Q&A: From the lab to the clinic

It's a rather perplexing quandary for the United States: Despite spending 16 percent of its gross domestic product and more than $7,000 per person on healthcare --2.5 times the average of the 30 member countries of the Organization for Economic Cooperation and Development (OECD) -- the average lifespan of US citizens ranked 24th in the OECD in 2007.

Michael Crow
Image: Arizona State University

With an annual budget for the National Institutes of Health (NIH) of more than $30 billion, the problem is not that the amount invested in medical research, said linkurl:Michael Crow,;http://president.asu.edu/about/michaelcrow the president of Arizona State University and founder of its Consortium for Science Policy and Outcomes, but how it is used. The Scientist spoke with Crow, who wrote a linkurl:commentary;http://www.nature.com/nature/journal/v471/n7340/full/471569a.html on this topic published today (March 30) in Nature, about how he thinks researchers and public funding agencies need to reevaluate their research goals to shift the scientific culture towards outcomes that will improve healthcare for US citizens.The Scientist: What do you see as the core problem with research in the United States that influences its ability to improve healthcare?Michael Crow: Our scientific enterprise that works to give us these new approaches to enhance health outcomes is fantastic scientifically, but is too narrow in its scope. It's spread out across these 27 institutes [of the NIH], but it's spread out in a way where it focuses on science outcomes only, as opposed to the broader outcomes of healthcare. Our broader social outcome from health-related science is not being attained, not even close. [This structure also results] in scientific culture where reductionist approaches are perceived to be superior. Why is it that we don't have more investment in understanding why we behave the way that we behave since so many diseases are related to behavior? And if so many diseases are related to behavior, what's the relationship between behavior and biology? And what's the relationship between behavior, biology, and outcomes?TS: In your Nature commentary, you suggest that restructuring the NIH could help the outcome of US science. Can you describe your proposed three-institute system?MC: The notion [is] transforming the system to one where science is linked to healthcare which is linked to the people that pay for healthcare. The first institute assumes that healthcare outcomes and the study of the science related to biomedicine is, in fact, a systems-level science, which means you need to integrate between the physical sciences, social sciences, and behavioral sciences. The second institute focuses on health outcomes and that means measuring improvements in health itself. This again is an integrated approach, but the funding of projects is actually related to measuring health outcomes themselves, and not scientific outcomes. The last institute is where you're looking to measure the cost of delivery. Because if right now we're going to spend 20 percent of our economy on healthcare and get a marginal return, then we're wasting a lot of money.TS: Restructuring aside, within our current system, how can we improve healthcare research? MC: All science investments at the NIH must be linked to measured outcomes associated with lowering the cost of healthcare and making it more equitably distributed. I think right now we're operating under the assumption that somehow there's a yet-to-be-discovered silver bullet, and that if we just spend more money on fundamental science, that silver bullet will be discovered and all will be well. It's not going to work that way. TS: With all the focus on outcomes, where does basic science fit in?MC: There's plenty of room for fundamental research -- it's just not the be all and end all. There are core questions that we need to understand: How do cells behave? How is genetic information transferred? Why is it that we get these misbehaving cells with faulty DNA instructions, also called cancer? Some of those very fundamental things are important to understand, but in isolation by themselves, they don't have as much ability to deliver. M.M. Crow, "Time to Rethink the NIH," Nature, 471:569-71, 2011. DOI: linkurl:10.1038/471569a;http://www.nature.com/nature/journal/v471/n7340/full/471569a.html
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[10th Nov 2008]*linkurl:An Economic Gamble;http://www.the-scientist.com/article/home/53302/
[1st July 2007]

**__Related F1000 Evaluations:__** *linkurl:Why the NIH Trial to Assess Chelation Therapy (TACT) should be abandoned;http://f1000.com/1124066?key=0hmbghm2t9k3h7c
K.C. Atwood et al., Medscape J Med, 10(5):115, 2008. Evaluated by Stephen Salzberg, University of Maryland.*linkurl:Moving toward transparency of clinical trials;http://f1000.com/1108750?key=kcf2p4rbfpd7v6p
D.A. Zarin and T. Tze, Science, 319(5868):1340-2, 2008. Evaluated by Todd Wagner, VA Palo Alto and Stanford University.