Delivering care in the new virtual world…
American Biomedical Research Is Losing Its Leadership Position – A new study was recently published in JCI Insight revealing that the USA is losing ground in its leadership role in biomedical research. While still the unquestioned leader, there are a lot of other countries that have made substantial gains in the last few years. The study reviewed ten renowned medical journals over the period of 2000 to 2015, noting the nationality of the research and the authors. American leadership continued in the Journal of the American Medical Association (JAMA), the Lancet, the New England Journal of Medicine (NEJM), Cell, Nature, Science, the British Medical Journal (BMJ), JAMA Internal Medicine, Journal of Cell Science, and FASEB Journal. However, the percent of papers in the top six journals decreased from 44% to 37% by 2015. The UK came in at #2 but also lost ground going from 9% to 4%. The reason this is very important is that the Trump Administration has proposed cuts in the National Institutes of Health (NIH) budget which is one of the core drivers of USA leadership. In fact, funding for NIH has been flat over the period of 2008 – 2015, although it was increased in FY17. But, the trend is disconcerting. The importance of the investment cannot be overstated from my perspective. It drives very important research related to discovery, prevention, usage and a whole range of ideas that ultimately prove to improve health and health care
So, who’s assuming leadership? The Chinese are one of the primary new points of research and development. What was particularly interesting is that many of the Chinese authors received their advanced education at American institutions, returned home, and continued prior research projects. This is not bad but, it simply reflects that China – through its government and other sources – is offering substantial support to advance the position of the nation in biomedical research.
Is there a concern? Not on the face of it. However, I’m just finishing the book Sapiens by Yuval Noah Harari which points out quite aptly that the marriage of science and ideology (p. 274) or religion has been a very important point of leverage for nations providing leadership in the world. The ideology of an open, free society dominated by the rule of law (yes, there are some of us who still believe very strongly in this concept) is the type of leadership that we should be encouraging throughout the world. While I love the Chinese, their focus on government control of all societal elements is concerning at best. As for India, it is a great nation with wonderful people who also have a troubled leadership and governance that lacks transparency and accountability on far too many levels – not just at the national level but in all aspects of government from local municipalities all the way to the national legislature. In sum, it’s good that other nations are investing more but that should not translate into the USA investing less.
More On The Microbiome – Two studies were recently published in the online journal Science noting that the “composition” of gut bacteria could potentially have a very significant impact on the efficacy of certain cancer drugs. There have been a lot of studies in recent years showing that the microbiome can affect the treatment of chronic diseases. However, the new findings on the impact of drugs takes care delivery decisions into a new realm. Specifically, the research related to the impact on PD-1 inhibitor drugs which are used in the treatment of melanoma, lung, bladder and stomach cancers by freeing the immune system to attack the cancer cells. This is an area of research that we are going to see many more results in the coming years. The impact will no doubt be very significant (I’ve stopped using the word “huge” :-) ).
Artificial Intelligence (AI): Moving From Influence To Managing – AI is infusing its capabilities into every imaginable part of our lives. From redirecting the ads we want on Facebook, to helping us find the books or products we want on Amazon, to creating music, to making clinical diagnoses – AI is now a part of life as we know it. Underlying all of the apparent parts of AI; however, is an even more striking change that will continue the unrelenting march of AI services across all industries. For example, at the recent Neural Information Processing conference – the premier artificial-intelligence summit –Tesla, the electric-car maker, discussed its partnership with AMD, a microprocessor manufacturer where they are working on AI decision algorithms that can be used across all sorts of industries. Nvidia, another chipmaker, is doing the same. There were other examples as well. The long and short is that the “use” of data in becoming optimized and it is not just coming from the health care industry. In fact, some of the more interesting developments are coming from the “outside-in” – which is an increasingly common refrain I see in the technology field. The health care community needs to keep an eye on other industries outside of our mainstream efforts as well as a focus on inside to stay abreast. My mantra continues – embrace the change.