The National Academy of Medicine and the Cardiovascular Community: Partnering for a Healthier Future.

Abstract

HomeCirculationVol. 134, No. 3The National Academy of Medicine and the Cardiovascular Community Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBThe National Academy of Medicine and the Cardiovascular CommunityPartnering for a Healthier Future Victor J. Dzau, MD Victor J. DzauVictor J. Dzau From National Academy of Medicine, Washington, DC. Search for more papers by this author Originally published19 Jul 2016https://doi.org/10.1161/CIRCULATIONAHA.116.022139Circulation. 2016;134:183–185We are entering an era of unprecedented opportunities and challenges in health and medicine. With recent advances in science and technology, as well as the advent of big data, we have seen tremendous developments in biomedical science and the practice of medicine. Yet, the global disease burden continues to rise, demand for care is increasing, costs are unsustainable, and health inequity persists. Globally, cardiovascular disease (CVD) is the No. 1 disease burden, driven by the rise in noncommunicable diseases such as obesity and diabetes mellitus. The need for cardiovascular medicine will continue to grow as the global population ages and developing countries become more affluent, adopt a Western lifestyle, and become more urbanized. There have been impressive advances in cardiovascular diagnostics and therapeutics in the areas of precision medicine, molecular/metabolic imaging, endovascular procedures, gene and cell therapies, RNA therapeutics, tissue engineering and regenerative medicine, and digital health. However, cardiovascular care is fragmented and expensive. Furthermore, in the current healthcare landscape, access, quality, and costs are top priorities. The Affordable Care Act introduced a number of payment and delivery system reforms to increase the quality of health care while controlling costs, such as accountable care organizations, patient-centered medical homes, and mechanisms to link payments to quality. This value-focused health care is here to stay; therefore, we must adopt this approach for cardiovascular medicine. Importantly, we must do more to move from a disease-treatment model to a model that prioritizes and enables prevention.Unfortunately, current health challenges do not always lend themselves to straightforward solutions. There is a real need for evidence-based, independent, and nonpolitical advice that can inform health policy and thereby shape solutions and drive change. Indeed, society can benefit enormously from the activities of an independent scientific academy with the directive to mobilize the best minds to provide objective and independent advice on critical issues in health, health care, and biomedical science. The National Academy of Medicine (NAM) (formerly the Institute of Medicine) has served as that trusted advisor in the United States since its founding in 1970 as the health arm of the congressionally-chartered National Academy of Sciences. Through its convening activities and influential reports, such as To Err Is Human, Better Care at Lower Cost, and Promoting Cardiovascular Health in the Developing World,1–3 NAM has successfully bridged health and policy and provided domestic and global advice of the highest quality. However, we seek to do more than advise; our aim is to have a positive impact on policy and practice, and, ultimately, to improve human health.In this Perspective, I would like to articulate the strategic directions of NAM and examine how NAM can partner with the cardiovascular medicine community for a healthier future. For NAM, our work must advance the principles of leadership, innovation, and impact for a healthier future. NAM has identified 3 major goals: (1) to advance science and its application, (2) to identify and respond to top priorities in health and health care, and (3) to lead and inspire for the future. Following are examples of our activities addressing these goals.Advance Science and Its ApplicationIt is an incredible time for science and technology; there has been substantial progress in the fields of genomics, biosensors, gene-editing technology, regenerative medicine, and big data, to name just a few. However, the advent of new technology often raises social, ethical, and legal questions. NAM plays an important role in assessing how these developments can be advanced to confer maximal benefits to health and society. One of the most illustrative examples is our recent work on human gene editing.4 Powerful new gene-editing technologies, such as CRISPR-Cas9, hold great promise for advancing science, treating disease, and potentially developing new cures. There is no question that this technology has the potential to transform the field of CVD; however, there are critical issues that must be addressed before research can advance. In particular, this technology raises concerns and presents ethical, social, and regulatory challenges, because of its potential to be used for germline modification. As a result, NAM and the National Academy of Sciences have launched a major initiative to guide decision making about research involving human gene editing. The initiative involves a multidisciplinary advisory group to help steer the initiative; an international summit to obtain multinational perspectives on recent scientific developments in human gene editing and the associated ethical and governance issues; and a multidisciplinary, international committee to undertake a comprehensive study providing recommendations on the proper scientific