Significant findings are being made in medicine, but to support and develop effective new treatments, the United States will need to create innovative new public and fiscal policies, said Kenneth L. Davis, MD, CEO and President of the Mount Sinai Health System in New York City. Dr. Davis discussed his ideas for creating “an ecosystem of innovation,” during the 2014 Aspen Ideas Festival held in Aspen, Colorado from June 24 to July 3.
Taking a drug from conception to human trials is a costly endeavor, estimated at $1 billion, said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai and President for Academic Affairs, Mount Sinai Health System. "The challenge—even after advances in the human genome, and other discoveries, in cancer, for example—is to create more of a collaboration between the National Institutes of Health (NIH), basic scientists, and industry."
In addition, funding for NIH grants is decreasing, making it more difficult for scientists to pursue their research. Overall success rate for grant applications at NIH last year was 16.8 percent, with the average age of scientists receiving their first independent grant from the NIH at 42 years of age. "We are losing a generation of outstanding young scientists because funding is not available to support their science. This lost generation will negatively impact the future of biomedical research.”
Presented by The Aspen Institute and The Atlantic, the Aspen Ideas Festival is unique in its dedication to the global exchange of ideas, gathering leading thinkers from around the world to discuss the issues that inspire them.
“This is an unprecedented time in academic medicine as a revolution in biology is upon us, reminiscent of the breakthroughs in physics that occurred in the early 1900’s,” said Dr. Davis. “However, will we be able to fund research of devastating brain diseases, such as Alzheimer’s, which is nearing epidemic proportions? The only way to do this is to prioritize, realizing that the stakes are great in terms of where we are and where we could be going.”
He added, “We need to create an ecosystem of innovation in order to find treatments for the world's most devastating diseases. What we need are public and fiscal policies that increase the likelihood of development of therapeutics for these chronic and costly conditions.”
Just as the United States created years of market exclusivity for biologics that treat orphan diseases, Dr. Davis said we need to create the same incentives for compounds that treat the most chronic diseases, such as Alzheimer’s disease."
Dr. Charney pointed to the importance philanthropy plays in allowing scientists to take risks that result in unexpected discoveries. “As the NIH budget constricts, philanthropy is critical in terms of our engine of discovery at Mount Sinai,” said Dr. Charney. Mount Sinai also has taken some of its endowment to create a venture fund that accelerates drug development and partners with industry in the later stages of discovery.
Both leaders recognize the “revolution in genomics” and the growing ability to personalize therapy based on an individual’s biology. Both called for “open access” to clinical trial information and “open sourcing” of data repositories, as well as drug development incentives.
Discussing the Affordable Care Act (ACA), Dr. Davis described how it has created an increase in number of patients who are insured. “The model of delivering medical care is moving away from fee-for-service. Instead of treating illness, we are trying to prevent disease,” said Dr. Davis. “In general, we will move from volume-based health care to value-and-evidence-based care.”
When asked what health care will look like in the near future, Dr. Davis said “Academic medical centers will likely be in the risk business, where we manage large populations with an emphasis on wellness. Doctors may also be less willing to perform expensive tests and procedures.” If the Affordable Care Act leads to administrative simplification with a reduction in rules, denials, claims, and codes, and appeals, then the cost of health care will go down, he said. Dr. Davis also described a future of supercomputers, advanced algorithms, monitors, and apps to help patients identify risk factors and improve their health.
For health care to succeed, Dr. Davis said it must be imbedded in the community. “The social needs of patients and the community must be addressed,” he said. “The best way to cut costs, for example, and reduce hospital readmissions, is to help patients with their everyday lives so that they can make their health a priority.”
During Aspen Ideas Festival founder Walter Isaacson’s conversation with former U.S. Department of Health and Human Services Secretary Kathleen Sebelius, Dr. Davis asked about the controversy surrounding the public option under the Affordable Care Act. “Would the exchange be more viable if we had a public option?” asked Dr. Davis. Secretary Sebelius welcomed it as a good option, saying she was a believer that competition is the best driver of marketplace strategies. When Dr. Davis wondered why we subsidize corn and so many products with high fructose corn syrup, despite the administration’s concern with obesity, Secretary Sebelius said, “It makes no sense. We also subsidize tobacco, by the way … but the likelihood of this Congress tackling the issue, I don’t think is very good. I think, so then you go back to the fallback position, which is educating consumers about what they’re eating and what it does to their bodies.”
After a conversation between former First Lady, United States Senator for New York, and Secretary of State Hillary Rodham Clinton and Mr. Isaacson, Dr. Davis asked, “As you look at what's happened to the ACA as it plays out, what do you wish we could have done differently?" Ms. Rodham Clinton responded, “We should be mending it, not ending it." She also applauded the ending of discrimination against preexisting conditions and putting young people on their parents’ policies for additional years, as well as more transparency and data collection that can be used for health purposes.
