Building the Case
Hearing on the "Impact of the Nation's Investment in Medical Research: Economic Benefits and Emerging Scientific Opportunity." Washington, DC. May 10, 2001
Thank you, Mr. Chairman, members of the committee. It's wonderful to be back here among so many familiar faces.
I'd like to congratulate Senator Jeffords, Senator Kennedy and the committee for dedicating time to the important issue of medical research. With oversight of both NIH and NSF, this committee has a very important role in setting science priorities for this nation. Some of the most difficult issues of our time come before this committee, such as stem-cell research and bioethics, to name but two.
I believe we need to invest in the continuum of science — from NIH to NSF to better mathematics and science education in our schools. We need to have a consistent and broad-based support of science if we expect the next generation to move into careers of research and discovery. But it is within biomedical research that I believe the greatest opportunities lie.
A Passion For Medical Research
As many of you know, medical research is a passion of mine. That's why, since my retirement from the Senate, I've largely dedicated my energies to two endeavors: the Lasker Funding First Initiative and Oregon Health & Science University, or OHSU.
OHSU is Oregon's only academic health center, and for years I was an advocate of OHSU as Governor and Senator. Now I have had the honor of formally joining the team, as it were, as the newest member of the Board of Directors.
One of the privileges I've enjoyed as an OHSU board member is meeting our most famous patient, cycling champion Lance Armstrong. As many of you know, Lance was diagnosed a few years back with an advanced form of testicular cancer. Rather than succumbing, he underwent an innovative treatment program and came back to a resounding win in the 1999 Tour de France — one of the most grueling sporting events ever imagined by the human mind. For good measure, he followed it up in 2000 with a repeat victory.
While Lance's comeback is very much a product of his own personal courage, it is also a testament to what is possible through medical research. As recently as 1960, when Senator Richard Neuberger of Oregon was diagnosed with testicular cancer, that diagnosis was lethal. Today, we cure testicular cancer 91 percent of the time — a cure rate attributable to a 17-year research program that invested only $56 million and yet returns annual savings of $166 million.
I'm also privileged to serve as chairman of Funding First, an initiative of the Mary Woodward Lasker Charitable Trust. Mary Lasker was one of the principal leaders in the War on Cancer, which, in 1971, took the budget of the National Cancer Institute from $232 million to $378 million. She also was a potent force in the expansion of the National Heart, Lung, and Blood Institute in 1948. It is no exaggeration to say that the NIH would not be the multi-billion dollar research enterprise it is today were it not for Mary Lasker's tireless efforts that began five decades ago.
Recently the Lasker Funding First Initiative commissioned a series of papers, published in the February 7, 2001 issue of the Journal of the American Medical Association, to take stock of where medical research has been and where it is going over the next quarter century. Some of the highlights include:
- Alzheimer's disease and osteoporosis are strong candidates for disease prevention.
- Many chronic diseases, including Parkinson's and arthritis, will be brought under [control]
- Improved treatment of inherited diseases such as sickle cell anemia can be ensured
- Many cancers may well be put into the category of curable diseases
- The clinical problem of chronic inflammation in the lungs that defines cystic fibrosis may be solved
- Individuals at risk for cardiovascular disease will be identified and targeted for specific preventive intervention, improving the quality and length of their lives
These are just a few of the findings. Over the years, we've seen major breakthroughs, such as with testicular cancer. But as the specter of one enemy fades, another takes its place. Heart disease has long been the nation's #1 killer, but cancer will soon overtake it.
This is part of a recurring challenge. We've seen a recurrence of tuberculosis — a war we thought we'd won. With diseases like this and smallpox, the enemy is changing its face. The only constant is the need for medical research.
This is especially true today, as we stand poised on the edge of a revolution in genetics that will change the face of science, of medicine, and indeed of society itself. With the results of genomic research pouring in, the potential is there to treat or prevent breast cancer, Alzheimer's, depression, and diabetes — in short, to confront some of our worst medical maladies.
If we want to see some of the glorious predictions of a bright medical future come true, we have to invest now. Congress has taken an important first step, leading the way to cures and treatments through the doubling of the NIH budget. I hope when the time comes we will double it again.
The Economic Impact of Research: Oregon as a Microcosm
In addition to the extraordinary impact medical research has on reducing mortality and morbidity, there is an as yet untold economic impact on cities and states around the country.
For years, Oregon Health & Science University was a deliberate, somewhat bureaucratic state agency. When the health care marketplace got competitive in the 90s, there was nowhere for academic health centers like OHSU to hide. Margins began to erode, then disappear.
