The Government Shutdown, Sequestration & The Future of Medical Research

As you know, these are concerning times. It’s hard to comprehend that the government of the United States of America has been closed for business for nearly a week now. Recently, I had occasion to meet with colleagues in three different settings to discuss common and pressing concerns. The day before the shutdown, I met with the advisory board to the director of the Clinical Center at the NIH. A few days earlier, I met with the board of the Association of Academic Health Centers and before that with a collective of CEOs of major health-related organizations. All of us are deeply concerned about what awaits with respect to federal funding for research, the Affordable Care Act, Health Care Exchanges and more. I imagine these topics are top of mind for you, as well.

Notably, at present, our Health System is in an enviable position, given that most of my colleagues said that their hospitals are seeing a drop in census to 60 percent or less, as well as decreasing revenue. We, on the other hand, grapple with challenges of high demand and have markedly recovered from the financial challenges of last year. This isn’t by happenstance or luck. Our high census is because of our excellent reputation and the outstanding care we provide. And our current financial stability is because of your deliberate and conscientious efforts to see more patients, control resources and improve workflow – all while improving patient satisfaction scores to their highest levels ever. We should take great pride in this, but, at the same time, we must continue to be diligent and focused as we navigate ongoing challenges, such as the current government shutdown and sequestration.

promoimageThis weekend, I shared our concerns in the Detroit Free Press about the $1.5 billion cut to National Institute of Health funding because of sequestration, along with the shutdown (Article). We continue to monitor the impact on our Health System now and in the long term. While current grants have been safe, researchers preparing to submit applications for new grants — including a large number who expected to submit applications in time for a major October 5 deadline – are on hold until the shutdown ends. This may lead to delays in obtaining funding and starting research. Clinical trials already under way at UMHS are continuing, though there may be some slowing in cases where federal agencies process experimental drugs. Some research funded by federal contracts has stopped or may need to, including that of a seven-person team analyzing data from the 2009 pandemic H1N1 flu outbreak for the Centers for Disease Control and Prevention. This group has been told to cease all activities on this project when flu season is right around the corner.

But even without these new threats, it has already been difficult for scientists to get crucial funding for new discoveries. In fiscal year 2013, despite overall growth in federal research funding, NIH funding to U-M fell 1.8 percent. That represents a $9.6 million cut, a significant reduction for those hoping to discover new cures and treatments.

This is a problematic trend. NIH is by far the university’s largest research sponsor, amounting to $509.7 million last year, or more than 38 percent of the total research budget at U-M. And it’s the research conducted on campuses like ours that develops the people and ideas that drive the creation of new products and services, new companies and new industries.

With research funding at risk, research itself is at risk, as is our standing as a global leader in medical innovation. While the rest of the world increases spending for crucial biomedical research — spending is up 20 percent in China and India and 10 percent in Japan and Brazil — U. S. funding has dropped 5 percent. We are falling behind in research spending, and the impact is potentially devastating for our nation’s physical and economic health.

It’s important to note that medical research is a major economic driver, too. The U.S. government invested $3.8 billion in the Human Genome Project and achieved an estimated return on investment of $141 for every dollar spent. That work laid the foundation for significant advances in molecular medicine, energy, bioarchaeology, DNA forensics and even agriculture. According to Robert Wood Johnson Foundation studies, preventing just 5 percent of new cases of chronic conditions would reduce Medicare and Medicaid spending by nearly $5.5 billion each year by 2030. The Information Technology & Innovation Foundation estimates that the impact of sequestration on research will be a loss of up to $200 billion in our GDP over several years.

When we stop investing in research, we’re saying that we as a nation are no longer committed to leading the world in discovery and being on the cutting edge of medical science. We’re saying that we are okay with the fact that our nation — a nation built on pioneering innovation — will no longer be in the lead. We’re saying that we are comfortable becoming increasingly reliant on other nations to develop and produce new drugs, therapies and treatments, even if those nations have different and potentially less stringent regulatory requirements. We’re saying that we are okay with discouraging some of our most prolific and innovative minds from pursuing careers in science and biomedical research because we have decided against funding this work.

Science moves the world forward and medical research offers limitless potential to improve lives and communities. Academic health centers and research institutions like ours are where life-changing science happens. Like you, I take immense pride in being part of the University of Michigan Health System because it means being part of a passionate commitment to making the world a better place, one discovery, one encounter, one family and one patient at a time.

