Journal of the American College of Cardiology Ó 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 62, No. 19, 2013 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.10.001
FROM THE ACC
President’s Page: The Perfect Storm Part 2: A Rally Cry for Medical Research Funding s highlighted in last month’s President’s Page, “cardiovascular medicine is experiencing a confluence of events that pose a significant threat to the future health of the nation” (1). Among the converging factors are cutbacks in support for graduate medical education (GME) and significant reductions in funding for medical research. The scope of the crisis is enormous, and the impacts of inaction are far-reaching both within our profession as well as for the entire nation. As we noted in October, the GME crisis alone is threatening “an entire generation of bright and ambitious physicians who wish to contribute to patient well-being through clinical care and discovery of new medical knowledge” (1). However, when you couple declining GME funding with massive cuts in medical research, you have a “perfect storm” that threatens to undo the extraordinary achievements that we have made over the past 50 years in reducing death from cardiovascular disease and helping our patients live longer, healthier lives. The federal government plays an essential role in funding medical research in the United States, primarily through the National Institutes of Health (NIH), which is made up of 27 institutes and centers, each with a specific research agenda. Unfortunately, over the last decade, NIH funding has remained essentially flat. When factoring in the rate of biomedical inflation, the agency has lost approximately $6 billion, or 20%, of its purchasing power since 2003, hindering its ability to fund life-saving research at a sustained pace (2). According to a recent article in Cardiology Today (3), the likelihood of getting a successful NIH grant has fallen from 1 in 4 to about 1 in 10 as a result of these cuts. Study investigators are being forced to reduce staff, extend timeframes, and/or limit studies in order to maintain their research laboratories. “Newly emerging investigators are particularly vulnerable in this fiscal climate,” the article notes (3). To make matters worse, the recent sequestration slashed the NIH budget by an additional $1.5 billion, or a little more than 5%. The Framingham Heart Studydthe longest running cardiovascular research project in the countrydwas among the victims of the sequestration cuts, losing $4 million in funding. According to NIH Director Francis Collins, MD, the agency will try to “prioritize things that seem most promising, most critical to public health, but there is no question there will be across-the-board damage to virtually everything” (4). Meanwhile, federal research funding is not the only resource being cut. Industry spending on research is also waning. For example, biomedical research expenditures by industry have decreased substantially in the last decade from a compound, inflation-adjusted annual growth rate of 8.1% (1994 to 2003) to 5.8% (2003 to 2007), and this decline is relatively greater in the domains of cardiovascular research and development (5). In 2010, 13 novel oncology drugs were approved, but only 3 cardiovascular medications were approved (6). There is also inadequate research underway in cost-containment strategies, systems of care, and reductions in healthcare disparities. Unfortunately, these cuts are coming at a time when we need the funding the most. The 20th century witnessed remarkable advances in the realm of heart disease thanks to the very research support that is now under fire. However, given a population that is not only growing but living longer, with a high percentage of risk factors ranging from obesity to hypertension
A
John Gordon Harold, MD, MACC President, American College of Cardiology
Patrick O’Gara, MD, FACC ACC President-Elect
Joseph A. Hill, MD, PHD, FACC Co-Chair, ACC Academic Section Advisory Council
Marvin A. Konstam, MD, FACC Co-Chair, ACC Academic Section Advisory Council
1812
JACC Vol. 62, No. 19, 2013 November 5, 2013:1811–2
Harold et al. President’s Page
and high cholesterol, cardiovascular disease is unlikely to lose its ranking as the number 1 cause of death any time soon. In fact, according to current projections, there will be a 25% increase in the prevalence of both heart failure and stroke over the next 20 years (7). Without continued, robust investments in research aimed at improving the entire spectrum of patient care, from prevention and early detection to diagnosis and treatment, we cannot hope to meet these challenges head on, and we stand to lose ground on the hard-fought advances we have already made to date. Already there have been exciting advances in regenerative medicine, personalized medicine, and biomarkersdall of which hold tremendous promise. For example, cardiac biomarkers are proving to be important tools when it comes to better identifying individuals at high risk for cardiovascular disease, diagnosing