Biomedical Research and the Nation's Health-Care Bill
Healy, Bernadine P., National Forum
Virtually all approaches to health-care reform include provisions for saving money. I contend that funds committed to basic and clinical biomedical and behavioral research result in savings that far exceed the original investment. Simply put, the more we understand about preventing illness, the greater the opportunity for savings.
Since World War II, the American public's investment in medical research supported by the National Institutes of Health (NIH) has not only alleviated human suffering, but it has also created new products, new jobs, and new industries. Today, the biotechnology, pharmaceutical, and related life-science-based industries are among the most successful components of our nation's economy. In fact, the success of America's public and private investment in biomedical research and development is now creating a world "bioeconomy."
The NIH has been the private sector's "silent partner" in the burgeoning biotechnology industry, which last year had $4 billion in sales. It is estimated that by the year 2000 sales will approach $50 billion. The President's Council on Competitiveness recently predicted that the biotechnology industry could surpass the computer industry in size and importance.
Two major research efforts underwritten by the NIH serve to illustrate the two arms of inquiry - basic research and clinical study - whose ultimate aim is to reduce human suffering and associated economic burdens.
The Human Genome Project, a fifteen-year, $3 billion federal effort to map the twenty-four human chromosomes and sequence the DNA contained therein, is an example of basic research that will lay the groundwork for the next century of biomedical investigation. It was basic, untargeted investigation into genetics and molecular medicine at NIH that gave rise both to this far-reaching project and to the aforementioned biotechnology industry, which currently holds so much promise.
More than 4,000 disorders are known to result from altered genes, and virtually all human diseases, save trauma, have a genetic component. Today, our capacity to treat, let alone cure, most of these diseases-including cancer, schizophrenia, alcoholism, Alzheimer's disease, manic-depression, heart disease, diabetes, immune-system disorders, and birth defects-is limited by our incomplete knowledge of what biological mechanisms cause them.
NIH invests in the search for genes because having a gene in hand allows scientists to study its structure and characterize the molecular alterations, or mutations, that result in disease. The goal of the Human Genome Project is to provide investigators with powerful new tools to help them clear the hurdles in research that now keep them from understanding the molecular essence of these tragic and devastating illnesses. The savings yielded by our understanding of the underlying causes of common diseases will pay for the project many times over in the years to come.
Perhaps the best example of a clinical trial is one recently launched by NIH called the Women's Health Initiative. This fifteen-year study has a budget of approximately $625 million and is expected to yield important information on the causes of, and preventive therapies for, heart disease, cancer, depression, and osteoporosis, which are the major causes of death and disability in women of all races. The study's three arms - clinical trial, observational study, and community trial - are designed to increase our knowledge of how to prevent cardiovascular disease, cancer (especially of the breast and colon), and osteoporosis among women, mainly through systemic study of low-fat diet, hormone-replacement therapy, and supplements of calcium and vitamin D. How does one demonstrate the economy of investing in biomedical research? A few examples make the case. A recent NIH study found that use of a simple diuretic pill can cut strokes by 24,000 and prevent 50,000 heart attacks among older people. …