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July
2002
Balancing the
Research Portfolio
More and more seniors are taking advantage of Medicare's prevention
and screening services, and Congress is taking a new look at what
else ought to be covered beyond flu and pneumonia shots and screening
for breast, cervical and colon cancer.
I had the privilege
of testifying recently on this subject before the Subcommittee on
Oversight and Investigations of the House Energy and Commerce Committee.
I pointed out that although Congress has doubled the funding for
the National Institutes of Health, its largess may not necessarily
result in improved health outcomes; that behavioral research is
critical to realizing the potential benefit of new discoveries.
For instance,
biomedical researchers say that we are on the verge of seeing a
new genetic test that will tell people whether or not they will
get colon cancer. But this incredible advance coming from basic
science necessitates a more powerful understanding of human behavior
if we are to make the best use of it.
We will have
to answer: How do you persuade people to take a test that may indicate
with high certainty that they are going to get a deadly disease?
What environmental and behavioral factors influence whether people
who test positive actually get the disease? What lifestyle changes
can individuals make to reduce the probability that they would?
What programs can we put in place to help people change and maintain
those long-held habits? How can we ensure that physicians routinely
provide such care? What are the implications of this test for insurance
generally and for Medicare in particular - to cover the cost of
the test, to cover monitoring and to cover treatment for those who
test positive?
As behavioral
and social scientists conduct research to answer these questions,
Congress has a role to play as well. Without much difficulty, congressional
oversight of Medicare could include:
- Raising
the priority within Medicare for addressing behavioral risks.
- Increasing
the extent to which Medicare administrators make use of evidence
on how to overcome behavioral barriers in developing preventive
services policy.
- Fostering
cooperation among federal agencies with responsibility for applications
research and program implementation for seniors.
- Balancing
the federal research portfolio between basic and applied research.
The investment
we have made in basic science will be diluted if we do not translate
these advances into use - and use implies systematic changes in
the behavior of health professional, health systems and individuals.
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