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Continuing Innovations for Health

A critical factor in the success of America’s health science enterprise has been the close connection of science to patients and to education. The vibrant basic science research activity in academic health centers has placed investigators and their ideas close to those who care for patients and to the patients themselves. Increasingly, the time and distance between gene sequence, gene product, clinical relevance, and application is closing. Moreover, in an environment in which routine care, clinical trials, incremental technological advancements, and training are interrelated, new diagnostic and therapeutic modalities rapidly develop. To take just one example from my own field of cardiology: I spent evenings as a medical student administering morphine to patients whose lives depended on painful electrical stimulation of the heart through metal plates on the chest wall. The steps that were required to move from this acute intervention to fully implanted units capable of transvenous sensing, pacing, and defibrillation were climbed as a series of incremental improvements. These improvements occurred in experiments on human subjects over a period of years and were accomplished by integrating innovation with the usual care of individuals with heart block or arrhythmias. This is not to say that all such experimentation has always been of the highest quality. Institutional review boards assure that informed consent and ethical considerations are met, but peer review of clinical studies has been largely reserved for projects funded by the National Institutes of Health (NIH) or voluntary health agencies. Moreover, a major goal of some investigators has been to generate substantial monies from clinical trials from which funds could be spent on other studies in the laboratory and with patients.