IOM President Focuses on Noncommunicable Diseases, High Healthcare Costs, Disease Outbreaks, and Health Inequities
When Victor Dzau, M.D., was ten-years old and fleeing the Communist takeover of his native China, he was even then dreaming of becoming a doctor. However, back in 1957, he couldn’t have imagined where those dreams would take him.
Today, as president of the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, he advises both the U.S. government and the nation on health policy issues. Recommendations from the IOM regularly influence health and healthcare not only in the United States; they often have a global impact.
The IOM is an independent, nonprofit organization that works outside of the government to provide unbiased and authoritative advice on health policy. The IOM, together with the NAS and the National Academy of Engineering, make up the National Academies.
Dr. Dzau is now half a year into his six-year term. What are his goals for the IOM? Sitting in his conference room at the IOM, and surrounded by memorabilia including framed degrees, honorary doctorates, citations, and board resolutions from institutions such as McGill, Harvard, Stanford, Duke, and King’s College, London, Dr. Dzau talks about those plans.
“I’ve set three goals for the next five and a half years,” he begins. “First, we must tackle our most pressing health problems, including health inequities, noncommunicable diseases, high costs of care, and disease outbreaks. Second, we need to plan for the nation’s healthcare system as we transition from the current administration to the next. And third, we need to play a role in helping the nation coalesce around shared priorities and audacious goals for addressing the big challenges and opportunities in science and medicine. How can we inspire people to put their energy toward big ideas that will make our world healthier?”
Clear Goals but Task is to Reach Them
The goals are clear, but how does Dr. Dzau intend to reach them? Part of the answer involves how the IOM is organized. Immediate issues get addressed in part because 60% of the IOM’s activities are funded by the government, which requests advice and discussions on policy and programs. For example, when Congress writes a bill that touches on medicine and health, members might turn to the IOM for recommendations. Federal agencies such as the NIH, FDA, and the Department of Veterans Affairs also come to the IOM for independent advice. The IOM responds by convening independent experts, doing studies, writing reports, and making recommendations. In the process, the IOM helps move ideas into policy.
The remaining 40% of the IOM’s work is funded by private and even internal sources, and it’s here that the IOM has its biggest opportunity for being proactive. In its role as advisor to the nation as a whole, the IOM calls attention to important policy issues and catalyzes action. Regardless of where funding comes from, the IOM impacts governments and organizations across the globe.
As an example of the IOM’s impact, Dr. Dzau talks about the IOM study, To Err is Human. This 15-year-old study revealed that at the time, there were up to 98,000 unnecessary hospital deaths per year due to medical errors in the U.S. “As a result of the attention generated by the report and follow-on actions recommended by the IOM,” says Dr. Dzau, “clinical practices have been transformed throughout the nation and today this number has been halved.”
What about efforts for now and the future? One of Dr. Dzau’s goals is not to impose his personal priorities on what gets studied. “People always ask me, ‘What areas do you want to work on?’ and I answer, ‘I want to reflect the people’s priorities, not my personal ones. I haven’t finished my listening tour.”
That tour is an effort to create a mechanism for public engagement. He is currently visiting a variety of stakeholders, including the government, business, academics, advocates, and the general public. When talking with people, he’ll typically ask, “In your mind, where are the opportunities and challenges?” He goes on to say, “We want to hear from people, and then we’ll curate the information through a transparent process.”
Dr. Dzau’s preliminary expectation is that the answers from his listening efforts will shape the priorities of the IOM for immediate initiatives as well as a longer term Grand Challenges in Health and Medicine initiative he plans to launch. The Grand Challenges initiative will engage experts in all fields, in both the public and private sectors, through an inclusive and transparent process. He anticipates that the goals that emerge will fall into four major buckets. The first is noncommunicable chronic diseases that include obesity, diabetes, and mental health disorders. “These conditions are responsible for the majority of global disease burden and the rising cost of care.”
Aging is another bucket. “The infirmities of aging include Alzheimer’s Disease or cardiovascular disease. It is a great success that we are living long lives now, but we also want to make sure that we live these years well.”
The third bucket is personalized healthcare. “How do we make the best use of technology, including genomics, electronic health records, and other breakthroughs? How do we democratize these technologies so that they are accessible and helpful to everyone?”
The fourth potential bucket is health equity. “As a nation, we continue to witness significant disparities in healthcare and health outcomes across ethnicities, geographies, and socio-economic states. Globally, these inequities are dramatic. Take Ebola and West Africa. We are witnessing the results of severely underequipped health systems—these outbreaks would not be nearly as destructive in countries with stronger systems.”
Key Role for IOM
Once the Grand Challenges initiative has been formally launched, the next step will be for the IOM to spur action to solve the challenges. The IOM has the ability to convene panels of experts, and further, the organization has a highly qualified staff of more than 200 available to support these efforts. In addition, the institution can also draw on the resources of the National Academies of Sciences and Engineering and the National Research Council with its staff or more than 1000. “This effort is not as big as a moonshot,” he points out, “but when we put our best scientists and resources together the outcomes are going to be beneficial for everyone.”
An obstacle along the way to achieving this semi-moonshot is funding. U.S. science funding is facing budget cuts, but Dr. Dzau is not deterred. “When there’s not enough funding, we aren’t interested in fighting over the pie; instead we want to come together to find creative new sources of nourishment. Further,” he adds, “the government does provide money for great ideas, such as the Brain Initiative. The power of a great idea is that it brings together government, industry, and academia.”
An overarching issue that ties directly to the size of the pie, and which consistently surfaces during his listening tour, is the problem of excessive and unnecessary regulation and paperwork in both research and health care. Assuming that this issue continues to merit being a priority, how might the IOM deal with it?
“We know from a previous IOM analysis that there’s as much as 30 percent waste in medical care. I believe that a similar situation may exist for research expenditures. We know that excessive paperwork, for instance, accumulates because over the years lawmakers want to make sure that things are done right, and to ensure this, they require more and more paperwork. The end result is a huge bureaucracy with layers and layers of paperwork.”
The good news for Dr. Dzau, and also for the rest of us is, “Legislators are likely to be very interested when they see how much better off we would be if we eliminated paperwork that doesn’t pass a cost benefit analysis.” He is considering undertaking a study on this issue. “In the case of a study of excess paperwork, the anecdotes we’ve all heard about the burden of excess paperwork can be translated into analysis, and once the information is validated, the recommendations become a powerful tool for change.”
Dr. Dzau knows that solutions to a broad array of problems do exist. In some cases a small change in approach, accompanied by relatively minimal expense, can have outsize impact on the problem. An IOM project begun in November is now addressing the serious and occasionally life-threatening problem related to delayed patient scheduling at the Department of Veterans Affairs, the problem of long waits for patients seeking care. “What if,” asks Dr. Dzau, “we get our best systems engineers to use their knowledge of the science of scheduling, and we use this knowledge to study patient flow in order to find what works best for the patients?”
He lowers his head for a moment, and smiles, almost shyly. “You can see why I love this job. The possibilities are endless!”