What's Needed Now

Editor's Note: This Opinion is adapted from remarks prepared for a hearing of the U.S. Senate Health, Education, Labor and Pensions Committee, chaired at the time by Sen. James Jeffords, then a Republican, now an Independent, of Vermont. I had the privilege to speak to a recent Senate committee panel about the unprecedented research opportunities in the medical and health sciences. These opportunities are unprecedented because of the advances in cell and molecular biology, in information and computational sciences, in molecular and physiological imaging, and in genomics that have occurred in the last 20 years. A seminal advance well known to all of you occurred only a few months ago. That is, for the first time in human history, we know the location and sequence of all of the genes in the human genome. The opportunities of which I speak are the result of past public and private investments in the physical and biological sciences by many individuals and many nations. In the last 50 years, thanks to the work of many of the members of this committee, and of their colleagues in the House of Representatives, as well as former leaders like Senator Mark Hatfield, the United States has led the world in the generosity of its commitments to medical and health research. As Americans, we should be proud of these commitments. Twenty thousand children won't get meningitis this year because of the availability of a vaccine against Hemophilus influenza b, and 450,000 adults who would have died in 1970 will not die this year because of better methods for preventing, diagnosing, and treating cardiovascular diseases. New drugs and treatments provide hope for advances on other fronts. We still have a long way to go to prevent heart disease, AIDS, and diabetes; to treat arthritis, cancer, and mental illness; and to reverse the devastating effects of spinal cord injuries and strokes, to name but a few. But, for the first time in my lifetime I can say that we understand the cellular and molecular basis for several of these diseases, and that we are making good to excellent progress in understanding others. The speed with which we accomplish the goals of preventing and curing these and other diseases depends on our willingness to continue to invest broadly in all areas of science. Research in medicine and the health sciences cannot succeed without the support of robust physical, information, and social sciences research and education programs at the National Science Foundation (NSF); epidemiological and disease prevention and health promotion research and training programs at the Centers for Disease Control and Prevention (CDC); outcomes research and training programs sponsored by the Agency for Healthcare Research and Quality and the Health Resources and Services Administration; and, of course, the biomedical research and training programs of the National Institutes of Health and the Department of Veterans Affairs. Please note the importance of support for both the research and for the training programs of these agencies. We must do more than we are doing at present to attract the brightest young people to all disciplines of science, and to encourage them to reach for the highest levels of educational achievement. This means increased emphasis on math and science at every level of our educational system. It means increased support for the curriculum development and the science and mathematics education programs at the elementary and secondary school levels sponsored by the NSF's Education Directorate. It means demanding higher standards of achievement in math and science of high school and college graduates, and of teachers. It means increasing stipends for graduate students and postdoctoral fellows. It means providing adequate grant support for the most promising young scientists in the early stages of their academic careers. Unless we do these things now, we will not have the skilled workforce needed to keep American science at the cutting edge in the 21st century. In fact, unless we focus on these challenges now, we will not have an electorate that will be prepared to make the difficult decisions that will be needed to keep our nation economically strong and politically free. It is no accident that three successive American presidents have focused attention on education as a top national priority. In this context, I want to commend the Senate for its support for the Specter-Harkin resolution to sustain the doubling of the NIH budget, and for the Bond-Mikulski resolution to double the NSF's budget. If we act on the good intentions expressed in these resolutions, we will have taken important steps toward assuring the success of the next generation of medical and health professionals in the 21st century. Their successes will benefit us in at least three major ways. First, their successes will reduce the enormous drag of disease and disability on our economy. As Robert Topel has told us, improvements in health accounted for almost half of the gains in the American standard of living in the past 50 years. Mary Lasker may not have been an economist, but she understood the bottom line when she said, "If you think research is costly, try disease." Second, they will develop valuable new drugs, devices, and processes that will save lives and create new industries. Biotechnology is an example of one of these new industries. In 1999 the U.S. biotechnology industry comprised 1,273 companies with a total capitalization of $353.5 billion, employed more than 160,000 people, and generated revenues of more than $22 billion.1 Forward-looking legislation, such as the Bayh-Dole Act, enabled licensees of innovations created at American academic institutions to generate over $40 billion in economic activity in 1999. Over 60 percent of these licensees were small companies, the acknowledged engines of our nation's economic growth. Business activity associated with sales of products produced by these licensees generated an estimated $5 billion in federal, state, and local tax revenues in 1999. Finally, and most importantly, they will reduce the impact of disease and disability on our own lives, on those we love, and on the many others who continue to contribute importantly to our society. For the last several years I have had the privilege of welcoming the incoming class of medical students to Columbia's College of Physicians and Surgeons. In so doing, I have stressed the commitment shared by all Columbia administrators and faculty to the well-being and success of our students. I remind them that our commitment is motivated by both altruism and self-interest. Altruism because they are our future colleagues and the future of our profession. Self-interest because among them are the medical scientists who will discover drugs and treatments for diseases that are presently untreatable, and the physicians who will care for us in our later years. Similarly, I know that the members of this committee care deeply about the well-being and success of our nation. I also know that every person in this room shares with me the expectation that the medical care we receive as we grow older will be provided by compassionate and well-trained professionals whose work will be informed by advances in the physical and biological sciences, and empowered by the new drugs and devices created by these advances. What should be done now to assure that the advances of the last century catalyze greater advances in health in the 21st century? We ask that Congress remain on course to double the NIH budget by 2003. We ask for similar expansions in the budgets of the CDC, the NSF and the Agency for Healthcare Research and Quality; those increases are required to enable us to translate research discoveries into medical and health practices, and to train and nurture the next generation of epidemiologists, physicists, chemists, computer scientists, and outcomes researchers so that they can build on these research discoveries. We ask Congress to remember the interdependency of all parts of our health research, education, and clinical care system. Translation of advances in basic medical sciences into better strategies for the maintenance of health and the prevention, diagnosis, and treatment of diseases requires that our medical school-affiliated research and teaching hospitals be well supported. Science and education build on one another one discovery and one person at a time. Each increment may seem small, but in aggregate the investments we have made in science and education have increased the life expectancy of Americans by 31 years since 1900 and have given us the highest standard of living in the history of humankind. Congress's actions this year will likely set the pace for the next several years. They will affect the future health and economic well-being of all Americans. Samuel C. Silverstein, M.D., is president of Lasker/ Funding First and the John C. Dalton Professor and chairman of the Department of Physiology and Cellular Biophysics at the College of Physicians and Surgeons of Columbia University. 1. Convergence: The Biotechnology Industry Report Executive Summary, Ernst & Young, 2000.

What's Needed Now

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