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Conrad Notes
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WHO SHOULD PAY FOR BASIC RESEARCH AND CLINICAL TRIALS?
J. Stossel, ABC News, New York, NY, chaired a panel selected from government, oncology, and managed care to help answer this important question. Each presenter offered insight and advice for a highly expectant public and equally concerned physicians. Our limited financial resources demand changing the present methods for financing basic research and clinical trials.

Lenfant gives US government perspective C. Lenfant, MD, National Heart, Lung and Blood Institute, NIH, Bethesda, MD, highlighted some benefits from NIH-supported research. The last 47 years saw a 59.5% decline in the death rate from coronary heart disease. Life expectancy increased by 5.6 years between 1965 and 1995. Lenfant expressed concern about current budgetary constraints. Limited federal funding will impede the flow of eligible study patients and qualified clinical investigators.

Views of two clinicians T. Stossel, MD, American Society of Hematology (ASH) President, Brigham and Women's Hospital, Boston, Mass, called attention to several important medical advances presented initially at ASH meetings. Bone transplants and the cures of childhood leukemia and lymphoma were first presented at ASH meetings. Reports at this year's meeting on basic blood coagulation research led to reduced patient morbidity and mortality. Stossel advised the specialists, "We have not worried enough about actuarial matters in the past. Someone has to pay the bills for basic and clinical research ... Like it or not, raising the money for those bills involves the political process."

J. Armitage, MD, former President of the American Society of Clinical Oncology (ASCO), University of Nebraska, Omaha, spoke about the goals of clinical research and current funding sources. In the nonprofit setting, the goals are improving the survival of people, curing fatal disease, decreasing suffering, and sometimes lowering the cost of health care. Armitage identifies funding sources for clinical research as the National Institutes of Health (NIH), pharmaceutical and device companies, patients through third-party payers to cover healthcare costs, donors, in addition to others who provide "in kind" support such as universities, hospitals, and physicians. NIH needs to become more efficient in patient enrollment, recruiting and training clinical investigators, and funding cancer clinical research, according to the Armitage Commission report.

Newcomer speaks for United HealthCare Corp L. Newcomer, MD, Chief Medical Officer at United HealthCare Corp, Edina, Minn, presented as a trained research oncologist, business manager, and proprietary medical provider affecting 14 million individuals. The cost of conducting medical research can be lessened by reducing duplication of effort and completing more trials. For example, the 1997 May/June issue of Cancer Clinical Trials, according to Newcomer, shows 32 active studies on high-dose chemotherapy with hematologic rescue. Only 4 of the 32 could result in information on the usefulness of the treatment; the remaining 28 studies involve case series. With prodding, the National Cancer Institute (NCI) recently installed a procedure to track clinical trial results for estimating wasted effort and funding.

The limited financial resources supporting US medical research prompt Newcomer to recommend open debate on these issues:

  • How much money do we want to spend for clinical research and what will be the trade off?

  • How will we raise the funds?

  • How do we rank our research priorities?

The panel agreed with Newcomer's recommended open debates on the issues. Several specialists voiced concern about proprietary healthcare company policies as related to practicing physicians. In this case, a dialogue may be more appropriate than open discussion.

J. Stossel expresses concern As a skeptical outsider to research, Stossel does not feel that the taxpayer should pay. Researchers need to participate in the debate to convince the public to pay for basic and clinical research. Stossel advises clinicians to speak up and point out medical advances in lay terminology to inform the public why government should be funding medical research and not cutting back.

Conrad comments This Panel agreed that answering the "who pays" question needs open debate by the major players. Managed care, represented by Dr. Newcomer, offerred an agenda for The Debate. No one can disagree with the advances made by NIH's support of clinical research and physician training. Duplicative cancer research is an expensive way to train specialists. Perhaps a less costly method can be devised.

For correspondence, please contact John Stossel by E-mail at: stossel@abc.com

Eugene A. Conrad

Presented at The American Society of Hematology (ASH) Meeting, December 5-9, 1997
Copyright © 1998 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / February 1998
Send comments to: ConradNote@aol.com

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