Amid the unbearable heat in D.C., some fresh news comes from the House Energy and Commerce Committee hearings. Their 21st Century Cures Initiative is showing real, visionary leadership in solving some of the most urgent problems in health and medicine: regulatory reform, stronger intellectual property, and more effective clinical trials. If they get that right, it will also have huge positive consequences for economic growth, American prosperity and our global competitiveness.
The solutions to these problems have been quite rightly identified as pathways to incentivize greater investment in innovative therapeutic solutions for non-communicable diseases (NCDs). NCDs like cancer, heart disease and Alzheimer’s are quickly becoming the world’s greatest health and fiscal time bombs, as these diseases increase exponentially as the global population ages.
So two cheers to Congressman Joe Pitts (R-PA), who is demonstrating real policy leadership as he works to bring the public health community into the 21st century.
What will success look like with Mr. Pitts’s initiative?
First, it will help re-align our health investment with our health needs. This misalignment is not the US’s failure alone. Globally, NCDs cause nearly two-thirds of all deaths, but only 1.2 percent of all development assistance for health in 2013 was spent on NCDs. That’s less than a billion of the $32 billion in development assistance – places like US AID, its counterpart UK DIFID, the Norwegian Fund, and Gates -spend on health. How could they be so far off the mark?
That’s an amazing misallocation of funding. True that solving for NCDs is hard. But it’s also a case of bad policy based on inertia: Until recently, it was the communicable diseases that accounted for most mortality; but with the aging of the global population, partly a consequence of successful communicable disease policy of the 20th century, the need has shifted. And it’s not an easy shift.
New research by the Cleveland Clinic finds that with Alzheimer’s – one of the world’s most devastating NCDs – an astounding 99.6 percent of clinical trials fail. Joe Pitts goal to redesign trials is absolutely necessary to keep R&D going even against such foreboding headwinds.
Still, the stakes couldn’t be higher. NCDs must be solved if the aging of the global population is going to become a story of healthy and active aging. If we are to transform some reasonable proportion of the billions of us on the planet by 2020 from dependency and disability to economic growth and engagement.
Second, Mr. Pitts's initiative will succeed if he connects the dots between innovation and technology to solve new health challenges. This is most explicitly needed in the ways that we test and approve medicines and medical devices. Health challenges in the 21st century – exacerbated by age-related NCDs – require 21st century solutions.
A case in point is the recent report from the WHO and Alzheimer’s Disease International, which shows that smokers have a stunning 45 percent increased risk of Alzheimer’s. How can we discover further links and connections with disease as we age? Surely, one very promising avenue is the application of big data analytics to existing data bases – sickness funds in the Netherlands or America’s own Framingham Heart Study claims data from the likes of Cigna or Kaiser, or even more creative partnerships with caregivers of the elderly, like Home Instead.
Perhaps we can push this avenue of discovery even further. What if new technologies were used to study and monitor usage in clinical trials? The model that is used for clinical trials today was invented in the 1960s, which, in terms of technology and medicine, is practically pre-Copernican. Here we are over a half-century later still collecting small groups of patients at hospitals and doctors’ offices for years – sometimes decades - to fill quotas. One wonders if the data is shared between researchers using the telegraph.
If the 21st Century Cures Initiative can break new boundaries, one can then also expect the usual, flaccid objections about privacy. Privacy matters, indeed, and it’s of tantamount importance to secure medical data, but let’s not let fear-mongering hold back progress for cures in Alzheimer’s, cancer, or diabetes. Had we applied that to HIV/AIDS we certainly would not have made the progress to turn a certain death sentence into a manageable illness in twenty short years. Indeed, one begins to see AIDS advocates concerned about Alzheimer’s as they, too, now grow old.
So instead of knee-jerk privacy objections, let’s think about solutions. What if a Google or an Intel collaborated with traditional pharma leaders to create secure, usable records? What if leaders in storage, cyber security, and risk got in on the game and created a new solution?
Mr. Pitts’s summertime initiative would go down in history as a turning point in the 21st century health care struggle if they could pave the way for such partnerships.
Long-term thinking and visionary solutions are often not very popular inside the Beltway. But if we do the math, it is clear that NCDs will sap growth unless we find the creativity to drive profound reform. As lives extend and birthrates drop, older adults will need to remain active, healthy contributors to social and economic life.
Health is the foundation of it all. Let’s hope Mr. Pitts can unstick the obsession with 20th century traditions. Coming as it does on the heels of July 4th - America’s independence and project in freedom - the symbolism of the Cures Initiative deserves our support and applause.