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On Board with the Cures Acceleration Network

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Science Translational Medicine  19 May 2010:
Vol. 2, Issue 32, pp. 32ed2
DOI: 10.1126/scitranslmed.3001136
CREDIT: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

On 23 March 2010, President Obama signed into law the Patient Protection and Affordable Care Act (1). This comprehensive national health care reform harbors provisions that aim to expand coverage, improve care delivery, and control health care costs. It also contains an unprecedented opportunity for translational research, in the form of the Cures Acceleration Network (Section 10409). The provision, introduced in 2009 by Senator Arlen Specter (D–PA) as an amendment to the original Senate bill, creates new funding mechanisms at the National Institutes of Health (NIH) through which grants and contracts will be awarded to accelerate the development of “high-need cures.”

Deciding whether any need is “high” may well be in the eyes of the decider, but it is clear that need exists. Few can argue that there is not a very real gulf separating cutting-edge laboratory discoveries from their transformation into effective treatments. The reasons for this gulf—dubbed by many as the “valley of death”—are multifold and complex, which doesn’t make the task of addressing the gulf any less urgent. What are we missing when the demand for cures is out of sync with the supply of knowledge, resources, and coordination needed to create them? Could we have effective combination regimens for conditions, such as cancer and autism, that most likely result from a mix of genetics and environmental triggers? What about inexpensive, portable behavioral interventions for smoking cessation and weight control that could stem the national and worldwide epidemic of preventable chronic diseases? Or point-of-care diagnostics and preventive vaccines for global scourges such as malaria, tuberculosis, and other rampant infectious diseases?

CREDIT: PHOTOS.COM

Insufficient data sharing, mismatched goals, incomplete knowledge about human pathophysiology, and regulatory hurdles all contribute to the translational block in biomedicine. The translational challenge is arduous, and one could argue persuasively that each of these roadblocks is itself enough to dig a valley too deep to cross. There is a timing problem as well: The long-term investments needed to uncover new knowledge and iteratively perfect technology are not well aligned with balance sheets, investment risk, and short-term political will. Yet convening scientists, investors, and policy-makers is a vital step toward solving tough problems in the health arena.

Although research progress on all fronts must continue, and vigorously, the Cures Acceleration Network opens new doors and sets a more proactive, collaborative tone. The legislation introduces a new vehicle to award grants and contracts to eligible entities, which previously have had insufficient market incentives to move timely research toward the development of medical products and behavioral therapies. The most promising aspect of the Cures Acceleration Network is its focus on shifting incentives. The initiative invites participation from public and private enterprises, including research institutions, academic medical centers, biotechnology and pharmaceutical companies, venture capitalists, and advocacy organizations. These are exactly the right partnerships.

The Cures Acceleration Network is authorized to spend $500 million a year, although an appropriation for fiscal year (FY) 2011 has not yet been made. Initial awards—each up to $15 million, paid in a single installment—will fall into two categories. Partnership awards require matching funds at the rate of one nonfederal dollar per three dollars of NIH award. Grants will contain no matching requirement. It’s time now for an appropriation to be made to NIH for FY 2011 funding.

One of the most vital tasks of the Cures Acceleration Network will be to “facilitate review in the Food and Drug Administration (FDA) regarding the status of activities.” Although the coordinates of this review need to be defined, it does present a prescient opportunity for forging close scientific coordination among investigators, NIH, and the FDA.

Finally, while science is an objective pursuit, determination of need is not. As defined in the health care legislation, a 24-member review board will advise the NIH director on the conduct and activities of the Cures Acceleration Network. This advisory body will consist of public and private representatives, aiming to coalesce public health need, resources, and business savvy. It will be important that all members of the group adopt a cooperative spirit and put aside their provincial interests.

Translating discoveries into cures is not a new concept, but as science and medicine have become increasingly complex, it has become more and more difficult to do. As a biomedical community, it is our social responsibility to find ways to make it happen. Rather than building a single bridge, it’s time to find creative modes of transportation across the gap. The Cures Acceleration Network is a great start.

Footnotes

  • Citation: E. G. Nabel, On board with the Cures Acceleration Network. Sci. Transl. Med. 2, 32ed2 (2010).

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