The white-marble Rayburn House Office Building, in Washington DC, looks like a giant courts building or a central bank, fully intimidating and imposing in its hulking stony blockiness.
And the US Congress, of course, is an institution best known for its tedium, albeit a tedium that is regularly punctuated by fiery partisan combat. On a typical day, the Rayburn building–acronymed as RHOB–is a place where politicos and bureaucrats struggle for and against some special interest, yea or nay, on regulation or appropriation. And the biggest single activity in RHOB, or in any of the other five office edifices on Capitol Hill, is answering the phone and answering the mail, both snail-mail and e-mail. In a country of 318 million souls, plenty of people have the urge to write their Member of Congress–and they want an answer, pronto. So the life of a “Hill rat” is a life of constituent service. From museum tours to Social Security checks, from requests for flags that have flown over the Capitol to requests for an admission to one of the Service Academies, there’s always work, work, work, to be done.
In such a grinding environment, one never knows when genuine hope will pop up. Indeed, amidst the thrum of institutional activity, a sighting of hope might seem improbable.
Yet on Tuesday, inside the marbled majesty of RHOB, several hundred people gathered for an expression of hopeful humanity, a flowering of bipartisan cooperation on behalf of an important issue–namely, medical cures. Come to think of it, it’s fair to say that medical cures are more than an important issue; they are, in the most literal sense, a vital, life-saving issue.
In fact, not many in Washington have noticed, but the number of new drugs, antibiotics, and medical devices approved by the Food and Drug Administration is lower today–dangerously lower–than it was 15 or 20 years ago.
How did this fall-off happen? How did this “cure crash” occur, right under the noses of Washington officialdom? In truth, the decline of medicine in America is deeply ironic, insofar as American politics has been vexed by healthcare controversies for a full quarter-century: first, the Hillarycare debate of the 90s and then, more recently, Obamacare. In other words, while DC politicos have been fighting over health insurance, the more fundamental issue of health itself–is there a treatment, or a cure, for what ails us?–has been mostly ignored.
And so it has come to pass, for example, that we have a raging epidemic of Alzheimer’s Disease (AD), costing the US economy some $200 billion a year–headed toward a cumulative $20 trillion by mid-century–and no effective treatment. Thus we are in a paradoxical situation: We have extended a financial commitment to provide healthcare coverage for all, and yet we haven’t made a similar scientific commitment to actual cures. The message seems to be: Uncle Sam can guarantee you a card that says “health insurance” on it, but nobody has bothered to make sure that a health-insurance policy can, in fact, buy health. (Even if Obamacare were repealed, we might note, Uncle Sam’s commitment to the elderly, through Medicare and Medicaid, would continue.)
Thus, if present trends continue, we face a ghastly and costly future: We will be paying trillions to warehouse AD patients as they decline into dependency and dementia–providing the ultimate in compassionate, but futile, care. Lots of expenditure, but no hope.
Fortunately, one little-known but very powerful Member of Congress has said, “Enough!” Yet he said it quietly, because, well, that’s how Fred Upton rolls. Upton is the 60-something Republican Representative for Michigan’s Sixth District, in the southwest corner of the Wolverine State. (The flamboyance in the family is seen in model/actress Kate Upton, his niece.)
Way back when, Fred Upton was a young officer in the Reagan Revolution. From 1981 to 1985, he served in Ronald Reagan’s Office of Management and Budget; his office was in the Eisenhower Executive Office Building, just across the driveway from the White House. The following year, 1986, he went home to St. Joseph, Michigan, and won election to a US House seat.
Since being sworn in to the 100th Congress in 1987, Upton has worked his way up the ladder; in the “workhorse” vs. “showhorse” continuum, he is definitely a Clydesdale. While a reliable vote for Republican causes, he has mainly focused on issues relating to his district. Still, he he has never hesitated to venture into important national controversies, such as the expansion of liquid natural gas exports and opposition to the Obama administration’s plan to turn the Internet over to the “international community.”
Upton’s work-ethic and diligence have paid off: He is now chairman of the mighty House Energy and Commerce Committee, which oversees the pharmaceutical and medical device industries. It’s fair to say that no one in the House is better positioned to help facilitate an American medical comeback–a resurgence of drugs, devices, and yes, the often elusive hope.
The Energy & Commerce Committee, known inside the Beltway as “E & C,” boasts broad jurisdiction over much of the US economy, from food safety to environmental regulation, from telecommunication to consumer protection. Past chairs of E & C have included such Democratic powerhouses as Sam Rayburn, John Dingell, and Henry Waxman. Each of those men wielded the gavel, orchestrated the hearings, lectured the witnesses, and enacted legislation–often draconian, even punitive legislation–that left corporate chieftains quaking and America transformed.
Today, as a Republican chairman, Upton envisions a different kind of transformation–the revival of the “pipeline” of American-made treatment and cures. Fully mindful of the reality of divided government, he wants to engineer this revival in cooperation with like-minded Democrats. The idea of both sides working together on behalf of cures might not seem particularly radical, but DC is so polarized that there’d be a fight over a resolution praising motherhood–to say nothing of a resolution praising apple pie.
Yet hope springs eternal, even in DC. On Tuesday in 2123 RHOB, the hearing room of E & C, Upton announced that he is working toward a “21st century cures initiative,” which he defined as “a collaborative, bipartisan effort that aims to accelerate the pace of cures and medical breakthroughs in the US.” In so announcing and defining, Upton made a significant departure from the familiar battle-as-usual pattern of Congress.
