The 21st Century Infrastructure – Science and Education
Alastair Wood Sunday, February 15, 2009
COMMENTARY:
The deteriorating economy and recession has highlighted the need for an economic package to stimulate the economy. This economic stimulus provides an opportunity to invest in "infrastructure" to allow the country to emerge from this economic crisis with rejuvenated support systems to support robust future economic growth.
The discussion of such infrastructure support has focused on distinctly 19th-century concepts of infrastructure - based largely on bricks, mortar and asphalt so that projects seeking economic stimulus funding are sold as being "shovel ready" to justify their support.
Substantial economic stimulus funding also should be directed toward industries that, because they are growing, will contribute substantially to the nation's future economic health. These include biotechnology, medical research and the academic medical centers.
Biotechnology, science- and health-related industries are responsible for a large and increasing amount of economic activity in the United States. The research support provided by the National Institutes of Health (NIH) to academic medical centers (AMCs) supports $50 billion in economic activity in the states, or $2 for every one NIH dollar invested - a proven economic stimulus with an average associated wage of $52,000 in 2007.
The biotechnology industries and AMCs produce discoveries that grow industries of world wide reach and influence. The country's future will depend not so much on "shovels" but on education, research and the discovery and innovation that comes from prepared minds.
Thus at this critical time we must invest all we can in retooling our economy to move beyond "shovels" to knowledge, discovery and innovation.
but is increasingly at risk from rapidly expanding centers of excellence in Europe and
Our research-based universities and academic medical centers, responsible for both the basic discoveries on which future economy depends and for training the graduates who will maintain our global research leadership, are at major risk. Their support for the necessary research leading to new cures comes from government grants, pharmaceutical company sponsored clinical trials and their own resources.
But government grants from NIH and the National Science Foundation have provided less support because their budgets have failed to match inflation. This reduced funding will result in the loss of young scientists. Just a few days ago, the University of Chicago Hospital announced a 10 percent reduction in staff, and similar reductions are occurring widely and often quietly.
Even the biotechnology industry itself is at risk - young biotechnology companies consume large amounts of cash as they carry out the research necessary to obtain regulatory approval for their drugs or devices. Such cash is no longer available and thus a large segment of this sector will totally disappear along with the drugs these companies were developing for the treatment of cancer, Alzheimer's and other diseases.
What should be done? We need to recognize that "infrastructure" today is not what it was in the Depression of the 1930s. Today the country's future depends on high technology and its underpinning research and discovery. Immediate, substantial increases are required to support our college and graduate student education and for our university and academic medical center research programs.
The budgets of NIH and NSF require immediate large increases so a generation of
One of the president's goals is to improve the nation's health, which ranks poorly compared to other nations despite the country's medical prowess. We spend the highest proportion of our gross domestic product (16 percent) on health yet rank 42nd in infant mortality and 46th in life expectancy. We know almost nothing about comparative effectiveness of various therapies and interventions yet we embrace the latest and sometimes most expensive therapies, interventions and tests.
We need to achieve the most appropriate care, always striving for better quality while understanding the cost impact. Because we lack the infrastructure to obtain the data needed to understand what needs to be done to fix our nation's health and provide optimal cost effective care, we need to immediately increase the research budget for AHRQ - the agency responsible for researching health quality - and build up our schools of public health to train and fund the epidemiologists and health-care economists needed to find the solutions to the nation's health crisis.
In the 21st century, our national future depends on investment in the infrastructure of innovation - education, basic and clinical research, academic medical centers, research-based universities, schools of medicine, engineering and public health and the biotechnology and high-tech companies. All will be lost without adequate investment. We must not squander this opportunity to secure our nation's economic future by not investing in the industries of the future. Our children expect it of us.
Alastair J.J. Wood, M.D., former assistant vice chancellor for clinical research and associate dean of