disease conditions promptly and accurately, and effectively treating and monitoring patients with cardiovascular disease. In addition, development of novel inhibitors of PCSK9 could change how we treat patients with lipid disorders. Also on the drug front, new oral anticoagulants are already affecting treatment of patients with atrial fibrillation. Compared with traditional treatment, ongoing research suggests that these newer drugs can lower bleeding and stroke risk and that they require less frequent monitoring and dietary restrictions in some patients. Beyond drugs, research is also advancing cardiovascular devices and therapies. Transcatheter aortic valve replacement is one of the most recent transformational new therapies, providing options for patients with severe aortic valvular stenosis who are either high-risk candidates or inoperable for surgical aortic valve replacement. Percutaneous coronary intervention (PCI) via radial access versus femoral access is another growing trend that, thanks to ongoing research, appears to pose less bleeding risk and shorter recovery times in patients in whom it is feasible. New data from the American College of Cardiology’s (ACC’s) CathPCI Registry show that the percentage of patients undergoing PCI via a femoral access site between 2009 and 2011 decreased from 96.5% to 88.8%, whereas the amount of patients undergoing PCI with radial access increased dramatically from 2.9% to 10.9% (8). The list goes on and on, which is why the College is actively engaging in efforts to educate the cardiovascular community, as well as members of Congress and patients, about the benefits of cardiovascular research funding and the need for it to continue. This past September, the College asked members to stand with the more than 150 national organizations and institutions participating in the Rally for Medical Research and to call on our nation’s lawmakers to invest funding for medical research. In addition, the nearly 400 ACC members who
attended the ACC’s Legislative Conference from September 22 to 24, 2013, in Washington, DC, had an opportunity to personally meet with lawmakers and their staff to emphasize the importance of research funding, continued support for GME, and the need for meaningful payment reforms. Moving forward, we are asking all members to carry the message to their lawmakers at both the state and local levels. We must do a better job of educating our elected and regulatory officials regarding the critical importance of medical education and research. We must emphasize that this research has an immeasurable impact on all of our lives by enhancing public health, lengthening life, reducing the burden of illness and disability, and most importantly, saving lives. We also must work together to find new, innovative ways to generate funding, whether through collaborative public/private initiatives like the Million Hearts campaign or some other cross-disciplinary alliance not yet imagined. If we hope to weather this “perfect storm” we must act now and we must act together, both as a profession and as part of the broader medical community. Our lawmakers need to hear from us about the devastating impacts of continued cuts in research funding, GME support, and other key factors on our ability to achieve the triple aim of appropriate, high-quality, cost-effective patient care. The health and well-being of our entire nation is at stake. Let’s rally! Address correspondence to:
John Gordon Harold, MD, MACC American College of Cardiology 2400 N Street NW Washington, DC 20037 E-mail: [email protected] REFERENCES
1. Harold J, O’Gara PT, Hill JA, Konstam MA. President’s page: an urgent call to action: graduate medical education funding and the future of health care. J Am Coll Cardiol 2013;62:1394–5. 2. Harold J. “Call to action: an opportunity to unite around medical research funding” [ACC in Touch Blog]. Sept. 17, 2013. Available at: http://blog.cardiosource.org/post/call-to-action-an-opportunity-to-unitearound-medical-research-funding/. Accessed September 30, 2013. 3. Gerszten R, Singh J, Ellinor P. Budget cuts and the importance of continued innovation. CardiologyToday. July 2013. Available at: http://www. healio.com/cardiology/practice-management/news/print/cardiology-today/ %7B9f1d6535-fb3e-456d-b189-7864d6873449%7D/budget-cuts-andthe-importance-of-continued-innovation. Accessed September 30, 2013. 4. Why medical research is at risk. Rally for Medical Research. Available at: http://rallyformedicalresearch.org/Pages/MedicalResearchAtRisk.aspx. Accessed September 30, 2013. 5. Dorsey ER, de Roulet J, Thompson JP, et al. Funding of US biomedical research, 2003-2008. JAMA 2010;303:137–43. 6. Pammolli F, Magazzini L, Riccaboni M. The productivity crisis in pharmaceutical R&D. Nat Rev Drug Discov 2011;10:428–38. 7. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933–44. 8. Masoudi FA, Ponirakis A, Yeh RW, et al. Cardiovascular care facts: a report from the National Cardiovascular Data Registry: 2011. J Am Coll Cardiol 2013 Sep 18 [E-pub ahead of print].
