Research News

Redefining Biomedical Research and Healthcare Spending

IPR lecturer suggests moving beyond “find it, fix it” research models


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If you want to extend your life by the longest time possible, should you a) get a pap smear every year, as opposed to every third year, b) strive to keep “bad” cholesterol (low-density lipoprotein, or LDL) under control, or c) get a graduate degree?

According to Robert Kaplan, Chief Science Officer at the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services, the best answer is c. Research from a Whitehall Study follow-up has shown that annual pap smears will prolong your life by a couple of days and keeping bad cholesterol in check will add about six months, but the difference in lifespan between a person with less than a high school degree and one with a graduate degree has been estimated to be as long as 12 years.

These are “huge effects,” Kaplan emphasized for the latter finding, noting similar results from a national study on cardiovascular disease that he is co-authoring. Yet most biomedical research is focused on finding and fixing a specific health issue, largely ignoring complex feedback systems. “There are factors that might have profound effects on health outcomes, which we’re not attending to,” he said.

Kaplan, who delivered IPR’s 2015 Distinguished Public Policy Lecture and who stated that his lecture represented his own views and not those of AHRQ, has devoted his career to assessing the impact of medical treatments on patients’ longevity and quality of life, with thought-provoking results.

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Robert Kaplan (center) poses with IPR researchers (from left): Thomas McDade,
Greg Miller, David Figlio, and David Cella.

In introducing him, IPR health psychologist Greg Miller noted his substantial contributions to the field, “Along with our own Dave Cella [IPR associate and medical social sciences founding professor], Bob has been really influential in bringing patient-centered outcomes to the forefront of the way medical decisions are made these days, both in practice and in policy.”

Medical "Quick Fixes" Ignore Longevity

Delving into the state of U.S. healthcare and the thorny issue of reliability and trust in published biomedical research, Kaplan pointed out that the results coming out of basic science laboratories, where scientists study molecular and cell biology, have become increasingly difficult to replicate. This means that a large portion of U.S. investment in this research “never really leads to clinical interventions,” Kaplan said.

The medicines that do result from U.S. biomedical research—about one licensed pharmaceutical product for every 10,000 patented molecules—do “fix” the problems for which they were designed, such as increasing amounts of hemoglobin in anemic patients, or lowering LDL cholesterol among people at risk for heart disease. But these “quick fixes” may not make people live longer or better, Kaplan argued. In fact, they often have no effect on a person’s longevity, and some even decrease it, he continued.

He added, “If you look at all trials with the goal of doing something to make people live longer, it’s been about 18 years since any large trial at the National Heart, Lung, and Blood Institute has shown an increased life expectancy.”

He cited statistics revealing that of wealthy, developed countries, the United States ranks among the lowest in terms of life expectancy; moreover, it has fallen in rank since 1980. In a recent international study, the U.S. ranked dead last of 11 nations in overall healthcare—a measure that encompasses healthcare quality, access, efficiency, and equity, as well as indicators of healthy lives, such as infant mortality. 

“We tell people that we have the best medical care system in the world,” Kaplan said. But “if you look at our health system in relation to other wealthy countries, we’re doing quite poorly.”

Three Eras of Healthcare

The disconnect between U.S. healthcare and the lives of patients reflects a disconnect between current scientific thinking and the design of the American healthcare system, Kaplan remarked.

He sees healthcare as having three eras, each dominated by the scientific thinking of the day. The first era focused on the germ theory of disease, “so we built a health care system to deal with infectious problems. The goal of this was to reduce deaths,” Kaplan explained. Then, a second one emerged where scientists began identifying risk factors for disease, and healthcare refocused on caring for people in earlier stages of the life cycle.

The U.S. healthcare system is currently stuck in this “second era” of healthcare, but “scientific thinking now has moved beyond this,” Kaplan argued. “We realize that what affects health outcomes is much broader than germs and risk factors,” yet the current model “fails to recognize the complexity within the human body—and also fails to recognize complexity in the social world." 

Suggestions for Improvement

Instead of throwing more money at the U.S. healthcare system in the hopes that it will improve, Kaplan instead suggests reallocating the annual $2.8 trillion in U.S. healthcare expenditures, perhaps giving more funding to social services like education—in European countries, expenditure is roughly $2 for other social services for every $1 spent on healthcare, while in the United States, it is about 83 cents. He also recommends reallocating the money that the nation spends on biomedical research, investing more in clinical and behavioral research rather than on basic science.

“If our investment is really designed to make people live longer, healthier lives, we need to redefine a heath system that [addresses the full range of health determinants],” he concluded. “Maybe it’s time to make patients and families the center of this discussion.”

IPR Director David Figlio thanked Kaplan for his insights, noting what a delight it was to host him, especially in a year where IPR is highlighting “the centrality of health in all aspects of social issues.”

Photo credit: J. Ziv