PUBLIC HEALTH 101:

Building Capacity to Meet America’s Mounting Health Needs

Coalition for Health Funding

March 2, 2010

The Gold Room

2168 Rayburn House Office Building

12:00-1:00 p.m.

Mark O. Lively, Ph.D.

President, Federation of American Societies for Experimental Biology

I want to thank the Coalition for Health Funding for the invitation to participate in this important briefing today. I thank you for coming. I know your time is valuable. In addition to being the current president of FASEB, I am a Professor of Biochemistry at Wake Forest University School of Medicine and I am a scientist who conducts research funded by the National Institutes of Health. I am also a 25-year cancer survivor, a beneficiary of research progress funded by our tax dollars.

Today, at a time when our nation is searching for ways to repair and improve our troubled healthcare system, I am here to re-emphasize the importance of providing steady and sustainable funding for biomedical research in the United States as a critical means of insuring the future health of the citizens and the economic strength of this great nation.

Chronic disease impacts our national economy dramatically – patients with chronic diseases account for 75 percent of the nation’s health care spending.  But the good news is that biomedical research has contributed significantly to improved health and the opportunities for continued progress have never been brighter.

However additional funding is needed to fully develop the knowledge we have gathered to date and apply that knowledge in clinical settings.  The NIH is the largest single source of biomedical research support in the world. We invest more than $30 billion of our precious tax dollars each year in the NIH and 85 percent of that money supports investigation at research institutions in every state in the union. The result of our continuing investments in biomedical research is that we can now anticipate even more dramatic improvements in the future. 

Yes, this is a time of many challenges, not the least of which is the very fragile state of our economy. But now is NOT the time to pull back from our historic commitment to investigation and discovery.  Our worldwide leadership in science and engineering has made us the envy of the world.  We continue to be a beacon for those with hopes and dreams for a better future.  We need to nurture our research investments to benefit from the knowledge that we have gained.  We must ensure that continued progress is not curtailed.  President Obama has recognized the importance of continuing support for the NIH by proposing a significant increase in his FY2011budget.

Fundamental scientific discoveries funded by NIH form the basis for the ongoing transformation of the practice of medicine today and hold such great promise for tomorrow. Here are just a few examples of the many ways that research dramatically improved our nation’s health:

Ø     The National Research Council reported that of the 21 drugs with the highest therapeutic impact, only five were developed without input from the public sector.^[1]  Basic research funded by the NIH provides essential information for discovery and development of new medicines.

Ø    We have seen a 63% reduction in deaths from heart disease and a 70% reduction in deaths due to stroke in the US; more than one million lives are saved each year by therapies developed to prevent heart attack and stroke; American life expectancy has increased by 4 years over the past 30 years.

Ø    Since 2002, the number of deaths from cancer has decreased steadily.  In the past 30 years, survival rates for childhood cancers increased from less than 50 percent to over 80 percent. Today, four out of five children with leukemia will survive.

Ø    HIV/AIDS has been transformed from an acute, fatal illness to a chronic condition; the prophylactic use of anti-virals prevented almost 350,000 deaths worldwide in 2005.  In the U.S., deaths from AIDS dropped nearly 70% between 1995 and 2000.  Life expectancy for those infected with HIV has increased by 10 years.

While the research accomplishments of the past are a great legacy, the job is far from over. Millions of Americans and their families still suffer from the ravages of disease.  Sustained and predictable public support for biomedical research is needed - now more than ever. With continued support for research, we will accelerate the pace of discovery. 

The power of genomics, an area highlighted in the President’s FY2011 NIH budget, illustrates how research is accelerating discovery. Results from the Human Genome Project have already begun to transform the practice of medicine.  Begun in 1990, the genome project took 13 years and approximately $3 billion to produce the first complete sequence of one human genome.[2]  Just 4 years later in 2007, when James Watson, the co-discoverer of the DNA double helix, had his personal genome sequenced, the cost had plummeted to $1 million.  Last year, a California company announced that it had sequenced an individual genome for $60,000,[3] and a recent report in The New York Times identified 17 start-up companies with sequencing prices for individual genomes as low as $5,000.[4]  The same article reported plans by IBM to further reduce the cost to only $100. These advancements are bringing the cost of genomic sequencing into the realm of routine clinical tests.

The astonishing reduction in genome sequencing costs is more than just an abstract example of the dramatically increased pace of discovery and the power of our technology.  It has real meaning for every one of us.  It brings us to the threshold of personalized medicine, where knowledge of our own individual genetic makeup will be used to target cures and identify the most effective therapies for us as individuals.  We are at the beginning of a whole new era of pharmacogenomics that will identify ways to tailor treatments and scientifically match therapies to individual circumstances in ways that were not conceivable a few years ago. 

Knowledge of an individual’s genetic make-up has already made a difference in determining which drugs work best with certain cases of AIDS, breast cancer, acute lymphoblastic leukemia, and colon cancer.  The number of new applications will expand dramatically as researchers exploit this new line of inquiry.[5] But continued progress toward that goal depends on sustained and predictable funding support for the NIH.

As a nation, we currently find ourselves confronting a number of daunting social and economic challenges, and once again our leaders have turned to research in the quest for solutions to these vexing problems.  Funds from the American Recovery and Reinvestment Act (ARRA) have inspired the creative energies of research teams across the nation.  After many years during which our capacity for research has been eroded by flat budgets, these new resources have provided a lifeline for new ideas, research personnel, and progress.

ARRA funding, however, was only appropriated for a two year period, and we face a major shortfall when these funds have been spent.  Returning to pre-ARRA funding levels presents a frightening prospect for those whose hopes for a brighter future rest with medical research.  It will also be a setback for those scientists who have invested so much of their time and talent in this quest.

We have built a research enterprise that is pre-eminent and are realizing its many benefits.  We have a new director at NIH, Dr. Francis Collins, and he has outlined his research priorities for NIH in his important statement in the January 1, 2010 issue of Science. As we enjoy the fruits of our earlier investments and anticipate the continuing returns, we must make sure that we provide the funds needed to generate the knowledge that will drive innovation and progress in the future. Sustaining an appropriate level of investment in NIH and biomedical science is one critical part of the prescription for improved health. Research means hope.⁶