Vol. 62, No. 19, 2013 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.10.001
FROM THE ACC
President’s Page: The Perfect Storm Part 2: A Rally Cry for Medical Research Funding s highlighted in last month’s President’s Page, “cardiovascular medicine is experiencing a confluence of events that pose a significant threat to the future health of the nation” (1). Among the converging factors are cutbacks in support for graduate medical education (GME) and significant reductions in funding for medical research. The scope of the crisis is enormous, and the impacts of inaction are far-reaching both within our profession as well as for the entire nation. As we noted in October, the GME crisis alone is threatening “an entire generation of bright and ambitious physicians who wish to contribute to patient well-being through clinical care and discovery of new medical knowledge” (1). However, when you couple declining GME funding with massive cuts in medical research, you have a “perfect storm” that threatens to undo the extraordinary achievements that we have made over the past 50 years in reducing death from cardiovascular disease and helping our patients live longer, healthier lives. The federal government plays an essential role in funding medical research in the United States, primarily through the National Institutes of Health (NIH), which is made up of 27 institutes and centers, each with a specific research agenda. Unfortunately, over the last decade, NIH funding has remained essentially flat. When factoring in the rate of biomedical inflation, the agency has lost approximately $6 billion, or 20%, of its purchasing power since 2003, hindering its ability to fund life-saving research at a sustained pace (2). According to a recent article in Cardiology Today (3), the likelihood of getting a successful NIH grant has fallen from 1 in 4 to about 1 in 10 as a result of these cuts. Study investigators are being forced to reduce staff, extend timeframes, and/or limit studies in order to maintain their research laboratories. “Newly emerging investigators are particularly vulnerable in this fiscal climate,” the article notes (3). To make matters worse, the recent sequestration slashed the NIH budget by an additional $1.5 billion, or a little more than 5%. The Framingham Heart Studydthe longest running cardiovascular research project in the countrydwas among the victims of the sequestration cuts, losing $4 million in funding. According to NIH Director Francis Collins, MD, the agency will try to “prioritize things that seem most promising, most critical to public health, but there is no question there will be across-the-board damage to virtually everything” (4). Meanwhile, federal research funding is not the only resource being cut. Industry spending on research is also waning. For example, biomedical research expenditures by industry have decreased substantially in the last decade from a compound, inflation-adjusted annual growth rate of 8.1% (1994 to 2003) to 5.8% (2003 to 2007), and this decline is relatively greater in the domains of cardiovascular research and development (5). In 2010, 13 novel oncology drugs were approved, but only 3 cardiovascular medications were approved (6). There is also inadequate research underway in cost-containment strategies, systems of care, and reductions in healthcare disparities. Unfortunately, these cuts are coming at a time when we need the funding the most. The 20th century witnessed remarkable advances in the realm of heart disease thanks to the very research support that is now under fire. However, given a population that is not only growing but living longer, with a high percentage of risk factors ranging from obesity to hypertension
A
John Gordon Harold, MD, MACC President, American College of Cardiology
Patrick O’Gara, MD, FACC ACC President-Elect
Joseph A. Hill, MD, PHD, FACC Co-Chair, ACC Academic Section Advisory Council
Marvin A. Konstam, MD, FACC Co-Chair, ACC Academic Section Advisory Council
1812
JACC Vol. 62, No. 19, 2013 November 5, 2013:1811–2
Harold et al. President’s Page
and high cholesterol, cardiovascular disease is unlikely to lose its ranking as the number 1 cause of death any time soon. In fact, according to current projections, there will be a 25% increase in the prevalence of both heart failure and stroke over the next 20 years (7). Without continued, robust investments in research aimed at improving the entire spectrum of patient care, from prevention and early detection to diagnosis and treatment, we cannot hope to meet these challenges head on, and we stand to lose ground on the hard-fought advances we have already made to date. Already there have been exciting advances in regenerative medicine, personalized medicine, and biomarkersdall of which hold tremendous promise. For example, cardiac biomarkers are proving to be important tools when it comes to better identifying individuals at high risk for cardiovascular disease, diagnosing disease conditions promptly and accurately, and