Wally Prechter, The University of Michigan & The Fight Against Bipolar Disorder

Creating the Future of Health Care . . . Through Philanthropy

Meeting amazing people is a daily perk of working at the University of Michigan Health System. Soon after I came to Michigan, I had the great privilege of meeting Waltraud “Wally” Prechter, a generous donor and passionate advocate in the fight to treat and cure bipolar disorder. Today, I am proud to call her my friend.

Wally is an extraordinary woman of remarkable courage, passion, zeal and determination. She is a great partner to our Health System, and she is one of my personal heroes.

Twelve years ago, on July 6, 2001, Michigan’s automotive community lost one of its great visionaries when Wally’s husband, legendary business leader Heinz Prechter, committed suicide after an ongoing battle with bipolar disorder. Their daughter, Stephanie, also suffers from the disease.

Deeply motivated to find a cure, Wally turned her deep personal pain and adversity into unwavering advocacy and action. In October 2001, she established what is now known as The Heinz C. Prechter Bipolar Research Fund at The University of Michigan Depression Center to partner with leading U-M researchers and physicians to advance understanding and treatment of bipolar disorder.

More than 20 million people nationwide suffer from mood disorders including bipolar disorder. Unlike cancer or cardiovascular disease, the stigma of mental illness prevents millions from seeking proper medical care. Former president Bill Clinton astutely said “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” Currently, less than 10 percent of those suffering from depressive disorders receive adequate treatment.

Wally’s faith in our Health System’s leading scientists and overall ability to create the future of mental health care through discovery has been rewarded. Currently, we are one of only a handful of institutions in the country using stem cell models to study bipolar disorder – exciting work that already has led to new understandings about bipolar brain cells and the differences in the neurons they produce versus those produced by normal brain cells. Our faculty are now investigating whether the activity of the bipolar neurons can be altered to make them behave like healthy ones, which could ultimately lead to the development of more effective treatments. Additionally, UMHS is home to the largest long-term study of individuals with bipolar disorder, with more than 900 participants.

Wally and the incredible UMHS team associated with The Heinz C. Prechter Bipolar Research Fund are working together to prevent others from experiencing the pain she and her family have experienced. I am in awe of Wally’s dedication and passion to making a lasting difference in the fight against bipolar disorder and to making the world a better place.

Her story is a powerful example of how philanthropy, and the donors who give, are vital partners in our mission to create the future of health care. Wally’s story:

In Celebration of Nurses

“You must never so much think as whether you like it or not, whether it is bearable or not; you must never think of anything except the need, and how to meet it.”  ― Clara Barton, Nurse & Founder of the American Red Cross

Each year for a week, in honor of Florence Nightingale’s birthday on May 12, we celebrate those individuals who have dedicated their lives to a profession that is among the most noble, demanding and rewarding: Nursing.

Nurses are important ambassadors of the patient and family experience because they are on the frontlines delivering care and comfort 24 hours a day, seven days a week, 365 days a year.  They are in classrooms, labs and clinics training future generations of nursing professionals and discovering ways to improve care and care delivery. They are in the community working and volunteering at shelters and in schools.  And, across the country, nursing professionals are strong voices for innovation and change when it comes to shaping health care policy and influencing health care reform.

Under the steadfast leadership of Kate Potempa, Dean of the U-M School of Nursing, and Margaret Calarco, Chief Nurse at UMHHC, nursing at Michigan is thriving and our institution continues to be regarded as one of the country’s best academic nursing centers.  The School’s Master’s Program is the sixth best in the nation, according to U.S. News & World Report, its research-focused Ph.D. programs rank in the National Research Council’s top 5 percent and it ranks sixth in NIH research funding. Additionally, it is a hub of groundbreaking innovation, as demonstrated by being the first U.S. nursing school to partner with the Peace Corps’ Masters International Program, achievement of a 5-year grant to fund the prestigious Hillman Scholars Program in Nursing Innovation, and, in partnership with the UMHS nursing community, establishing the Clinical Initiative for Excellence in Education, Practice and Scholarship to improve the quality and safety of nursing care practice and delivery. UMHS nurses have influenced the profession by publishing more than 50 manuscripts and book chapters this past year alone and presenting more than 70 paper and poster presentations to national and international audiences. Additionally, the Health System’s new Nursing governance model is enabling deeper partnerships with patients and families and establishing new models of nursing care.  As clinical mentors to the hundreds of nursing students we serve, our nurses join with nursing students and faculty to educate our next generation of nurses and create the future of health care delivery.

From care at the bedside to outpatient appointments to nursing education and research to professional and peer support and mentorship, there is no more committed community of nurses than the 4,000 plus nursing professionals at Michigan.

