Innovations for Medical Progress

In “Medicine Means More Than Molecules” (Issues, Summer 2024), Sindy Escobar Alvarez and Sam Gill argue for the need to broaden investments in science beyond biomedical research. This is not just a matter of debate. It’s an urgent call to action that demands our immediate attention.

Over 35 years ago, Congress recognized that while increasing our understanding of the processes that lead to disease is essential for medical progress, it is wholly insufficient. Medical progress requires scientific advances along three intersecting paths: biomedical research to understand the physiological underpinnings of the disease process, technology assessment that allows for new technologies and materials to be introduced into existing treatment protocols, and health services research in real-world settings that recognize that care innovations require external validity and not just a study’s internal validity.

These last two paths were why Congress elevated the National Center for Health Services Research and Technology Assessment to agency status, creating what is today known as the Agency for Healthcare Research and Quality. AHRQ’s unique scientific mission is to improve the health care quality available to everyone by producing scientific evidence, synthesizing the body of evidence for improving care quality, and disseminating resources, tools, and guidance for implementing innovations in our diverse health care delivery systems.

At the forum that Alvarez and Gill mention, I asked the attendees to raise their hands if they had developed an innovation in their careers to improve patient care. Almost everyone raised their hand. I then asked how many of them had that innovation adopted by the health care delivery system where they worked. There seemed general surprise when no one raised their hand. However, this stark response clearly reflects the underinvestment in health services research and technology assessment to improve care and the preference noted by the authors for funding “molecular research.”

With the right investments, we can reverse this trend and see the medical progress the nation deserves. We have the potential to benefit greatly from the interplay between the three scientific paths that lead to medical progress, offering a promising future for health care.

We need to reverse this tide of misplaced funding, replacing the incentives that reward investigators for the number of publications produced and grants they bring to their institutions. In many settings, individuals are expected to fund their salaries this way rather than rewarding scholars for “creative works” that could include implementing care improvements and outcomes derived from the science they produce.

To be sure, research and development is needed to transform our health care systems, deliver care differently, and meet the demands of an aging and more diverse society. No one would argue otherwise. To that end, AHRQ invests in new training approaches that embed investigators in care delivery systems to improve care, not just publish journal articles.

Improving health care quality in the United States is not just a goal; it’s a collective responsibility that we all share. It means investing in making health care safer and more effective and ensuring that it’s delivered more efficiently and equitably. It must also be patient-focused, ensuring that the consumer experience meets their emotional and physical needs and raises their well-being.

Robert Otto Valdez