effectively treating and monitoring patients with cardiovascular disease. In addition, development of novel inhibitors of PCSK9 could change how we treat patients with lipid disorders. Also on the drug front, new oral anticoagulants are already affecting treatment of patients with atrial fibrillation. Compared with traditional treatment, ongoing research suggests that these newer drugs can lower bleeding and stroke risk and that they require less frequent monitoring and dietary restrictions in some patients. Beyond drugs, research is also advancing cardiovascular devices and therapies. Transcatheter aortic valve replacement is one of the most recent transformational new therapies, providing options for patients with severe aortic valvular stenosis who are either high-risk candidates or inoperable for surgical aortic valve replacement. Percutaneous coronary intervention (PCI) via radial access versus femoral access is another growing trend that, thanks to ongoing research, appears to pose less bleeding risk and shorter recovery times in patients in whom it is feasible. New data from the American College of Cardiology’s (ACC’s) CathPCI Registry show that the percentage of patients undergoing PCI via a femoral access site between 2009 and 2011 decreased from 96.5% to 88.8%, whereas the amount of patients undergoing PCI with radial access increased dramatically from 2.9% to 10.9% (8). The list goes on and on, which is why the College is actively engaging in efforts to educate the cardiovascular community, as well as members of Congress and patients, about the benefits of cardiovascular research funding and the need for it to continue. This past September, the College asked members to stand with the more than 150 national organizations and institutions participating in the Rally for Medical Research and to call on our nation’s lawmakers to invest funding for medical research. In addition, the nearly 400 ACC members who
attended the ACC’s Legislative Conference from September 22 to 24, 2013, in Washington, DC, had an opportunity to personally meet with lawmakers and their staff to emphasize the importance of research funding, continued support for GME, and the need for meaningful payment reforms. Moving forward, we are asking all members to carry the message to their lawmakers at both the state and local levels. We must do a better job of educating our elected and regulatory officials regarding the critical importance of medical education and research. We must emphasize that this research has an immeasurable impact on all of our lives by enhancing public health, lengthening life, reducing the burden of illness and disability, and most importantly, saving lives. We also must work together to find new, innovative ways to generate funding, whether through collaborative public/private initiatives like the Million Hearts campaign or some other cross-disciplinary alliance not yet imagined. If we hope to weather this “perfect storm” we must act now and we must act together, both as a profession and as part of the broader medical community. Our lawmakers need to hear from us about the devastating impacts of continued cuts in research funding, GME support, and other key factors on our ability to achieve the triple aim of appropriate, high-quality, cost-effective patient care. The health and well-being of our entire nation is at stake. Let’s rally! Address correspondence to:
John Gordon Harold, MD, MACC American College of Cardiology 2400 N Street NW Washington, DC 20037 E-mail: [email protected] REFERENCES
1. Harold J, O’Gara PT, Hill JA, Konstam MA. President’s page: an urgent call to action: graduate medical education funding and the future of health care. J Am Coll Cardiol 2013;62:1394–5. 2. Harold J. “Call to action: an opportunity to unite around medical research funding” [ACC in Touch Blog]. Sept. 17, 2013. Available at: http://blog.cardiosource.org/post/call-to-action-an-opportunity-to-unitearound-medical-research-funding/. Accessed September 30, 2013. 3. Gerszten R, Singh J, Ellinor P. Budget cuts and the importance of continued innovation. CardiologyToday. July 2013. Available at: http://www. healio.com/cardiology/practice-management/news/print/cardiology-today/ %7B9f1d6535-fb3e-456d-b189-7864d6873449%7D/budget-cuts-andthe-importance-of-continued-innovation. Accessed September 30, 2013. 4. Why medical research is at risk. Rally for Medical Research. Available at: http://rallyformedicalresearch.org/Pages/MedicalResearchAtRisk.aspx. Accessed September 30, 2013. 5. Dorsey ER, de Roulet J, Thompson JP, et al. Funding of US biomedical research, 2003-2008. JAMA 2010;303:137–43. 6. Pammolli F, Magazzini L, Riccaboni M. The productivity crisis in pharmaceutical R&D. Nat Rev Drug Discov 2011;10:428–38. 7. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933–44. 8. Masoudi FA, Ponirakis A, Yeh RW, et al. Cardiovascular care facts: a report from the National Cardiovascular Data Registry: 2011. J Am Coll Cardiol 2013 Sep 18 [E-pub ahead of print].