While it shouldn’t take a national event to remind us to thank the incredible nursing professionals who enable excellence across our Health System and University, there certainly is no better time for all of us to offer gratitude to the nursing heroes, teachers, mentors and leaders in our community. Thank you for all that you do!!

A Comment on Sequestration

While there is much still unknown about how sequestration will affect the nation and academic medical centers like the U-M Health System, we will continue to monitor the situation. I encourage you to read today’s University Record article What does sequestration mean for U-M? to gain further insight and understanding of the potential impact of sequestration on our University.

 

The Importance of Clinical Research

This month, I decided to write about the power of clinical research because it has the potential to change patients’ lives. I recently experienced this in a powerful way myself.

In November, I received an invitation from Drs. Christine Holland and Jennifer Rai to attend Internal Medicine Morning Report and participate in a discussion of a patient who had anaphylaxis (severe allergic reactions) to her own progesterone production. The literature review for this case turned up an article published 28 years ago in the New England Journal of Medicine, in which the authors detailed the first reported case of progesterone induced anaphylaxis and its treatment with a new class of drugs called long-acting GnRH analogs. I was one of the authors on that first case report. Since then, numerous other cases have been reported, and I learned that the patient that was being treated here at Michigan was the beneficiary of research that was started so very long ago.

A few weeks later, on Dec. 18, I received a touching note from my daughter, Naomi. Naomi is a television news reporter in Minneapolis, which is where I completed my pediatrics residency and held my first faculty position. She received the note from a viewer. It said:

Naomi,

For several months we have been watching and admiring your reporting. … But, it was not until just recently that we satisfied our curiosity and investigated the possibility of your relationship to Ora.

Twenty-five years ago when our daughter was just four, she entered a precocious puberty experimental drug trial that your mother conducted at the University of Minnesota.  [We saw your mother] for 7 to 8 years, and were always impressed with the understanding and care she expressed.  But, outside of a couple of follow-up calls, we have lost touch.  Today, our daughter is pastor for a congregation in Iowa. We are so thankful that we found your mother and that she was able to help us.

[We] will always be thankful for the impact that your mother’s care had on our family.  

I remember this patient and her family very well. The patient was a 4-year old girl with precocious puberty who was enrolled in a clinical trial for which I was the principal investigator. Were it not for this clinical research and the new drug that this little girl was able to access as a result of this trial, she would not have gone on to live a normal adult life. Even now, 25 years later, her family remains indebted to biomedical innovation and clinical research.

This is why clinical research is so incredibly important – because it is how we test, improve and advance new drugs, devices and methods of treatment that save and improve lives. It is how we help to build healthier and more productive communities. And it is how we create the future of health care through discovery.

This type of research and discovery is happening every day across our Health System. Currently, 800 active clinical trials are in progress at UMHS, and we have more than 12,000 people on our clinical research volunteer registry. Additionally, medical school researchers begin 90 new industry-sponsored clinical trials each year, and the results of the work are impressive! For example:

  • Dr. Charles Burant, professor of Metabolism and Internal Medicine, and his colleagues conducted phase 2 clinical trials which found that a new treatment for type 2 diabetes improves blood sugar control without increasing the risk of a dangerous drop in blood sugar (hypoglycemia). More on this study
  • Researchers from UMHS and the Veterans Administration Ann Arbor Healthcare, led by Drs. Fernando Martinez and Jeffrey Curtis, both professors of Internal Medicine, participated in a large-scale national clinical trial that found adding a common antibiotic to the usual treatment regimen for chronic obstructive pulmonary disease (COPD) can reduce acute symptoms and improve quality of life. COPD impacts more than 12 million Americans and is a leading cause of death in the United States. More on this study
  • Research conducted by the U-M Department of Aerospace Engineering and supported by MICHR showed that the beating heart may generate enough electricity to power a heart-regulating pacemaker, thus negating the need for battery-replacement surgeries. More on this study

I was thrilled to be directly involved in clinical research myself, and I am so very proud now to be part of an institution that is on the cutting-edge of some of the most exciting clinical discoveries today. And yet, this work is threatened by sequestration which presents significant reductions in research funding. As our government grapples with the federal budget, we must commit ourselves more than ever to advocate for increased research funding, and we must find new and creative ways to support discovery. Because when research is compromised, society bears the burden of a decrease in new therapies and treatments that improve and save lives. Medical research means hope, and America needs to invest more, not less, in medical research.