Cures matter, implementation counts too, aim high

James Burrus/NIST

Biomedical engineer Jenni Popp with NISTs prototype bioreactor for tissue engineering February 29, 2012.

Article Highlights

  • In our efforts to improve American medicine, we shouldn’t scale back on our fundamental ambitions. @DShaywitz.

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  • Even as we try to use available resources effectively, it’s key to develop & offer novel treatments that may work better.

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  • Bottom line: Biomedical science is difficult, fragile and essential. @DShaywitz

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In the online edition of today's Atlantic, I share a piece that distills several topics familiar to readers of this column.  I write that in our efforts to improve American medicine, we shouldn't scale back on our fundamental ambitions - specifically, our investment in high-tech medical science, and our belief that each patient deserves the best care possible.

I argue that it's incredibly important to ensure technological advances are accessible to patients, and actually benefit them; yet, in attempting to effect a more equitable distribution of health, let's be careful not to reduce either our drive or ability to maximize individual health. 

Phrased differently: even as we strive to use available resources as effectively as possible, we must continue to develop and offer patients novel treatments that might work even better.

Most importantly, we must ensure physician remain advocates for the individual patients in their care, and not ask doctors to balance care of an individual patient with a broader commitment to preserving resources for society.  I don't want my doctor to recommend unnecessary or unhelpful treatments, and I certainly wouldn't want to stay in any hospital for one nanosecond longer than medically necessary - yet I also want to be positively sure that my doctor's recommendations are based on an absolute commitment to optimize my health, and not on some gauzy ethical balancing act he or she is trying to achieve.  (See here, and links therein, for more complete discussion.)

In the Atlantic piece, I also discuss the increasing concern that modern high-tech medicine has overpromised and underdelivered.  While I'm proud of the many achievements of biomedical science, it's true that we've come up short in a number of areas - neurodegenerative disease and most cancers come immediately to mind.  Our scientific foundation is considerably more fragile than many appreciate (a fact definitely not lost on most biotech investors these days), and industry plays a vital role in pressure-testing this knowledge, unfortunately discovering in the process just how shaky it is.

Consequently, while it's fashionable to critique the business-oriented executives who run most biopharmaceutical companies - and I certainly have - it's also likely the industry owes its survival not only to the  valiant effort of scientists, but also to the executives in suits who've found a way to manage through the frequent productivity droughts, usually through shrewd business acumen (and occasionally, as recent scandals suggest, through unfortunate and obviously unacceptable means).

Bottom line: biomedical science is difficult, fragile, and essential - qualities that map directly to the current state and esteem of the biopharmaceutical industry.   It's also critically important to figure out how to best use the technologies we already have, and to significantly improve care delivery - a vital area of medical research that has historically suffered from significant underinvestment.  Our key challenge is ensuring that in our increasingly deliberate efforts to manage and improve the health of society as a whole, we not lose focus on doing our utmost to improve the present and future health of the individual patients in our trust and care.

Final note: CATCH (the Center for Assessment Technology and Continuous Health), the new (non-profit) Boston-based innovation initiative I recently co-founded with MGH Chief-of-Medicine Dennis Ausiello (who will lead the effort) and several others, seeks precisely this balance between potential and attained health.  The idea is that improved real-world measurement of people and patients can improve care delivery and implementation in the short-term, and lead to fundamental advances and novel scientific insights down the road (see here, here, and here.)

 

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David
Shaywitz

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