WASHINGTON, D.C.--New therapies and cures for diseases are jeopardized by a decline in money, time, and training for clinical research, scientists said here today at a town meeting organized by the Institute of Medicine (IOM). Shortfalls in clinical research "will compromise our capacity to bring innovation to health care at the bedside," warned Kenneth Shine, IOM president.
Most clinical research is carried out at hospitals run by medical schools. But the rise of managed care, such as health maintenance organizations (HMOs), is forcing training and research hospitals to cut costs and compete. This "rapid, irrevocable momentum toward cost control … is quickly squeezing out time and money from clinical research," George Lundberg, editor of The Journal of the American Medical Association (JAMA), said at a press conference.
As evidence of this trend, Lundberg pointed to a JAMA report released today that details how cost cutting is taking a toll on clinical research. According to a study of 50 university hospitals by Eric Campbell of Massachusetts General Hospital and his colleagues, clinical researchers based at hospitals in more competitive markets (defined, in part, by numerous, large HMOs) published, on average, 15% fewer articles in peer-reviewed journals than did peers in less competitive markets. Campbell also found that faculty members at the competitive hospitals reported more patient care duties and more department stress than their did their less competitive colleagues.
To reverse the decline, Shine today advocated a 1% tax on health care premiums and self-insurance plans to support clinical research. Phased in over several years, Shine estimates the tax could raise as much as $5 billion per year that could be allocated as peer-reviewed grants.