With an Aspen Ideas Festival theme on “The Future of Medicine: What will it look like in Ten years?”, Mount Sinai experts at the festival provided the following thoughts:
Angela Diaz, MD: “By 2024, there will be more than 42 million adolescents in this country. As a society, we need to offer them comprehensive, coordinated care that covers the spectrum from primary care, to sexual and reproductive health and behavioral and mental health. In this way, we will be able to give them the information and tools to make responsible decisions.”
• Angela Diaz, MD, is the Director of the Mount Sinai Adolescent Health Center, the Jean C. and James W. Crystal Professor in Adolescent Health and Professor of Pediatrics and Preventive Medicine at the Icahn School of Medicine at Mount Sinai.
Eric M. Genden, MD: “The use of robotic surgery will continue to increase over the next ten years. However, the results will always be dependent on the skill of the surgeon. At Mount Sinai, we'll see more robotic procedures in the areas of urological procedures, including prostatectomies, full and partial nephrectomies (including donor), and bladder surgery. More than 80 percent of head and neck oncology procedures will continue to be performed robotically, as well as in other specialties, such as gynecology, thoracic surgery, general surgery, heart surgery and colorectal surgery."
• Eric M. Genden, MD, is the Dr. Isadore Friesner Professor and Chair of the Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
James Gladstone, MD: “With 41 million Americans over the age of 65 by 2030, 50 percent will be arthritic. We hope that our joint replacements will be able to be placed in a more minimally invasive fashion to save muscle and allow quicker returns to good function including work and sports. Cartilage transplants will evolve to the point where they are not only reproducible, but can cure small areas of arthritis and avoid future degeneration of the joint. Part of this evolution will involve the use of stem cells, which can optimize the quality of the cartilage cell that is produced and ultimately create better and more uniform transplants.”
• James Gladstone, MD, is the Co-Chief of Sports Medicine in the Department of Orthopaedics at The Mount Sinai Hospital
Errol L. Gordon, MD: “Our physicians at Mount Sinai are using 3D brain surgery technology to rehearse operations before they step into the operating room. Patient-specific data can be inputted to produce an exact image of an individual case. We are also using the technology to train residents and give them more experience with complex procedures. We foresee a future of using technology like this to improve patient outcomes and reduce side effects."
• Errol L. Gordon, MD, is Assistant Professor of Neurosurgery, and Neurology Director, Neurosurgical Intensive Care Unit
Diane E. Meier, MD: “My vision for the future is a policy shift whereby more resources are placed into community services rather than acute care systems. As individuals age, we need to make it easier for people and their families to get the help and support they need to stay safely and comfortably at home. Also, my hope is that people understand the difference between hospice services and palliative care – palliative care is to help people protect their quality of life during any serious illness, whether it can be cured or not, and to relieve the pain, symptoms, and stress, and help people live as well as possible while getting treatment for their underlying illness. Hospice is a form of palliative care that is limited to care of the dying, providing comfort and support to people whom doctors determine have six months or less to live."
• Diane E. Meier, MD, is Director of the Center to Advance Palliative Care, Co-Director of the Patty and Jay Baker National Palliative Care Center and Catherine Gaisman Professor of Medical Ethics at the Icahn School of Medicine at Mount Sinai.
David Muller, MD: "As educators, we need to prepare medical students for the changes going on in health care by nurturing their passion and willingness to defy conventional wisdom. At the Icahn School of Medicine at Mount Sinai, we have instituted a program called FlexMed for half of the incoming class, allowing college sophomores in any major to apply for early assurance of admission to medical school without having to take all the traditional pre-med requirements or the MCAT exams. We believe this freedom to explore areas from engineering to the liberal arts, from global health to genomics, will allow these aspiring doctors to drive the change we need in clinical practice, biomedical research, and service to society."
• David Muller, MD, is the Dean for Medical Education and the Charles C. Morchand Chair for Medical Education at the Icahn School of Medicine at Mount Sinai.
Ashutosh (Ash) K. Tewari, MD: “The Davinci robot has transformed prostate cancer surgery over the last ten years, and I see the benefits continuing through the next decade. As compared to traditional open surgery, I am able to put my fingers into the body of a patient without an incision. I can also work more precisely in 3D. The patient is able to heal more quickly and lose less blood.”’
• Dr. Ashutosh K. Tewari, MD is Chairman of the Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai.
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven member hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community‐based facilities to tertiary and quaternary care.
The System includes approximately 6,600 primary and specialty care physicians, 12‐minority‐owned free‐standing ambulatory surgery centers, over 45 ambulatory practices throughout the five boroughs of New York City, Westchester, and Long Island, as well as 31 affiliated community health centers. Physicians are affiliated with the Icahn School of Medicine at Mount Sinai, which is ranked among the top 20 medical schools both in National Institutes of Health funding and by U.S. News & World Report.