The NIH Director On Why Americans Aren’t Getting Healthier, Despite Medical Advances

An anonymous reader quotes a report from NPR: It’s Dr. Francis Collins’ last few weeks as director of the National Institutes of Health after 12 years, serving under three presidents. Collins made his name doing the kind of biomedical research NIH is famous for, especially running The Human Genome Project, which fully sequenced the human genetic code. The focus on biomedicine and cures has helped him grow the agency’s budget to over $40 billion a year and win allies in both political parties.

Still, in a broad sense, Americans’ health hasn’t improved much in those 12 years, especially compared with people in peer countries, and some have argued the agency hasn’t done enough to try to turn these trends around. One recently retired NIH division director has quipped that one way to increase funding for this line of research would be if “out of every $100, $1 would be put into the ‘Hey, how come nobody’s healthy?’ fund.”

In a wide-ranging conversation, Collins answers NPR’s questions as to why — for all the taxpayer dollars going to NIH research — there haven’t been more gains when it comes to Americans’ overall health. He also talks about how tribalism in American culture has fueled vaccine hesitancy, and he advises his successor on how to persevere on research of politically charged topics — like guns and obesity and maternal health — even if powerful lobbies might want that research not to get done.

In regard to Americans not getting healthier over the last 12 years, NPR asked Collins why there haven’t been more gains and what role NIH should play in understanding these trends and trying to turn them around. Here’s what he said: Well, sure, it does bother me. In many ways, the 28 years I have been at NIH have just been an amazing ride of discoveries upon discoveries. But you’re right, we haven’t seen that translate necessarily into advances. Let’s be clear, there are some things that have happened that are pretty exciting. Cancer deaths are dropping every year by 1 or 2%. When you add that up over 20 years, cancer deaths are down by almost 25% from where they were at the turn of the century. And that’s a consequence of all the hard work that’s gone into developing therapeutics based on genomics, as well as immunotherapy that’s made a big dent in an otherwise terrible disease.

But we’ve lost ground in other areas, and a lot of them are a function of the fact that we don’t have a very healthy lifestyle in our nation. Particularly with obesity and diabetes, those risk factors have been getting worse instead of better. We haven’t, apparently, come up with strategies to turn that around. On top of that, the other main reason for seeing a drop in life expectancy — other than obesity and COVID — is the opioid crisis. We at NIH are working as fast and as hard as we can to address that by trying to both identify better ways to prevent and treat drug addiction, but also to come up with treatments for chronic pain that are not addictive, because those 25 million people who suffer from chronic pain every day deserve something better than a drug that is going to be harmful.

In all of these instances, as a research enterprise — because that’s our mandate — it feels like we’re making great progress. But the implementation of those findings runs up against a whole lot of obstacles, in terms of the way in which our society operates, in terms of the fact that our health care system is clearly full of disparities, full of racial inequities. We’re not — at NIH — able to reach out and fix that, but we can sure shine a bright light on it and we can try to come up with pilot interventions to see what would help.