Moving the focus from illness to wellness

Oct. 1, 2009

Running for President in 1912, Progressive candidate
Theodore Roosevelt included in his platform:
“The supreme duty of the Nation is the conservation of human resources
through an enlightened measure of social and industrial justice. We pledge
ourselves to work unceasingly in State and Nation for … the protection of
home life against the hazards of sickness, irregular employment and old age
through the adoption of a system of social insurance adapted to American

Almost 100 years later, we have repeatedly tried and
failed to provide universal protection for all Americans against the
hazards of sickness. In the coming days, the Obama Administration and
the U.S. Congress will make yet another attempt to create a
high-performance, high-value healthcare system based on access for all
Americans, with better quality, more choice, and lower cost.

While there are deep political and philosophical
divisions about the creation of a public-insurance option and the
employment of a new health regulatory-decision-making authority, there
is little difference of opinion on the value of and the need for greater
commitments to medical research.

That fact was demonstrated earlier this year with the
passage of the American Recovery and Reinvestment Act of 2009, better
known as the economic stimulus bill. The $787 billion package was signed
into law on Feb. 17, 2009, by President Obama. Ordinarily it would be
noteworthy for a federal agency to receive an increase in the budget of
10%. The National Institutes of Health (NIH) budget, however, was
increased 25% as we watched it grow from under $30 billion to $40
billion with enactment of the new law. Congress then saw fit to add
nearly another $1 billion for NIH when it passed the budget for the
current fiscal year.

This budget increase occurred for several reasons.
First, President Obama was following through on his campaign promise to
double the medical-research budget over 10 years. The economic stimulus
bill allowed him to make a down payment on that promise. Second, Senator
Arlen Specter (D-PA) demanded that this level of increased commitment be
included in the package for his vote.

The second phase, healthcare reform, is equally as
important, if not more so. Scientific progress is fundamental to solving
our most pressing national problems, thus, I look to science and medical
research to play an enormous role in the transformation of the medical
system. Whether it is scientific advance in the prevention of cancer
replication or in decoding new strains of flu, we must encourage the
application of science to our most pressing health problems.

Specifically, there are four vital public-policy
steps that will ensure a lasting commitment to high-quality, robust
medical research and the maximum impact of that research. First, as we
double our federal commitment to medical research, it is vitally
important that we understand the urgent need to put as much emphasis on
translational research as we can. Ideas often die between the bench and
the bedside — not because they are scientifically unsound, but because
there is no mechanism to carry them along. We must insist that this not
happen, especially as we increase the emphasis on providing personalized
medicine system wide. In this, as in other areas, it is incumbent upon
the medical community to come up with new and innovative ideas.

Second, we need to expand the research base on which
medical decisions are made. It has been estimated that no more than 20%
of what is done in medicine has been studied in clinical trials
applicable to the patients at hand. We need research to correct this.
Evidence-based medicine needs to go from the rallying cry to reality.
Comparative research is critical, as some of our finest medical
institutions continually prove. This, in turn, will enhance our ability
to create public policy that embraces true reform: information that is
timely and accurate, and payment systems that put the emphasis on value,
where it belongs.

Third, we need the information infrastructure to make
this work. It no longer works to have a 21st-century research capacity
and a 19th-century administrative one. The economic stimulus commitment
to healthcare IT is a powerful start. But it is just that — a start.
Imagine a system where scientists have the data to learn in real time
what is working and what is not, and where researchers can learn about
the impact of their innovations in very short order. Basic science would
have an even bigger impact on medical practice, and the cycle of health
improvement would be enhanced enormously.

Finally, as we change the paradigm from illness to
wellness in the United States, there are new questions that we must add
to the research plate — questions about how to get the most good for the
nation. Let me give just two examples. The first is about people with
chronic illnesses who do not take the medications they are supposed to
take and do not modify their lifestyles as recommended. What can we do
to help such people live better lives? The second question is about
social change. What positive steps can society take to reverse the rise
in obesity in America? How can healthcare providers, schools,
businesses, food producers, and retailers all join together to tackle
this problem? These questions, and countless others, demand attention.

For too long, Americans have waited for their
government to make good on Roosevelt’s promise of “the protection of
home life against the hazards of sickness.” Today, we are on the
threshold of achieving that goal.

Tom Daschle, former Senator and Democratic leader from South Dakota, is a special policy advisor to the law firm of Alston & Bird in Washington, DC. He serves on the boards of the Center for American Progress, the Bipartisan Policy Center, and the National Democratic Institute, and is a member of the Council of Foreign Relations.