As part of the 10 Ideas: Prescriptions for Health Reform series, the recognition of a little noticed problem: our medical innovation system is hampered by huge fees to access important research.
We recently saw a comprehensive overhaul of our health delivery system not seen since the likes of Lyndon B. Johnson. Indeed, the Affordable Care Act has ushered in a new era in American health care. However, the United States’ health research and development (R&D) paradigm — our health discovery system, the engine of our health technological progress — is at its own crossroads, poised to undergo a similar transformation.
In the U.S., biomedical research is federally funded by the National Institutes of Health, which allocates more than $70 billion a year in research funding to scientists across the country. The private sector adds another $50 billion into the mix. American physicians and researchers who receive these grants go on to develop the health care innovations that we’ve come to take for granted.
The importance of this biomedical innovation ecosystem cannot be overstated. After all, of the arguably six most important medical innovations of the past 25 years — MRI/CT Scans, ACE inhibitors, balloon angioplasty, statins, mammography, and bypass grafts — four were developed in the U.S., reaping tremendous rewards for American health care. Moreover, in the last 10 years, only seven Nobel Prizes in medicine have gone to researchers outside the country, compared to 15 within our borders. These statistics, while far from comprehensive, are indicative of a competitive advantage in biomedical innovation.
Yet, for all its vaunted progress, our health R&D paradigm faces pressing and significant limitations. Getting at one of the core weaknesses of this system requires examining the basics of the R&D procedure. The process is simple: a researcher obtains funding from the NIH, among other sources, to carry out experiments and obtain results at his or her home institution. These results are then submitted to, and potentially published by, a scientific research journal, the publishers of which compile the results and include them in their publication. Subscribers of this journal can then examine the results of the study.
It is the latter step that’s the crux of the issue. These journal articles, and their results and data, are hidden behind journal subscriptions that cost as much as $25,000 a year, putting them beyond the reach of anyone who can’t afford them. For example, many physicians — most significantly those in rural areas — do not have access to the cutting-edge medical research they need to provide the highest quality of care. Patients, too, are often simply unable to research the pathologies that plague them and their families, hindering their ability to make informed medical decisions. Most of all, students and educators are denied access to the latest scientific developments, which is a major blow to the learning process.
The effects of these barriers also extend to the research pipeline. For instance, the rate at which we translate basic biomedical discoveries into novel therapies has stagnated in recent years. In fact, despite a doubling of the federal budget for biomedical research and development, the number of new drug approvals fell from 53 in 1996 to 19 in 2009, and although 800,000 medical research papers helping to identify novel therapeutic targets were published in 2008, a paltry 21 new drugs found their way to the market. A recent study in the New England Journal of Medicine found that the primary contributor to this so-called “Valley of Death” is “the centralization of authority within large, inherently cautious bureaucracies in government, universities, foundations, and companies…[which] disregar[d]…the diversity of approaches that are necessary for innovation.” In reality, this exists in part because scientists, physicians, and biotech entrepreneurs lack access to cutting-edge research developments and data — currently monopolized by large research institutions in government, academia, and industry — to materialize their ideas.
There’s a compelling case, therefore, to enact what’s called open-access research: making all research publicly available through an unrestricted online database. Indeed, a study published by an economist at Victoria University established that enacting open access policies would reap over $1 billion in benefits over the next 30 years due to the catalysis of innovation in the creation of novel drugs and medical treatments. This amounts to an eight-to-one rate of return.
A movement to enact open access research policies is currently being led by several nonprofits, most notably the Right to Research Coalition. The implications of this policy, however, have not yet hit the mainstream. To students, at least, the movement has remained under the radar. But open access research permits patients, students, physicians, entrepreneurs, and educators to reap the benefits of cutting-edge medical research. Free access to data can spur drug development, providing the life-saving treatments of the future. This system needs to change. The foundation of our healthcare innovation ecosystem depends on it.
Rahul Rekhi is a Roosevelt Institute | Campus Network member from the Rice University chapter, where he is studying bioengineering and economics.