As an aside, I'd like to remind my colleagues that academic health centers across the country remain vulnerable. As recently as March 30, the San Francisco Chronicle reported that Stanford University Medical Center "faces program cuts and potential layoffs — and may even have to sell its hospitals." Restoring the Medicare pass-through is essential to the financial stability of academic health centers across the country.
In the face of this adversity, OHSU evolved from a state agency to a public corporation and committed itself to research. While some academic health centers struggle to survive, OHSU is booming. OHSU is Portland's largest employer, with over 10,000 workers; 3500 of these are new employees in just the past five years.
Today, OHSU is working to position Oregon to capture the biotechnology wave, through a $200 million bond from the state legislature and a $300 million private fundraising campaign. We really believe that medical research is the ultimate win-win: a win for the economy and a win for quality health care.
And there is no doubt that the biotechnology industry is poised to explode. The biotech industry created 437,000 new American jobs in 1999 alone, generating revenues approaching $47 billion. These are good jobs, in an environmentally clean industry, with an average salary of more than $50,000. An MIT study further suggests that 4 or 5 low-tech jobs are created for every technology job.
But this is just the tip of the iceberg. Those nearly half a million new jobs were created even before major genomic results began to pour in. Financial analysts project the industry nationally to grow at a 35 percent annual rate for the foreseeable future. Some day we may look back on that as a conservative estimate.
This is an economic lifeline for a small state like Oregon. In the past 20 years, we've done a good job diversifying our economy. Today, Oregon's high technology industry produces $13.2 billion of economic activity annually, a full sixty-seven percent more than forestry and agriculture combined. Yet for all our success stories, Oregon is still vulnerable to a national recession — or a downturn in high-tech. Our state's history reminds us there is no such thing as too much diversification when it comes to the economy. The emerging biotechnology sector is far and away the most promising new line of business.
OHSU has already produced some impressive research. You may have heard of Dr. Brian Druker, whose leukemia cure has been chronicled on the Today Show, the ABC News program 20/20, and in the pages of People magazine. As Dr. Peter Kohler, President of OHSU said, "People have won the Nobel Prize for lesser work."
Dr. Druker's dream had always been to replace chemotherapy with a more humane treatment that killed cancerous cells, but didn't ravage the body. Once he arrived in Portland in 1993, Dr. Druker rolled up his sleeves and began to experiment with potential treatments for chronic myelogenous leukemia, in collaboration with scientists from Novartis, a global pharmaceutical company.
One chemical compound — STI-571 — immediately showed the most promise. Clinical testing began in June 1998 and an effective dose was established for 31 patients. The results were nothing less than astonishing. In every case, white blood cell counts returned to normal within six weeks. Overnight, Druker became the most celebrated physician in the country.
Clinical trials for STI-571 (now known as Gleevec) have been extended to 30 countries and nearly 3000 patients. Over 90 percent of those in the disease's blast phase have seen their white blood cell counts return to normal, and one-third in the same phase have no remaining traces of leukemia. In other words, not only did Gleevec treat the leukemia symptoms, it began to eliminate the molecular basis of the disease altogether.
The cure for cancer has long been the golden ring of medical research, eluding the grasp of even the most intrepid scientists. Yet today, thanks to the work of Dr. Druker and others, that cure is within our grasp. We must never forget that medical research made it possible.
Exceptional Returns
Yet, even as we talk about the extraordinary health and economic benefits to medical research, the most dramatic returns have only recently been documented.
At the Lasker Funding First Initiative, we published a report that for the first time put an economic value on human life. To do so, we asked a distinguished panel of economists to assess the economic value of extending life, i.e., increasing longevity. The panel included economists from the University of Chicago, Yale, Harvard, Stanford and Columbia - men known for skepticism. Yet their conclusions are staggering. Economic gains from increased life expectancy have been enormous, on the order of $2.8 trillion annually. Let me repeat that: $2.8 trillion annually.
To discuss the report in more detail, I have with me today two colleagues, Robert Topel and Dr. Samuel Silverstein, whom you will hear from on your second panel. Dr. Topel is from the University of Chicago and is one of the lead investigators in Lasker's Economic Study; he is a member of the National Bureau of Economic Research. Sam Silverstein is the current President of Funding First and hails from Columbia University, where he is a professor of physiology in the College of Physicians & Surgeons. Sam has long been considering the economic facts about research in the medical sciences, and we are very fortunate to have him leading the charge for Funding First. I predict you will be humbled by the economic impact of our national investment when you hear from these two gentlemen.