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President Shalala Addresses the 36th Annual Eastern-Atlantic Student Research Forum

2/19/2010

As the Obama administration’s stimulus package pours more than $1 billion into comparative effectiveness research, President Donna E. Shalala urged 50 of the world’s next generation of physicians and scientists to pursue rigorous evidence-based medicine with an eye on the politics and money that drive it.

“Understand the politics behind this – that this is not simply, ‘We ought to find the best treatment and we ought to compare treatments and make sure we have the best outcomes,’’’ President Shalala told the attendees of the 36th annual Eastern-Atlantic Student Research Forum, or ESRF, on Thursday, the second day of the four-day international symposium.

“There’s a lot of money in this business,’’ she continued, “and you have to make sure you have the most credible research and it’s published in the finest journals so people will take it seriously. The politics is clearly linked to the money.’’

As an example, Shalala cited the pressure she was under as President Clinton’s secretary of Health and Human Services to establish a new NIH center for alternative medicine. Though the NIH director at the time, Nobel laureate Dr. Harold Varmus, had little regard for alternative medicine, Shalala said they came up with a compromise that appeased the center’s chief backer, powerful Iowa Sen. Tom Harkin, and assured the integrity of what would become The National Center for Complementary and Alternative Medicine.

“We convinced him that we ought to find a world-class researcher who didn’t know anything about alternative medicine to head the agency,’’ Shalala recalled.

The compromise gave the center credibility, Shalala said, and allowed it to develop a strategy of researching alternative therapies, such as St. John’s Wort, on which Americans spend the most money.

Hosted by the Miller School and sponsored in large part by the American Medical Association Foundation, ESRF brings together some of the brightest young minds in biomedical research. This year, 50 medical, graduate, M.D./Ph.D. students, and resident physicians from the Miller School, Harvard, Columbia, Vanderbilt and other universities across the nation, as well as from Pakistan, came to review and present original clinical and basic science research on everything from “The Role of Endogenous Cortisol Synthesis in Inflammatory and Wound Healing Response in Epidermis’’ to “Association of Type 2 Diabetes Mellitus with Depression.’’

In an informal question-and-answer session after her keynote address, President Shalala opined on a number of health care subjects, sharing the kind of illustrative stories that never fail to regale her audiences. When noting, for example, that people are living longer, she mentioned that Great Britain’s Queen Elizabeth once told her that, as a young monarch, she wrote every centenarian in the United Kingdom a personal note. Today, the 83-year-old queen needs a machine to keep up with the spiraling number of cards.

Disputing the widely held notion that end-of-life care consumes the most resources – chronic illness does – President Shalala also reminded her audience that their future patients must assume more responsibility for their health care, and their health. She recounted how, when her doctor recommended an MRI for a problem ankle, she surprised him by asking whether an X-ray would do. It would, and was, of course, much cheaper and more readily available.

“Your patients need to be more conscious about what they’re getting and how they’re getting it, and more self-conscious about taking care of themselves,’’ she said. “Most of us know that we got the biggest breakthroughs in low tech – in clean water, in sanitation, in nutrition – and right now we know exercise, nutrition and not smoking will get us the biggest breakthroughs.’’

For more information on the ESRF, please visit http://esrf.mededu.miami.edu/.