In 2005, Drs. Woolf and Johnson released a provocative work: “The Break-Even Point: When Medical Advances Are Less Important Than Improving the Fidelity With Which They Are Delivered“. This conceptual frame of reference, when applied to health research funding, highlights the huge disconnect between current NIH funding and actual improvement of America’s health.
Last month, the National Heart, Lung, and Blood Institute (NHLBI) of the NIH awarded a “Grand Opportunity” 64 million dollar grant paid for by the Recovery Act (American Recovery and Reinvestment Act of 2009). This large investment is to “find genetic causes and contributors to phenotypes that typify heart attack, stroke, diabetes, obesity, hypertension, asthma, chronic pulmonary disease.”
Stop right there. Don’t we know a great deal about what causes heart attack, stroke, diabetes, obesity, hypertension, asthma, and COPD? Have we maximized that knowledge through known, proven interventions? How, exactly, is genetic sequencing going to improve health?
What if that $64 million of our taxpayer money went instead toward:
1. Decreasing smoking rates ($21.3 million)
2. Community-based exercise, nutrition, and health education groups ($21.3 million)
3. Improving medication adherence rates for patients who take generic statins and anti-hypertensives, including financial subsidization for patients unable to afford medicines ($21.3 million)
Improving the fidelity of known effective health interventions for heart and lung disease (and lowering known modifiable risk factors) results in predictable and significant decreases in morbidity and mortality. How will genomic sequencing that pinpoints risk factors for disease improve health? Will new medications targeted to identified genomic groups cause dramatic improvement in health outcomes? Who will pay for the genomic sequencing of the general public? Who will pay for the new patented gene-targeted medicines?
Who are the beneficiaries of this NIH recovery act money? Academic medical institutions and genomic sequencing tech companies benefit the most, an unfortunate and ironic use of the American Recovery and Reinvestment Act funds.
Along with a push for comparative effectiveness research, Americans should demand a health optimization analysis of all publicly-funded research to prevent our taxpayer money from continuing to fund research unlikely to improve population health.
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The backlash against CER is really astounding. Conservatives claim that it can be used to interfere in the doctor-patient relationship in that someone besides you and your doctor would make decisions about your health. Wait, isn’t that pretty much what insurance companies already do?