Health and Biomedical Research:
Advancing Knowledge and Innovation to Improve Patient Outcomes
The scientific enterprise is deeply interwoven into the fabric of society. It draws its problems from society’s needs, performs research in ways that are shaped by society, and exerts a transformative influence on society through the results it produces. As the size of the scientific enterprise has expanded since 1970, the challenges facing the scientific enterprise have become challenges to the broader society as well.
Enabling Open Access to Medical Research
In 1971, the National Library of Medicine launched MEDLARS Online (or MEDLINE), providing researchers computerized access to a database of medical journal articles dating to 1879. In 1996, when home computers became widely available, PubMed, a public version of MEDLINE available through the internet was introduced. As of 2017, PubMed had indexed over 27 million articles, and about 2.5 million people worldwide accessed the database each working day.
Accelerating Cancer Research
The National Cancer Act (NCA) was signed into law by President Richard Nixon in 1971, kicking off what became known as a “war on cancer.” The NCA provided new funding for the National Cancer Institute, allowing the establishment of 15 new research centers, cancer control programs, and an international cancer research databank. Five decades later, the NCA is credited with fundamentally advancing scientists’ understanding of cancer biology, enabling the design of targeted therapies.
Advancing a Global Public Good
Scientific knowledge is a public good, and its applications have critical economic, social, political, and environmental consequences. To better assess both the generation and application of scientific knowledge, the InterAcademy Panel was founded in 1993 to bring together national academies of sciences, engineering, and medicine to advise governments and the public on the scientific aspects of critical global issues. In 2000, the InterAcademy Panel founded the InterAcademy Council and the InterAcademy Medical Panel to further this goal, and in 2016 these three interrelated networks merged into the InterAcademy Partnership (IAP), which continues to advise the world’s leaders today. IAP regularly releases reports and recommendations that draw on the expertise of more than 140 national and regional member academies to address key issues in the global scientific and policy communities.
Forging a New Path for Medical Research
In September 2003, the National Institutes of Health (NIH) announced the creation of the NIH Roadmap for Medical Research, a series of initiatives to transform the nation’s medical research capabilities and speed the movement of research discoveries from the laboratory into clinical practice. The Roadmap focused on new pathways to discovery, research teams of the future, and reengineering the clinical research enterprise. It fostered high-risk, high-reward research, enabled the development of transformative tools and methodologies, and filled gaps in fundamental knowledge. In this way, it sought to pursue major opportunities that no single institute at NIH could tackle alone but that the agency as a whole could address.
From Research to Rewards
Translation is the process of turning research results into interventions that improve the health of individuals and the public, while translational science studies the principles and procedures underlying the translation process. In 2012, the National Institutes of Health established the National Center for Advancing Translational Sciences to develop and apply translational science so that treatments and cures for disease can be developed and disseminated more effectively. The new center was designed to focus not on specific diseases but on the ways in which new knowledge can be used to benefit human health and well-being.
Pursuing the Promise of Precision Medicine
In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), shifting payment incentives to value-based care and requiring the development of a streamlined set of accountability measures for health care. The initiative—which proposed the customization of health care with outcomes tailored to the individual patient—encouraged patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools and knowledge to better treat their patients. MACRA served as a catalyst in 2016 and beyond for the Centers for Medicare & Medicaid Services to emphasize health care quality through mechanisms such as accountable care organizations, bundled payments, and other value-based approaches.
Our increasingly connected world, while a boon to the scientific enterprise in many ways, is posing challenges to the production and dissemination of high-quality research. The overwhelming amounts of data produced by scientific research complicate the processing, validation, use, and storage of those data. Statistical misinterpretation, nonreproducible results, and poor communication across disciplines are major hindrances to scientific advances. The rise of the internet has enabled scientific results to be disseminated much more widely, but it also has placed a greater burden on the users of scientific information to critically and accurately interpret results.