conduct and clinical, ethical, social, and regulatory frameworks for human gene editing.Identify and Respond Effectively to Priorities in Health and MedicineNAM cannot rely solely on outside parties to commission our work; instead, we must be proactive and identify the most pressing health problems, regardless of political sensitivity. NAM is leading several health initiatives that exemplify our commitment to responding to both the immediate and long-term health needs of the world.First, NAM is working to advise the nation and the world about the next directions in health and health care, with the goals of achieving better access, improved quality, and lower costs. With a new US presidential administration on the horizon, we need to thoughtfully consider how we can provide nonpartisan and evidence-based advice on key priorities for the future. As a result, NAM has undertaken a bold initiative, Vital Directions for Health and Health Care,5 to advise the next administration and other stakeholders on the future directions of health reform. The publication series will identify barriers and challenges to the overall health and well-being of our nation and propose possible policy opportunities for progress. The series will cover topics in 3 broad areas: better health and well-being, high-value health care, and strong science and technology, all of which have implications for cardiovascular medicine. In addition, NAM is working to build a society that enables every individual to lead a healthier life. There is a growing recognition that health is largely shaped by factors outside health care. This is readily apparent in CVD. For example, individuals with lower socioeconomic status are much more likely to develop heart disease than those who are wealthier or better educated. To this end, NAM is partnering with the Robert Wood Johnson Foundation to establish a multiyear Culture of Health6 program that aims to identify the conditions and solutions needed for every person to achieve equitable good health and well-being and to examine the policies and practices needed to support a culture that promotes health. This program is in line with NAM’s strong history of work promoting healthy behavior. It is noteworthy that the 2012 report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation,7 spurred an HBO film series that highlighted the importance of changes in people’s diet and exercise habits in combatting obesity. As a result of this work, NAM, in collaboration with the Public Good Projects, launched A Healthy America,8 an initiative leveraging media and marketing to shape the public’s health behaviors and encourage a healthy lifestyle.Serve As A Curator for Big Ideas to Inspire The Health Community to Unite Around Shared Priorities and Audacious Goals WorldwideLeaders in the United States and worldwide need aspirational and audacious goals to generate excitement around the idea that collectively we can do more, much more, to change the course of health. Imagine a world without CVD. What if there were vaccines for chronic diseases, such as diabetes mellitus and hypertension? Many people are eager to make the world a better place, and NAM can catalyze stakeholder engagement around shared goals. To do this, we are planning a Grand Challenges in Health and Medicine9 initiative. In the first phase of this initiative, NAM and its partners will identify the most important global challenges through a transparent process informed by many perspectives. In the second phase, NAM will catalyze action toward solutions, moonshots, by stewarding collective strategies from stakeholders in policy, business, philanthropy, academia, and the general public through public-private partnerships.Nam and Cardiovascular DiseaseThese are ambitious goals befitting the world’s premiere academy of health and medicine. Needless to say, these priorities impact the cardiovascular field, because CVD remains the No. 1 cause of death in the United States and worldwide. Although advances in science and technology have provided major improvements in novel CVD diagnosis, treatment, and prevention, much more needs to be done. In the past decade, NAM has tackled a range of issues in CVD, from promoting global cardiovascular health, to setting priorities for effectiveness research for acute myocardial infarction, to improving survival for sudden cardiac arrest to addressing obesity, diabetes mellitus, hypertension, and examining the impact of lifestyle factors, such as diet, smoking, and inactivity on cardiovascular health. As NAM proceeds to achieve its goals of leadership, innovation, and impact for a healthier future, we have identified CVD as a priority area for policy, healthcare delivery, innovation, and prevention.As the landscape of health and medicine continues to evolve, NAM must continue to provide the world with evidence and advice, forums for tackling tough issues, and innovative space for imagining the next century of health. The world will continue to face both progress and turmoil, and NAM looks forward to working with new and old partners, tools, technology, and ideas to collectively build a healthier future.AcknowledgmentsThe author wishes to thank Celynne Balatbat for her helpful assistance in preparing this manuscript.DisclosuresNone.FootnotesThe opinions in this article are not necessarily those of the editors or of the American Heart Association.Circulation is available at http://circ.ahajournals.org.Correspondence to: Victor Dzau, MD, President, National Academy of Medicine, 500 5th Street, NW, Washington, DC. E-mail [email protected]