment options when surgery or chemotherapy fail.
As our understanding of medicine improves, navigating different treatment options can be complex for patients and clinicians alike. PCORI’s focus on comparative effectiveness research is playing a key role in facilitating shared decision-making by helping the full range of stakeholders, including patients, families, and clinicians, understand the evidence on how various care options compare to one another.
In 2017, for example, two PCORI-funded studies outlined the differing effects on quality of life of the three most widely used treatments for prostate cancer with a low risk of spreading to other parts of the body: laparoscopic surgery, radiation therapy, and active surveillance. All three provide the same likelihood of survival, but the studies showed that they each carried different side effects. The results of the studies, conducted at Vanderbilt University Medical Center and the University of North Carolina at Chapel Hill, enable the nearly 3 million men with prostate cancer to understand their treatment options and work with their doctors to determine the best course of action based on their goals.
This important institute also works with stakeholders from across the health care community to determine its priorities. As its name suggests, it especially views patients as key partners in the research process. It also proactively works to disseminate and implement its findings across the health care system.
PCORI’s focus on engaging patients and ensuring its findings are integrated into medical practice — and the NIH’s continued funding of transformative biomedical research — will enable our physicians to continue to provide the most innovative, lifesaving care to millions of patients across the country. Recognizing the value of this important work, we are grateful that Congress renewed PCORI for another decade and made another meaningful investment in the NIH. Still, we know that even with these remarkable investments, more discovery awaits, and more work remains to be done to create the knowledge and tools to move research findings into clinical practice.
As we look to the year ahead, we must ensure that policymakers continue to understand the importance of a robust research pipeline, including PCORI and the NIH, as well as other federal research agencies that complement their work. The Department of Veterans Affairs, the Agency for Healthcare Research and Quality, the National Science Foundation, and others all advance our national research agenda. Likewise, public health agencies like the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and others are key partners in improving our nation’s health.
The AAMC will continue to be a strong voice for why federal investment in these agencies must be a top national priority. Our patients and their families deserve no less.
Karen Fisher, JD, is chief public policy officer for the AAMC.
Ross McKinney, MD, is chief scientific officer for the AAMC.