Upton emphasized that he would be working with his Democratic E & C colleague, Rep. Diana DeGette of Colorado. This duo, he continued, would be working together to “review the full arc” of drug development and delivery.
Upton described the cures issue as a twofer: improved medical treatment and improved economic development. The goal, he said, is to “cure the patients, and keep more jobs in the US. What family isn’t affected by this?” And so he asked, “What steps do we need to take as a nation to accelerate new cures and keep America as the innovation capital of the world?”
In fact, Upton has been working, quietly, on the cure issue for some time. Back on March 5, he published an op-ed for US News, entitled, “Curing Disease With a Little Help From Our Friends.” In that piece, Upton declared:
Our FDA regulatory structure should also encourage greater collaboration among scientists, doctors, patients and big data analysts. A little help from these friends will accelerate the pace of cures and help us live healthier lives.
Shortly thereafter, Upton and DeGette sat down together to produce a video in which they jointly affirmed their determination to enhance the cure pipeline.
For her part, DeGette is no conservative, but she approaches the world in problem-solving terms; she has eschewed the oft-heard Naderite rants against “greedy” Pharma companies and the like. As she said,”We can either work together, or we will fall behind.” Similarly to Upton, DeGette is soft-spoken; she would obviously rather have better medical treatments, not bigger headlines.
Still, both Upton and DeGette are firmly in league with their respective parties. For example, even as the RHOB cures hearing was taking place, the E & C website featured headlines such as “Future of Health Care Law Holds More #BrokenPromises.” And just on Wednesday, Upton joined the Republican House majority voted to hold Lois Lerner of the IRS in contempt of Congress, while DeGette sided with her fellow Democrats to vote the other way.
Yet on Tuesday, Upton and DeGette left all their partisan rancor outside of RHOB 2123. They teamed up to have a conversation with 11 witnesses, all experts in health and medical policy, including Dr. Francis Collins, director of the of the National Institutes of Health (NIH). Moreover, Upton & DeGette were joined by a dozen other Members of Congress, including the House Majority Leader, Eric Cantor, and Cathy McMorris Rodgers of Washington State, chair of the House Republican Conference.
The main themes of the witnesses’ testimony were five in number:
First, the need for more funding–and more predictable funding–for the NIH. This was a major theme of NIH Director Collins; he pointed out that NIH funding, adjusted for inflation, has declined 25 percent over the last decade. Admittedly, Collins has an institutional perspective to defend, but the other witnesses agreed. Maybe they’re all on to something.
Second, the need for FDA reform, defined as streamlining the approval process. Two FDA officials were on the panel, and they stoutly defended their agency, but as Cantor said, it shouldn’t take 10 years, and a billion dollars, to get a drug approved. And of course, if the drug isn’t approved, the company is still out the billion dollars.
Third, the need for adequate reimbursements for drugs that do come to market. Today, health insurers, public and private, are squeezing down payments to drug- and device-makers. Are we being penny-wise and pound-foolish? That is, in our skin-flintedness, are we discouraging future innovation? “Yes,” came the answer of venture capitalist Jonathan Leff, a partner at Deerfield Management in New York City. As Leff put it, “We need…a dialogue that provides for the value of innovation.”
Fourth, the need to make better use of Big Data. Dr. Andrew Von Eschenbach, a former FDA commissioner now with the Manhattan Institute, was particularly emphatic on the need for better data-sharing as a key to better medicine.
Fifth, the need for big goals and a big vision. In the words of McMorris Rodgers, “We have to do a whole lot more on brain research, Alzheimer’s…We have to do a whole lot more.” Another panelist, Margaret Anderson, executive director of Faster Cures, pointed out, “We have 7000 diseases, but we have treatments for 500. At the rate we’re going, I don’t think that any of the diseases were threatened with have a chance of being treated in the short run.” Anderson floated the idea of a “cancer megafund,” as a new way of getting private capital into the medical-research sector.
At the close of the session, Upton reminded the audience that this was just the first of many such hearings, to be held across the country. As he noted, the success of the whole effort depends on public support; that is, if the American people want to see a new commitment to the idea of cures, they will have to make their voice heard. And so he provided an e-mail address to make the public-input process as easy as possible: firstname.lastname@example.org. As a Reagan administration alumnus, Upton remembers the success that the Gipper enjoyed when he sought to mobilize the public for action on such issues as tax reform. Upton might not be The Great Communicator–who is?–but he has a powerful issue on his hands.
If the American people are presented with a clear choice–do you want more cures, or fewer cures?–the public answer will be thunderous. Which is to say, a big boost for the careers of pro-cure politicians.
In the meantime, RHOB is a huge place, and it’s open to all–Although, of course, some have a louder voice than others. Within its marble confines, myriad interests are there every day, each seeking attention. And if they don’t get the attention they seek, they escalate; they wheedle, cajole, and demand. Squeaky wheels get greased; that’s the way things work in a pluralistic country.
Meanwhile, as the trendlines of the last two decades show, other interests have crowded out the nation’s cure interest, and Americans are less healthy–and wealthy–as a result. Do we want that unhealthy status quo to change?
Once again, that e-mail address is email@example.com.